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Intravenous Complications<br />

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Objectives <br />Enumerate the kinds of intravenous therapy complications.<br />Identify the types of each kind of intravenous therapy complications and describe them according to the following:<br />Definition<br />Causes<br />Signs & Symptoms<br />Nursing Interventions<br />

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Intravenous Therapy Complications<br />LOCAL COMPLICATIONS<br />Infiltration<br />Extravasation<br />Thrombosis<br />Thrombophlebitis<br />Phlebitis<br />SYSTEMIC COMPLICATIONS<br />Embolism<br />Pulmonary embolism<br />Air embolism<br />Catheter embolism<br />Hematoma<br />Systemic infection<br />Speedshock<br />Circulatory overload<br />Allergic reaction<br />

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Infiltration<br />Extravasation<br />Thrombosis<br />Thrombophlebitis<br />Phlebitis<br />

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Infiltration<br /><ul><li>Results when the infusion cannula becomes dislodged from the vein and fluids are infused into the surrounding tissues.</li></li></ul><li>Signs & Symptoms<br /><ul><li>Increasing edema at the site of the infusion

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Discomfort, burning, pain at site

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Feeling of tightness at site

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Decreased skin temperature around site

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Blanching at site

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Absent backflow of blood

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Slower flow rate</li></li></ul><li>Cause<br />Device dislodged from vein or perforated vein<br />

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Nursing Interventions<br />Remove the device<br />Apply warm soaks to aid absorption<br />Elevate the limb<br />Notify the doctor if severe<br />Assess circulation <br />Restart the infusion<br />Document the patient's condition and your interventions<br />

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Prevention<br />Check the I.V site frequently <br />Don't obscure area above site with tape<br />Teach the patient to report discomfort, pain, swelling<br />

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Extravasation<br />It occurs when fluids seep out from the lumen of a vessel into the surrounding tissue. <br />CAUSES: <br /><ul><li>Damage to the posterior wall of the vein

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Occlusion of the vein proximal to the injection site</li></li></ul><li>

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Signs & Symptoms<br /><ul><li>Swelling

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Discomfort

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Burning

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Tightness

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Coolness in the adjacent skin

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Slow flow rate</li></li></ul><li>Truth about common Misconception:<br /><ul><li>Extravasation doesn’t always cause a hard lump.

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Patient may not always experience coldness or discomfort with extravasation</li></li></ul><li>Nursing Interventions<br /><ul><li>Immediately stop the infusion and remove the device

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Elevate the affected limb

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Apply cold compress to decrease edema and pain

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Apply moist heat to facilitate the absorption of fluid at grossly infiltrated sites</li></li></ul><li>Drugs Associated with Extravasation Necrosis<br /><ul><li>Generic Name Brand Name

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Calcium chloride Various

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Calcium gluconate Various

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Dacarbazine DTIC

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DactinomycinCosmogen

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DaunorubicinCerubidine

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Dopamine Various

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Doxorubicin Adriamycin

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IdarubicinIdamycin

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MechlorethamineMustargen

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Mitomycin C Mutamycin

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PlicamycinMithracin

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StreptozocinZanosar

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TeniposideVumon

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Vancomycin Various

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VinblastineVelban

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VincristineOncovin

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VinorelbineNavelbine</li></li></ul><li>Thrombosis<br /><ul><li>Occurs when blood flow through a vein is obstructed by a local thrombus.

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Catheter-related thrombosis arises as a result of injury to the endothelial cells of the venous wall. </li></li></ul><li>Signs & Symptoms<br />Painful, reddened, & swollen vein<br />Sluggish or stopped I.V flow<br />

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Cause<br />Injury to endothelial cells of vein wall, allowing platelets to adhere and thrombus form<br />

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Nursing Interventions<br />Remove the device; restart the infusion in the opposite limb if possible<br />Apply warm soaks<br />Watch for I.V therapy – related infection <br />

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Prevention<br />Use proper venipuncture techniques to reduce injury to the vein<br />

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Thrombophlebitis<br /><ul><li>Occurs when thrombosis is accompanied by inflammation.

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Infusions allowed to continue after thrombophlebitis develops will slow and eventually stop, indicating progression to an obstructive thrombophlebitis.

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Various terms can be used to distinguish the type of phlebitis a patient experiences. </li></li></ul><li>Signs & Symptoms<br /><ul><li>Local tenderness

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Swelling

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Induration

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A red line detectable above the IV site.</li></li></ul><li>Thrombophlebitis<br /><ul><li>All thrombotic complications have the associated danger of embolism, especially in cases where the thrombus is not well attached to the wall of the vein.

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The risk for the development of thrombotic complications can be greatly reduced when certain preventive measures are taken. </li></li></ul><li>Recommendations to Reduce the Risk of Thrombotic Complications<br />1. Use veins in the upper extremities2. Avoid placing catheters over joint flexions3. Select veins with adequate blood volume for solution characteristics4. Anchor cannulas securely5. Avoid multiple venipunctures<br />

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Phlebitis<br />Causes:<br /><ul><li>Injury during Venipuncture

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Prolonged use of the same IV site

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irritating./incompatible IV additives

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Use of vein that is too small for the flow rate

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Use of needle size too large for the vein size</li></li></ul><li>Signs & Symptoms<br /><ul><li>Pain

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Vein that is sore, hard, cord like and warm to touch

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Red line above the site

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Signs of infection </li></li></ul><li>Phlebitis Rating<br />0 = No symptoms<br />1 = Erythema at site with or without pain<br />2 = pain at site, erythema and/or edema; no streak, no palpable cord<br />3 = pain at site, erythema and/or edema; streak <br />present; palpable cord<br />4 = pain at site, erythema and/or edema; streak <br />present; palpable cord > 1 inch; purulent drainage<br />

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Common Medication that can cause Phlebitis<br /><ul><li>Phenytoin

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Diazepam

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Erythromycin

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Tetracycline

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Vancomycin

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Amphothericin B

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40 mEq/L or more doses of KCL</li></li></ul><li>Nursing Interventions<br /><ul><li>Upon assessment of phlebitis, removal the needle

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Avoid multiple insertion

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Application of warm compress

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Continuously monitor the patient- vital signs</li></li></ul><li>Embolism<br />Hematoma<br />Systemic infection<br />Speedshock<br />Circulatory overload<br />Allergic reaction<br />

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Pulmonary Embolism<br />It associated with venous access devices is usually the result of a thrombus that has become detached from the wall of the vein. It is carried by the venous circulation to the right side of the heart and then into the pulmonary artery. <br />Circulatory and cardiac abnormalities are caused by full or partial obstruction of the pulmonary artery, with possible progression to pulmonary hypertension and right-sided heart failure. <br />

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Air Embolism<br />Occurs most frequently with the use of central venous access devices. <br />Occur with the insertion of an IV catheter, during manipulation of the catheter or catheter site when the device is removed, or when IV lines associated with the catheter are disconnected. <br />

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Catheter Embolism<br />This can occur during the insertion of a catheter if appropriate placement techniques are not strictly adhered to. <br />The tip of the needle used during the placement of the catheter can shear off the tip of the catheter. <br />The catheter tip then becomes a free-floating embolus. <br />This can occur with both over-the-needle and through-the-needle catheters. If this happens, cardiac catheterization may be required to remove the embolus.<br />

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Signs & Symptoms<br />Sudden vascular collapse with the hallmark symptoms of cyanosis, hypotension, increased venous pressures, and rapid loss of consciousness. <br />Respiratory distress<br />Unequal breath sounds<br />Weak pulse<br />

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Causes<br />Empty solution container<br />Solution container empties; next container pushes air down line<br />Tubing disconnected from venous access device or I.V bag<br />

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Nursing Interventions<br />Discontinue the infusion<br />Place the patient in Trendelenburg position on his left side to allow air to enter the right atrium and disperse through the pulmonary artery.<br />Administer oxygen<br />Notify the doctor<br />Document the patient's condition and your interventions.<br />

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Hematoma<br />The seepage of blood into the extravascular tissue<br />Causes::<br /><ul><li>Coagulation defects

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Inappropriate use of tourniquet

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Unsuccessful insertion attempts

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Little pressure upon removal of cannula

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Discoloration of the tissue at the IV site</li></li></ul><li>Nursing Interventions<br /><ul><li>Frequent assessment of the site

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Upon insertion, slowly advance the needle to prevent puncturing both vein walls

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Discontinue therapy if with edema

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Apply pressure for at least 5 minutes upon removal</li></li></ul><li>Systemic Infection<br /><ul><li>Is the successful transmission or encounter of host with potentially pathogenic organism.

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Major hazard - can be local or systemic (septicemia)‏

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Caused by: Staphylococcuaureus, Klebsiella, Serratia, Pseudomonas Aeruginosa</li></li></ul><li>Signs & symptoms<br />Fever, chills, & malaise for no apparent reason<br />Contaminated I.V site, usually with no visible signs of infection at site<br />

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Causes<br />Failure to maintain aseptic technique during insertion or site care<br />Severe phlebitis, which can set up ideal conditions for organisms growth<br />Poor taping<br />Prolonged indwelling time of device <br />Immunocompromised patient<br />

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Nursing Interventions<br />Notify the doctor.<br />Administer medications as prescribed<br />Culture the site and the device<br />Monitor the patient's vital signs<br />

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Prevention<br />Use scrupulous aseptic technique<br />Secure all connections<br />Change I.V solutions, tubing and venous access device at recommended times<br />Use I.V filters<br />

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Management and Prevention Tips<br /><ul><li>Assess catheter site daily

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Accurately document visual inspection and palpation data.

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Refer to physician for any suspected infection.

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Use maximal sterile-barrier precautions during insertion (sterile technique)‏

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Practice good hand hygiene before and after palpating, inserting, replacing, or dressing any intravascular device.</li></li></ul><li><ul><li>If any part of the system is disconnected, don’t rejoin it

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Remove at first sign of infection

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Replace site, tubings and bags per policy</li></ul> example: change set= 72 hours, TPN and single use of antibiotics=24 hrs<br />

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Speedshock<br />Rapid introduction of a foreign substance, usually a medication, into the circulation.<br />

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Signs & Symptoms<br /><ul><li>Flushed face

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Headache

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Tight feeling in the chest

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Irregular pulse</li></ul>In extreme cases:<br /><ul><li>Loss of consciousness</li></li></ul><li>Nursing Interventions<br /><ul><li>STOP the infusion

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Careful monitoring of IV flow rate and patient response. Maintain prescribed rate.

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Know the actions and side effects of the drug being administered</li></li></ul><li>Nursing Interventions<br />Use of IV pumps when indicated<br />Begin infusion of 5% dextrose at a KVO rate in emergency cases<br />Evaluate circulatory and neurologic status<br /> Notify the physician<br />

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Circulatory Overload<br /><ul><li>An excess of fluid disrupting homeostasis caused by infusion at a rate greater than the patient’s system is able to accommodate</li></li></ul><li>Signs & Symptoms<br /><ul><li>Shortness of breath

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Elevated blood pressure

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Bounding pulse

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Jugular vein distention

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Increased Respiratory rate

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Edema

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Crackles or rhonchi upon auscultation</li></li></ul><li>Causes<br />Roller clamp loosened to allow run – on infusion<br />Flow rate too rapid<br />Miscalculation of fluid requirements<br />

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Nursing Interventions<br />Raise the head of the bed<br />Slow the infusion rate <br />Administer oxygen as needed<br />Notify the doctor<br />Administer medications as ordered<br />

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Allergic Reaction <br /><ul><li>Maybe a Local or generalized response to tape, cleansing agent, medication, solution or intravenous device</li></li></ul><li>Signs & Symptoms<br />SYSTEMIC<br /><ul><li>Runny nose

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Tearing

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Bronchospasm

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Wheezing

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Generalized rash</li></ul>LOCAL<br /><ul><li>Wheal

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Redness

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Itching at the site</li></li></ul><li>Nursing Interventions<br /><ul><li>If reaction occurs, stop the infusion immediately and infuse normal saline solution.

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Maintain a patent airway.

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Notify the doctor.

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Administer antihistaminic steroid, anti – inflammatory, & antipyretic drugs, as ordered.

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Give 0.2 to 0.5ml of aqueous epinephrine subcutaneously. Repeat at 3-minute intervals and as needed, as ordered</li></li></ul><li>Lets have an exercise!<br />

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Identify a local complication and describe according to the following:<br />Definition<br />Causes<br />Signs & symptoms<br />Nursing Interventions<br />

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Identify a systemic complication and describe according to the following:<br />Definition<br />Causes<br />Signs & symptoms<br />Nursing Interventions<br />

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Questions? <br />