iv complications

IV Complications

Infiltration and Extravasation: Definitions and Misc. Info

Infiltration: the process in which a substance enters or infuses into another substance or a surrounding area. Infiltration may be an intentional or unintentional process

Extravasation: the actual unintentional escape or leakage of material from a vessel into the surrounding tissue

Vesicant: an agent that is irritating and causes blistering

Infiltration and Extravasation: Etiology

1 of 2 Puncture of distal vein wall during

venipuncture Puncture of any portion of the vein wall by

mechanical friction from the catheter/needle cannula

Dislodgement of the catheter/needle cannula from the intima of the vein

Poorly secured IV device Poor vein or site selection

Infiltration and Extravasation: Etiology

2 of 2 Improper cannula size High delivery rate or pressure of the infusate Over manipulation of the IV device, the site,

or both Irritating infusate that inflames the intima of

the vein and causes it to weaken

Infiltration and Extravasation: Signs and Symptoms

1 of 2 Pain at or near the insertion site Swelling proximal to or distal to the IV site Puffiness of the dependent part of limb or

body Taut, rigid skin around IV site Blanching and coolness of skin around IV site Damp or wet dressing Slowed infusion rate

Infiltration and Extravasation: Signs and Symptoms

2 of 2 No back flow of blood into IV tubing when

clamp is full opened and solution container is lowered below IV site

No back flow of blood into IV tubing when tubing is pinched above cannula hub

Infusion stops running The infusion continues to infuse when

pressure is applied to the vein above the tip of the cannula

Infiltration and Extravasation: Interventions

The use of warm compresses to treat infiltration has become controversial. It has been found that cold compresses may be better for some infiltrated infusates and warm compresses may be more effective for others. It has also been documented that elevation of the infiltrated extremity may be painful for the patient. To act in the best interest of the patient, following IV infiltration, consult with the physician for order regarding compresses and elevation.

Infiltration and Extravasation: Clinical Criteria

1 of 3No symptoms

Skin blanchedEdema <1 inch in any directionCool to touchWith or without pain

Skin blanchedEdema 1-6 inches in any directionCool to touchWith or without pain

Infiltration and Extravasation: Clinical Criteria

2 of 3Skin blanched, translucent

Gross edema >6 inches in any directionCool to touchMild-moderate painPossible numbness

Skin blanched, translucent

Infiltration and Extravasation: Clinical Criteria

3 of 3(continued from previous slide)

Deep pitting tissue edemaCirculatory impairmentModerate-severe painInfiltration or any amount of blood product, irritant, or vesicant

Catheter and Needle Displacement:

Definitions and Misc. Info

Displacement: cannula has shifted from it's intended placement site in the vein, or is inadvertently removed from the vein.

Catheter and Needle Displacement

Etiology1 of 1 Cannula was inadedaquatly secured after

insertion Tape around site becomes loose or detaches

from the skin Insertion pulled out during transportation or

movement of the client

Catheter and Needle Displacement

Preventative Interventions1 of 1 Explain to the patient prior insertion their role

in caring for the IV Appropriate securing of IV line Frequent assessment of site to ensure patency IF THE SITE BECOMES DISLODGED,

THE SITE MUST BE MOVED!

Occlusion and Loss of Patency:Definitions and Misc. Info

Occlusion: occurs when there is some type of blockage that interferes with the passage of infusate into the vein. It can occur at any point within the vein, the cannula, or the tubing.

Occlusion and Loss of PatencyEtiology

Tubing may be kinked or bent Transition from electric pump to gravity flow Not saline-locking the site when infusate runs

out Fibrin sheath formation around and over the

tip of a cannula Too large of a cannula

Occlusion and Loss of PatencySigns and Symptoms

Slowed rate of infusion even if clamp is opened or height of infusate is raised

Infusion stops infusing Infusion site pain (with normal appearance) Blood backs up from the cannula into the IV

tubing

Occlusion and Loss of Patency: Interventions

For prevention, flush routinely, especially with intermittent infusion devices

Pinch the IV tubing open and closed or gently milk it

If the above doesn't work, attempt to irrigate the line with normal saline

Phlebitis:Definitions and Misc. Info

Phlebitis: The inflammation of a vein Inflammation: part of the body's normal

immune response to any type of injury or invasion

Suppurative phlebitis: phlebitis in which pus accumulates in the tissue

Phlebitis:Etiology

Bacterial: Pathogenic organisms can gain access and stimulate inflammation.

Chemical: caused by irritating or vesicant solutions.

Mechanical: physical trauma from the skin puncture and movement of the cannula into the vein during insertion; any subsequent manipulation and movement of the cannula; clotting; or excessively large cannula.

Phlebitis: Signs and Symptoms

Erythema at the site Pain or burning at the site and along the

length of the vein Warmth over the site Edema at the site Vein hard, red, and cord like Slowed infusion rate Temperature elevation on degree or more

above the baseline

Phlebitis:Grading Criteria

1 of 2Erythema at access site with or without pain

No symptoms

Pain at access site with erythema and/or edema

Pain at access site with erythema and/or edemaStreak formationPalpable venous cord

Phlebitis:Grading Criteria

2 of 2Pain at access site with erythema and/or

edema

Phlebitis:Preventative Interventions

Infusion container should be hung 36 inches higher than the IV site

Clip body hair around the IV site, but DO NOT SHAVE IT! Shaving may encourage bacterial contamination.

Insertion should be performed with aseptic technique

Phlebitis:Interventions

At the first sign of phlebitis, the IV must be discontinued and the cannula removed. If the site shows fever and drainage, contact the physician.

Warm compresses may be used, according to agency protocol

Thrombosis and Thrombophlebitis:

Definitions and Misc. Info Thrombosis: the formation of a clot Thrombophlebitis: the inflammation of a

vessel due to the development of a thrombus Deep Vein Thrombosis (DVT): inflammation

of the larger deeper veins of the extremities Venous Stasis: the condition wherein blood

flow is inhibited or stopped due to a clot formation

Thrombosis and Thrombophlebitis:

Etiology1 of 1 Usually the sequela of phlebitis, meaning it is

a consequence of it. A clot forms when the blood vessel becomes traumatized.

Thrombosis and Thrombophlebitis

Signs and Symptoms1 of 2 Slowed or stopped infusion rate

Aching or burning sensation at the infusion site

Elevation in temperature on degree or more above baseline

Skin warm and red around IV site Cording of the infusion vein

Thrombosis and Thrombophlebitis

Signs and Symptoms2 of 2 Malaise

Swelling and edema of the extremity Diminished arterial pulses Pallor

Thrombosis and Thrombophlebitis:

Interventions1 of 2 IV must be discontinued and restarted elsewhere

immediately Physician should be consulted as to whether the

extremity should be elevated and warm, moist compresses applied.

Physician may order antiembolic stockings and/or the use of sequential compression devices (SCDs)

Anticoagulants and anti-inflammatories and a balanced routine of active and passive activity and rest

Hematoma:Definitions and Misc. Info

Hematoma: the accumulation of clotted blood in the tissue interstices

Ecchymosis: a black and blue skin discoloration

Hematoma:Etiology

Faulty venipuncture technique, where the cannula passes through the distal vein wall

Infiltration following cannulation of a vein Flow control clamp for infusion is opened

before tourniquet is removed Vessel rupture due to large cannula Inadequate pressure applied following a

blood sampling stick or the discontinuation of an infusion or heparin/saline lock.

Hematoma:Signs and Symptoms

Ecchymosis over and around insertion area Pain at the site Swelling and hardness at the insertion site Inability to advance the cannula all the way

into the vein during insertion Inability to flush the IV line

Hematoma:Interventions

IV line discontinued, and a 2X2 inch gauze pressure dressing applied

Alcohol should not be used when removing the cannula because it enhances bleeding and may cause stinging

Once bleeding has stopped, the extremity may be elevated and warm moist compresses applied, depending on the severity

Venous Spasm:Definitions and Misc. Info

Venous spasm: a sudden involuntary movement or contraction of a vessel wall as a result of trauma or irritation; usually painful.

Cramp: a strong, painful spasm

Venous Spasm:Etiology

Administration of an irritating infusate with a high osmolarity or a high or low pH

Delivery of cold or viscous infusates For some patients, entrance of IV cannula,

especially if cannula is too large Too rapid infusion of infusate

Venous spasm:Signs and Symptoms

Slowed infusion rate Stopped infusion rate Severe pain from the IV site radiating up the

extremity Blanching over the IV site Redness over and around the IV site

Venous Spasm:Interventions

Prevention: use a large vein and a small-gauge cannula so that blood flow is unrestricted and allows for dilution of the infusate; administer fluids at room temperature

Once it occurs: Decrease infusion rate Apply warm compress if infusate is cold Pharmacist should be contacted about adding a

buffer if infusate is irritating

Vessel Collapse:Definitions and Misc. Info

Vessel collapse: the walls of a vein or artery retract abnormally

Vessel Collapse:Etiology

Decreased circulation, as seen with excessive blood or fluid loss and shock

Vessel Collapse:Signs and Symptoms

Inability to see a vein Inability to feel a vein Loss of vessel elasticity Vessel feels flat or flaccid Reduced or stopped infusion flow

Vessel Collapse:Interventions

Restart the IV elsewhere, preferably in a larger vein If patient is in shock a physician may need to insert

a central line

Stay with patient Provide reassurance Assist with central venous cannulation Keep the patient warm Lower head and elevate legs to promote venous

return Carefully monitor vital signs

Cellulitis:Definitions and Misc. Info

Cellulitis: the diffuse inflammation and infection of cellular and subcutaneous tissue. It is bacterial in nature.

Peau d'orange: site feels warm and the skin has the roughened appearance of an orange peel

Cellulitis:Etiology

Invasion and multiplication of bacteria into the IV site

Cellulitis:Signs and Symptoms

1 of 2 Tenderness Pain Warmth Edema Induration Red streaking on skin Peau d'orange Vesicles

Cellulitis:Signs and Symptoms

2 of 2 Abscess formation with pus Ulceration Fever Chills Malaise

Cellulitis:Interventions

Discontinue IV and start elsewhere Physician may need to incise and drain an abscess Limb may be elevated to reduce edema Cool compresses to promote comfort often

alternated with war, moist compresses to promote circulation

Sterile dressings should be used Antibiotics, analgesics, and antipyretics are

generally administered

Nerve, Tendon, Ligament and Limb Damage:

Etiology Incorrect insertion and placement of the IV

cannula, or improper securing and stabilization of the cannula and IV line after insertion

Nerve, Tendon, Ligament and Limb Damage:

Signs and Symptoms Tingling Numbness Loss of sensation Loss of movement Cyanosis Pallor Deformity Paralysis

Nerve, Tendon, Ligament and Limb Damage:Interventions

Prevent damage by properly placing the IV line

Frequently assess the extremity in which the IV is placed

Contamination and Infection:Definitions and Misc. Info

Contamination: the introduction of microorganisms or particulate matter into a normally sterile environment

Contamination and Infection:

Breaks in asepsis during the manufacture, packaging, and storage of infusates, medications, and delivery systems

Break in asepsis during setup and administration of infusion therapy

Contamination and Infection:Signs and Symptoms

Chills Malaise Fever Elevated leukocyte count Normal appearance of IV site

Contamination and Infection:Interventions

IV must be discontinued and move to another site with fresh equipment

Cannula, connection sites, tubing, and infusate should be cultured

Sepsis:Definitions and Misc. Info

Sepsis: the (usually) febrile disease process that results from the presence of microorganisms or their toxic products in the circulatory system.

Sepsis: Etiology

Most often attributed to Staphylococcus aureus and S. epidermidis, the Candida albicans yeast, and the coliform species Escherichiea, Enterobacter, and Klebsiella.

Sepsis:Signs and Symptoms

1 of 2 Chills Malaise Altered mental status Fever Tachycardia Tachypnea Leukocytosis Hypotension Flushing

Sepsis:Signs and Symptoms

2 of 2 S/S of Toxic Shock Syndrome:

Malaise with generalized myalgia and arthralgia Vertigo Nausea with vomiting Edema of hands and feet Desquamation of hands and feet

Sepsis:Interventions

Keep patient flat with legs elevated Provide oral fluids Keep warm Medications as necessary to support blood

pressure, circulation, and promote comfort Conserve strength Administer oxygen Analgesics and antipyretics may be given

Hypersensitivity: Info

Hypersensitivity: the profound physiologic response of the body to an antigen

Allergy: acquired abnormal immune response to an allergen following sensitization

Hypersensitivity:

Certain people are especially drug sensitive; others are simply allergic to some specific medications

Hypersensitivity:Signs and Symptoms

1 of 5 Facial edema Generalized edema Erythema along veins Palpitations Hypotension Cardiac arrest Dysphagia Gastric cramping

Hypersensitivity:Signs and Symptoms

2 of 5 Intestinal cramping Nausea Vomiting Flushing Red flare Rash IV site edema Pruritis

Hypersensitivity:Signs and Symptoms

3 of 5 Urticaria (hives) Agitation Anxiety Confusion Disorientation Headache Paresthesias Vertigo

Hypersensitivity:Signs and Symptoms

4 of 5 Nasal congestion Rhinorrhea (runny nose) Cough Sensation of tightness in throat Mucous membrane edema Wheezing Bronshospasm Respiratory obstruction

Hypersensitivity:Signs and Symptoms

5 of 5 Respiratory arrest Watery eyes Scratchy throat Tinnitus Buzzing sound in ears Throbbing sensation in ears Tingling/numbness in fingers and /or toes

Hypersensitivity:Interventions

At the first indication of a hypersensitivity reaction, the nurse must either discontinue the infusion and keep the vein open with normal saline or, if the reaction is mild, slow th IV to a KVO rate until further orders can be obtained. NEVER REMOVE THE CANNULA! Vital signs are to be taken and the physician notified. The nurse must stay with the patient, reassure him, and keep him warm. Emergency equipment must be readily available. Emergency drugs are administered according to agency policy and physician orders.

Embolism:Definition and Misc. Info

Embolus: an aggregate of undissolved material in the blood that is carried by circulatory flow.

Endogenous embolus: clotted blood, tissue particles, tumor cell mass, or fat globules

Exogenous embolus: particulate matter, liquids, gaseous material.

Ischemia: obstruction of a vessel due to embolus.

Infarction: an area of necrosis following the loss of blood supply.

Embolism:Etiology

Blood clot Air embolism: through severed IV lines,

tubings that are not primed with infusate, vented infusion containers that are allowed to run dry, or disconnected and loose tubing junctions

Catheter embolism: a portion of the catheter breaks off

Any small, particulate matter that can enter the bloodstream from the IV site

Embolism:Signs and Symptoms

1 of 2 Dyspnea Tachypnea Cardiac arrhythmia Hypotension Diaphoresis Anxiety Substernal pressure

Embolism:Signs and Symptoms

2 of 2 Chest pain with inhalation and exhalation Localized decreased breath sounds Pleural friction rub Cough (often with hemoptysis)

Embolism:Interventions

1 of 2 Blood clot

Low dose heparin or oral anti-coagulants Plan activity and movement Promote comfort and gas exchange by elevating

the head of the bed, assisting with coughing and deep breathing, administering analgesics, and maintaining a restful environment

Embolism:Interventions

2 of 2 Air embolism

Mostly preventative and supportive Catheter embolism

Apply tourniquet above IV site Prepare for surgery

Speed Shock:Definitions and Misc. Info

Speed shock: the systemic reaction to the rapid or excessive infusion of medication or infusate into the circulation

Speed shock:Etiology

Flow control clamp is inadvertently left completely open

EID (electronic infusion device) programmed incorrectly

Speed Shock:Signs and Symptoms

Flushing of head and neck Feeling of apprehension Hypertension Pounding headache Dyspnea Chest pain Chills Loss of consciousness Cardiac arrest

Speed Shock:Interventions

Best intervention is prevention. Do not give a medication without reading and following the manufacturer's guidelines.

When it occurs: Slow or stop infusion Notify physician Observe for cardiac arrest