Complications Of Intravenous Therapy

Intravenous Drug Therapy Chapter 3

Intravenous drug therapy  



Diagnostic Therapeutic Maintain patency of the intravenous access

Intravenous Infusion Therapy 

Fluid and electrolyte balance 









Acid-base balance

1. replace fluids, electrolytes, calories, nutrition 2. provide fluid, electrolytes, calories or nutrition to maintain homeostasis 3. transfuse blood and blood products 4. administer medications

Osmotic pressure 

Hydrostatic pressure 



Force water places against vessel walls or capillary membrane

Osmotic pressure 

Amount of hydrostatic pressure required to move particles and fluids in & out of vascular volume

Osmolality 

Measure of solute particles 

Normal human serum or plasma 280 to 295 mOsm/kg  Less than normal 





Fluid volume deficit

Greater than normal 

Fluid volume excess

According to Tonicity or Osmolality of the Fluid 

1. Isotonic Intravenous solutions have the same osmolality as body fluids and do not alter plasma osmolality  Fluid remains in the vascular space  240 to 340 mOsm/kg (50)  Replacement therapy  Maintenance (serum osmotic pressure) 

Hypertonic Solutions  





Greater than 340 mOsm/kg Higher solute concentration in the plasma Solutions cause fluids to be pulled from the cells into vascular compartments Increase vascular volume and dehydrate the cells causing them to shrink

Hypotonic Solutions   

Less than 240 mOsm/kg Move out of the capillaries----cells Swelling

Intravenous solutions     

1. colloids 2. crystalloids 3. hydrating solutions 4. hypertonic hyperosmolar solutions 5. blood and blood products

Colloids 

Increase colloid osmotic pressure (oncotic pressure) by having greater molecular weight in protein and pull fluids from the interstitial and intracellular vascular spaces



Hypertonic solutions Plasma or volume expanders  Albumin, dextran, plasmanate, hetastarch 

Colloids



Hypotension Protein depletion Expand intravascular volume



Disadvantage

 



Cause intravascular fluid overload

Crystalloids 



  

Solutions that create osmotic pressure by the movement of dissolved ions Freely cross the semi permeable membrane of the vessel walls into interstitial spaces Do not cross the cellular membranes Isotonic Volume expanders

Hydrating Solutions    

Supply caloric intake Nutrients Electrolytes Dextrose 

Most common electrolytes 

Potassium and chloride

Common Intravenous Solutions D5 & ¼ Normal saline 5% dextrose & .2 NaCl Dextran D5W 5% 40 & 0.9 NS dextrose in water Dextran 40 & D5 W

Isotonic

Dextran 70 & 0.9 NS

NS Lactated Ringer’s 0.9 NaCl Ringer’s Solution

Common Intravenous Solutions Plasma Expanders Dextran 70 & 0.9%NS 308 mOsm/L Dextran 40 & 0.9% NS 308 mOsm/L Dextran 40 & D5 W 255 mOsm/L

Hypertonic Solutions Hypertonic Solutions

D10 W 505 mOsm/L

D5 and ½ NS 391 mOsm/L

D20W 1.011 mOsm/L

D5 0.9 NaCl 560 mOsm/L

D30W 1,510 mOsm/L

D5 Ringer’s Solution 564 mOsm/L

D40W 2020 mOsm/L

D5LR 524 mOsm/L

D50W 2520 mOsm/L

D60W 3030 mOsm/L

D10LR 779 mOsm/L D70W 3530 mOsm/L

Hypotonic Solution 

½ NS – 0.45 NaCl 

154 mOsm/L

IV Site/s

IV Site/s

IV Site/s

Most Common Complications       

A. Infiltration B. Extravasation C. Thrombophebitis D. Pain E. Fluid overload F. Pyrogenic reaction G. Tissue necrosis

Infiltration 

Occurs when the needle becomes dislodged from or pierces the vein or from weak, overextended, stretched veins, permitting fluid to collect in the tissues surrounding the vein



Discontinue the infusion and restart using sterile needle in another site

Infiltration 

Signs of Infiltration: Swelling  Pain  Coolness of the skin  Loss of intravenous fluid flow 

Extravasation 





Fluid being infused escapes from the vein into surrounding tissues May occur when the infusion is running too rapidly Check to see if the needle is still within the vein 

Special measures 

Vesicant/antineoplastic drugs

Extravasation 

If extravasations occur: Stop infusion  Apply cold compress  Document the date and time of the event  Needle type and site (insertion site)  Take note for the drug/fluid being infused 

Thrombophlebitis 





Formation of blood clot and inflammation of the vein Pain, heat, redness, swelling, loss of motion in severe cases Discontinue infusion 

Place warm moist packs on the area

Pain 



 

Occurs hen irritating drugs such as POTASSIUM CHLORIDE are being infused, especially when superficial veins are used and or medications is infused rapidly or is inadequately diluted Check for tension, gently move the hub Check the rate of flow Change to larger vein

Fluid Overload 



Overload of the circulatory system which may be due to he excessive fluid or too rapid infusion of fluid Common in children 

Patient may have:   

 

Moist respiration Dyspnea Cough

Slow the infusion Central venous pressure monitoring

Pyrogenic reaction 

The development of fever and chills 



Nausea, vomiting and headache

Results of introducing pyrogens or substances like bacteria which causes fever

Tissue Necrosis 

Tissue damage with breakdown and sloughing which occurs following infiltration of infusions containing some toxic drugs like Antibiotics  Antineoplastics  Norepinephrine bitartrate 

Applying The nursing process 

1. Assessment Right intravenous fluids  Date on the tubing 48-96 hours  Right rate  Absence of kinks  Date on the access devise – 48-72 hours  Check for pain, redness, warmth or coolness & swelling 

Before administering IV Meds:          

Right client Right medication Right dose Right route Right time Right documentation Right to refuse Indications of effectiveness Presence of adverse effects Need for client teaching



Administration Through A special Administration Chamber Soluset or Buretrol

Administration by Piggybank

ADMINISTRATION BY AN IV PUSH OR BOLUS THROUGH A PRIMARY INTRAVENOUS SETUP 

SLOWLY OVER A PERIOD OF 1 – 7 MINUTES

Administration by IV push through an IVAD or saline lock

Electronic Infusion Devices 



Maintain patency of the Intravenous access Provide more accurate flow