This document discusses various complications that can arise from intravenous (IV) therapy and their prevention and treatment. It covers complications like needlestick injury, phlebitis, infiltration, extravasation, infection, air embolism, and occlusion. For each complication, the summary provides the causes, signs and symptoms, nursing interventions, and preventive measures. The overall goal is to educate on safely managing IV therapy and preventing associated risks.

1. MANAGING COMPLICATIONS
OF IV THERAPY-
PROPERTY OF GESUNDHEITS

2. Risks Associated
with IVT

3. Risks
1. Needlestick
injury
2. Infectious
organism
exposure

4. Needlestick Injury
An AIDS patient became agitated and tried to
remove the intravenous catheters. Hospital
staff struggled to restrain the patient. During
the struggle, an IV infusion line was pulled,
exposing the connector needle. A nurse
recovered the connector needle at the end of
the IV line and attempted to reinsert it. The
patient kicked her arm, pushing the needle into
the hand of the second nurse. Three months
later, the nurse who sustained the needlestick
injury tested positive for HIV1.

6. Prevention:




Avoid the use of needles where safe and
effective alternatives are available.
Avoid recapping needles.
Report all needlestick and other sharps
related injuries to ensure that you
receive appropriate follow-up care.
Create/maintain a safe, comprehensive
disposal system.

7. Infectious Organism Exposure




Prevention:
Do proper hand hygiene.
Do not reuse tourniquets.
Wear gloves.
Cleanse insertion sites with the
recommended solutions.

8. •
–
–
–
–
–
–
–
The following list is a summary of
some of the rules to be observed in
the workplace:
HEPATITIS B vaccine
STANDARD PRECAUTIONS
SHARPS AND WASTE DISPOSAL
PROTECTIVE DEVICE/EQUIPMENT
GLOVES
LAUNDRY
COMMUNICATING HAZARDS

9. COMPLICATIONS ASSOCIATED
WITH IVT

10. IV SITE PLACEMENT

11. PHLEBITIS

-
•
-



•

•

INFLAMMATION OF THE VEIN
CAN BE CAUSED BY THE FF:
1.MECHANICAL PHLEBITIS
Occurs when:
the movement of a foreign object (iv cannula) within a
vein causes friction
device left in vein to long
The size of iv cannula is too big for the selected vein.
2. CHEMICAL PHLEBITIS
Caused by the drug or fluid infused
3. INFECTIVE PHLEBITIS
Caused by an introduction of bacteria into the vein

12. SIGNS AND SYMPTOMS
•
•
•
Localized redness
and swelling
Pain or burning
along the length of
the vein
Vein being hard and
cord like

13. PHLEBITIS SCALE
•
•
•
•
•
GRADE 0 – no symptoms
GRADE 1 – erythema at access site, with or
without pain
GRADE 2 - pain at access site, with erythema or
edema
GRADE 3 - pain at access site, with erythema or
edema , streak formation, palpable venous cord
GRADE 4 - pain at access site, with erythema or
edema , streak formation, palpable venous cord,
with purulent discharge

14. 



Nursing Management
Stop the infusion at the first sign of redness or
pain.
Apply warm, moist compresses to the affected
area.
Document your patient ’s condition and
interventions.
If indicated,insert a new catheter at a different
site,preferably on the opposite arm,using a larger
vein or a smaller device and restart the infusion

15. 



PREVENTIVE MEASURES
Use proper venipuncture technique.
Use a trusted drug reference or consult
with the pharmacist for instructions on
drug dilution,when necessary.
Monitor administration rates and inspect
the I.V. site frequently.
Change the infusion site according to
your institution policy.

16. THROMBOPHLEBITIS
• Inflammation of the
vein cause by a
blood clot
formation
(thrombus)

17. SIGNS AND SYMPTOMS
•
•
•
•
REDNESS
SWELLING
HARDENED VEIN
SEVERE DISCOMFORT

18. -
-
-
-
-
NURSING
INTERVENTION
Remove the device;
restart infusion at
opposite limb if
necessary
Apply warm compress
Watch for ivt related
infection
Notify physician
Document
-
PREVENTIVE MEASURES
Frequent assessment
of iv site

19. HEMATOMA
-
-
POSSIBLE CAUSES:
Leakage of blood into tissue
Vein punctured through ventral wall at
time of venipuncture

20. SIGNS AND SYMPTOMS
•
•
BRUISING AROUND
VENIPUNCTURE SITE
TENDERNESS AT
VENIPUNCTURE SITE

21. -
-
-
-
-
NURSING
INTERVENTIONS
Remove the device
Apply pressure and
cold compress
Recheck the bleeding
Notify the physician
Document
PREVENTIVE MEASURES
- Choose an appropriate
vein and cannula size
- Release the tourniquet
as soon as successful
insertion is achieved

22. INFILTRATION
-
-
-
LEAKING OF NON-VESICANT INTO THE
SURROUNDING TISSUE
CAUSES:
IMPROPER PLACEMENT OR DISLODGE OF
THE CATHETER
TIP OF THE CATHETER IS POSITIONED
NEAR THE FLEXION AREA

23. SIGNS AND SYMPTOMS
-
-
-
-
-
-
blanching at site
Cool skin around site
Discomfort, burning
or pain at site
Feeling of tightness
at site
Sluggish flow rate
Swelling (may extend
along entire limb

24. 




NURSING INTERVENTIONS
Stop the infusion and remove the device.
Elevate the limb to increase patient
comfort; a compress may be applied.
Check the patient’s pulse and capillary
refill time.
Check the site frequently.
Document your findings and interventions
performed.

25. 




PREVENTIVE MEASURES
Select an appropriate I.V. site, avoiding
areas of flexion areas.
Use proper venipuncture technique.
Follow your facility policy for securing, the
I.V. catheter.
Observe the I.V. site frequently.
Advise the patient to report any swelling
or tenderness at the I.V. site.

26. EXTRAVASATION
- LEAKING OF VESICANT DRUGS INTO
SURROUNDING TISSUE

27. SIGNS AND SYMPTOMS
-
-
-
- blanching, burning,
discomfort at the iv
site
Cool skin around site
swelling
Blister formation

28. 




NURSING INTERVENTIONS
Stop the I.V. flow and remove the I.V. line.
Elevate the affected extremity.
Perform frequent assessments of sensation,
motor function,and circulation of the affected
extremity.
Record the extravasation site,your patient’s
symptoms,the estimated amount of extravasated
solution, and the treatment.
Follow the manufacturer recommendations to
apply either cold or warm compress to the
affected area.

29. 




PREVENTIVE MEASURES
Avoid veins that are small or fragile, veins in areas of
flexion, veins in extremities with pre-existing edema.
Be aware of vesicant medications.
Follow your facility policy regarding vesicant
administration via a peripheral I.V.; some institutions
require that vesicants are administered via central
venous access device only.
Give vesicant last when multiple drugs are ordered.
Strictly adhere to proper venipuncture technique.

30. CATHETER DISLODGEMENT
Possible Causes:
- loosened tape or tubing
- confused patient attempting to
remove it

31. SIGNS AND SYMPTOMS
•
•
- catheter back out of
the vein
- infusate infiltrating
into tissue

32. NURSING
INTERVENTIONS
- remove the device,
restart infusion at
opposite limb if
necessary
- notify the physician
- document
PREVENTIVE MEASURES
- secure properly
- use armboard or splint

33. CIRCULATORY OVERLOAD
-
-
-
Possible Causes:
flow rate too rapid
miscalculation of fluid
requirements
roller clamp loosened

34. SIGNS AND SYMPTOMS
-
-
-
respiratory distress
increased blood
pressure
large positive fluid
balance ( intake is
greater than output )

35. -
-
-
-
-
-
NURSING
INTERVENTIONS
administer oxygen as
needed
regulate to kvo as
ordered
raise head of the bead
notify physician
administer
medications as
ordered
document
-
-
-
PREVENTIVE MEASURES
use pump controller
recheck calculations
of fluid
monitor infusion
frequently

36. ALLERGIC REACTION
Possible Causes:
- Administration of
drugs, iv fluids,
blood products

37. SIGNS AND SYMPTOMS
-
-
-
-
-
-
skin rashes
fever and chills
flushing
itchiness
respiratory distress
cardiac arrest

38. -
-
-
-
-
-
NURSING
INTERVENTIONS
Stop infusion
Maintain a patent
airway
Notify physician
Administer
antihistamine, anti-
inflammatory, anti-
pyretics , cortisone
as ordered
Give .2-.5ml
epinephrine
IM(lateral thigh) as
-
-
-
PREVENTIVE MEASURES
obtain the patients
allergy history
assist with test
dosing
monitor patient
during the first
15minutes of
administration of new
drug

39. SYSTEMIC INFECTION
-
-
POSSIBLE CAUSES:
- Failure to maintain
aseptic non touch
technique
- Immunocompromised
pateint
Prolonged in dwelling
time of device
Severe phlebitis

40. SIGNS AND SYMPTOMS
• Fever, chills and
body malaise for
no apparent
reason

41. 


NURSING INTERVENTIONS
Stop the infusion and notify the
prescriber.
Remove the device, and culture
the site and catheter as ordered.
Administer medications as
prescribed.

42. 




PREVENTIVE MEASURES
Perform hand hygiene, don gloves , and use
aseptic non touch technique during I.V. insertion.
Clean the site with approved skin antiseptic
before inserting I.V. catheter.
Ensure careful hand hygiene before any
contact with the infusion system or the patient.
Disinfect injection port before each use.
Follow your institutions policy for dressing
changes and changing of the solution and
administration set.

43. AIR EMBOLISM
-are caused when gas
bubbles enter blood
vessels.
-
-
POSSIBLE CAUSES:
EMPTY SOLUTION
CONTAINER
DISCONNECTED
TUBING

44. SIGNS AND SYMPTOMS
•
•
•
•
•
•
•
low blood pressure
irregular heartbeat
extreme fatigue
(tiredness) or lack of
strength
blurred vision
disorientation
cyanosis
irregular breathing

45. 


NURSING INTERVNTIONS
Discontinue the infusion.
Administer oxygen as ordered.
Place patient on left side trendelenburg position, this
position helps trap the air in the apex of the right atrium
rather than entering the right ventricle and from there
moving into the pulmonary arterial system.

46. 


TREATMENT
HYPERBARIC OXYGEN THERAPY
a non invasive procedure in which the
patient breath 100% oxygen.
the increase pressure in hyperbaric
chamber makes bubbles smaller and
helps push them back into physical
solution,while high oxygen pressure
washes out the gas from the bubble.
.

47. HYPERBARIC CHAMBER



Once the bubbles
are smaller or
gone, blood flow
resumes.
It allows poorly
oxygenated
tissues to receive
high levels of
oxygen.
Each treatment
session will take
approximately 1-2
hrs per session.

48. OCCLUSION
-
-
-
-
-
POSSIBLE CAUSES:
Blood back up in the
line
Hypercoagulable
patient
Intermittent device
not flushed
Line clamped too
long
Kink in the IV tubing
or catheter

49. SIGNS AND SYMPTOMS
•
•
SLUGGISH FLOW RATE
STOPPED IV FLOW

50. -
-
NURSING
INTERVENTIONS
Use mild flush
pressure during
injection
If unsuccessful, start
another line.
-
-
-
PREVENTIVE MEASURES
Maintain iv flow rate
Flush promptly after
intermittent piggy
back administration
Have the patient walk
with his arm folded to
his chest

51. VEIN IRRITATION
- caused by
Erosive
medications
or drugs

52. SIGNS AND SYMPTOMS
•
•
Pain during the
infusion
Red skin over the vein
during infusion

53. -
-
NURSING
INTERVENTIONS
Slower the flow rate
as ordered
Try using an
electronic flow device
PREVENTIVE MEASURES
- Dilute solutions before
administration

54. VENOUS SPASM
POSSIBLE CAUSES:
•
•
•
Trauma (from
chemical irritation or
temperature
extremes)
Entrance of the IV
cannula into the vein,
especially if the
cannula is too large
for vein site
Rapid infusate
infusion, particularly
with a small-gauge

55. SIGNS AND SYMPTOMS
•
•
•
•
Pain (usually sharp and severe) that
radiates from the IV site up the extremity
Redness over vein (indication of phlebitis)
Slowed infusion rate
Stopped infusion

56. NURSING
INTERVENTIONS
•
•
•
Once spasm is
identified, slow the
infusion rate.
Apply warm
compresses to the
site of spasm.
Discontinue the IV if
spasm continues in
spite of measures
used to stop it.
PREVENTIVE MEASURES
•
•
•
Use blood warmer
IV fluids and
medications should
be administered at
room temperature
Dilute irritating
infusates

57. NERVE, TENDON, OR LIGAMENT
DAMAGE
•
•
•
•
•
POSSIBLE CAUSE:
incorrect insertion and placement of the IV
cannula
Improper securing and stabilization of the
cannula and infusion line
Extravasation
Infiltration
Anatomic displacement caused by
hematoma

58. SIGNS AND SYMPTOMS
•
•
•
•
•
•
•
•
•
Extreme pain
Tingling
Numbness
Loss of sensation
Loss of movement
Cyanosis
Pallor
Deformity
Paralysis

59. •
•
•
•
NURSING
INTERVENTIONS
Stop the procedure
Avoid moving the
cannula back and
forth in the
subcutaneous tissue
in an attempt to find a
vein.
Notify the Physician
Document
•
•
PREVENTIVE MEASURES
Always observe
proper venipunctured
technique
Secure properly

60. SEVERED CATHETER
POSSIBLE CAUSES:
•
•
Catheter
inadvertently cut by
scissor
Reinsertion of the
needle into the
catheter

61. SIGNS AND SYMPTOMS
•
•
Leakage from the
catheter shaft
sheared catheter

62. NURSING INTERVENTIONS
•
•
•
If the broken portion
of the catheter is
visible, attempt to
retrieve if
unsuccessful notify
the physician
If the broken of the
catheter enters the
bloodstream, place a
tourniquet above the
iv site to prevent its
progression
Notify the physician
PREVENTIVE MEASURES
•
•
•
Avoid using scissors
around the iv site
Never reinsert the
needle into the
catheter
Remove
unsuccessfully
inserted catheter and
needle together

63. Vascular Access Device Related
Infection
•
•
•
•
Possible Causes:
Inadequate skin antisepsis prior to VAD insertion
Multiple manipulation of infusion delivery system
Patient age, condition, acuity
Inadequate care and maintenance practices

64. SIGNS AND SYMPTOMS
>tenderness of site
>erythema within 2 cm of
catheter-skin junction
>necrosis of skin over
reservoir of implanted port
>acute on set of fever, chills,
and hypotension

65. Nursing
Interventions
>Apply warm, moist
compress
>Obtain culture of purulent
exudate on form the tip of
catheter
>Apply to topical ointment to
affected area
>Notify the doctor
>Administration oral on
parenteral infective therapy
>Continue to monitor signs
& review laboratory findings
>Perform site care &
maintenance catheter is not
removed
Preventive
Measures
>Perform hand hygiene and
maintain aseptic technique
prior to placing any VAD-
related intervention.
>Disinfect needleless
connectors prior to access
>Remove VAD when no
longer needed
>Teach patients/caregivers
who will set or manage their
VAD

66. WHAT TO DO WHEN INFUSION
SLOWS DOWN OR STOPS

67. 1.
2.



Assess the I.V. system to locate the problem.
Start at the insertion site. Check for infiltration,
extravasation, or phlebitis.
Check for patency. Obstruction of flow is caused
or affected by the following factors:
2.1 Patients limb is flexed; patient lying on the
side. Reposition limb to release venous pressure.
2.2 Tip of needle or cannula is against the vein
wall. Lift or pull-back the needle or cannula a
little.
2.3 Adhesive taping maybe too tight, release
every apply tapes.

68. •
•
•
2.4. Small cannulas or tubing may kink or fold,
gently adjust.
2.5. Local edema or poor tissue perfusion from
disease can block venous flow. Transfer I.V. line to
an unaffected site.
2.6. Presence of precipitates in solution either
from incompatibility of fluids and medications or
from infusion. Replace the entire venipuncture
device and solution. It may expose the patient to
embolism.
3. Check the clamps. Some sets have two:
the roller clamp and the side clamp. Check if both
are open or if these are properly adjusted.

69. 4. Check the patency of the air vent;
reposition it if needed
5. Check fluid level: if empty replace
as prescribed. If solution is too cold,
it may cause venous spasm and
decrease the flow; keep room
temperature regulated. Check the
spike of the set; push it more inside
the fluid bag or adjust it.
6. Check filters: ordinary sets usually
do not have in-line filters. If it has,
follow the manufacturer’s guide
instructions. Blood transfusion filters
retain blood product debris.

70. •
•
•
If flow rate decreases or stops after
more than one unit has been
transfused you may have to change
the set.
7. Check tubings: if patient is lying
on it or if it is kinked or it may be
crimped with too tight roller clamps,
release and round-up the tubing to
its original shape
8. Is gauge of the needle too small?
Is fluid container too low above the
venipuncture site? Adjust it around
36-48 inches above the site.

71. REFERENCES
•
•
•
Association of Nursing Service
Administrators of the Philippines, Inc.
(ANSAP). 2000. Nursing Standards on
Intravenous Practice 7th EDITION.
Cahil, Matthew. I.V. Therapy made
Incredibly Easy. Springhouse Corporation,
Pennsylvania.
Dionne, Lynn. Manual of I.V. Therapeutics.
Philips, F.A., Davis Co. Philadelphia.

72. •
•
•
Intravenous Nursing Society, Supplement
to Journal of Intravenous Nursing, Jan./
February 1998 vol.21, Fresh Pond Square,
10 Faucett street, Cambridge, MAO 218.
Lippincott Williams and Wilkins. 2005.
JUST THE FACTS I.V. Therapy.
Nursing Journal May and July 2000.