Iv Complications

IV Complications

Infiltration and Extravasation: Definitions and Misc. Info 

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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

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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

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Poorly secured IV device

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Poor vein or site selection

Infiltration and Extravasation: Etiology 2 of 2

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Improper cannula size

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High delivery rate or pressure of the infusate

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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

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Pain at or near the insertion site

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Swelling proximal to or distal to the IV site

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Puffiness of the dependent part of limb or body

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Taut, rigid skin around IV site

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Blanching and coolness of skin around IV site

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Damp or wet dressing

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Slowed infusion rate

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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 3

No symptoms

Skin blanched Edema <1 inch in any direction Cool to touch With or without pain Skin blanched Edema 1-6 inches in any direction Cool to touch With or without pain

Infiltration and Extravasation: Clinical Criteria 2 of 3

Skin blanched, translucent Gross edema >6 inches in any direction Cool to touch Mild-moderate pain Possible numbness Skin blanched, translucent

Infiltration and Extravasation: Clinical Criteria 3 of 3 (continued from previous slide) Deep pitting tissue edema Circulatory impairment Moderate-severe pain Infiltration 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.

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Catheter and Needle Displacement Etiology 1 of 1 secured after Cannula was inadedaquatly insertion

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Tape around site becomes loose or detaches from the skin Insertion pulled out during transportation or movement of the client

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Catheter and Needle Displacement Preventative Interventions 1 of 1 insertion their role Explain to the patient prior in caring for the IV

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Appropriate securing of IV line

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Frequent assessment of site to ensure patency

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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 Patency Etiology 

Tubing may be kinked or bent

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Transition from electric pump to gravity flow

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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 Patency Signs and Symptoms 

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

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Infusion stops infusing

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Infusion site pain (with normal appearance)

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Blood backs up from the cannula into the IV tubing

Occlusion and Loss of Patency: Interventions 

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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 

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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 

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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 

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Erythema at the site Pain or burning at the site and along the length of the vein

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Warmth over the site

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Edema at the site

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Vein hard, red, and cord like

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Slowed infusion rate

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Temperature elevation on degree or more above the baseline

Phlebitis: Grading Criteria 1 of 2

Erythema 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 edema Streak formation Palpable venous cord

Phlebitis: Grading Criteria 2 of 2

Pain at access site with erythema and/or edema

Phlebitis: Preventative Interventions 

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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 

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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

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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

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Thrombosis and Thrombophlebitis: Etiology 1 Usually the sequela1ofof phlebitis, meaning it is a consequence of it. A clot forms when the blood vessel becomes traumatized.

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Thrombosis and Thrombophlebitis Signs and Symptoms of 2 rate Slowed or stopped 1 infusion Aching or burning sensation at the infusion site Elevation in temperature on degree or more above baseline

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Skin warm and red around IV site

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Cording of the infusion vein

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Thrombosis and Thrombophlebitis Signs and Symptoms 2 of 2 Malaise

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Swelling and edema of the extremity

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Diminished arterial pulses

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Pallor

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Thrombosis and Thrombophlebitis: Interventions IV must be discontinued 1 ofand2 restarted elsewhere immediately

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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 

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Hematoma: the accumulation of clotted blood in the tissue interstices Ecchymosis: a black and blue skin discoloration

Hematoma: Etiology 

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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

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Pain at the site

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Swelling and hardness at the insertion site

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Inability to advance the cannula all the way into the vein during insertion Inability to flush the IV line

Hematoma: Interventions 

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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 

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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 

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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

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Stopped infusion rate

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Severe pain from the IV site radiating up the extremity

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Blanching over the IV site

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Redness over and around the IV site

Venous Spasm: Interventions 

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Prevention: use a large vein and a smallgauge 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

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Apply warm compress if infusate is cold

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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

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Inability to feel a vein

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Loss of vessel elasticity

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Vessel feels flat or flaccid

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Reduced or stopped infusion flow

Vessel Collapse: Interventions 

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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

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Provide reassurance

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Assist with central venous cannulation

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Keep the patient warm

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Lower head and elevate legs to promote venous return

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Carefully monitor vital signs

Cellulitis: Definitions and Misc. Info 

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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

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Tenderness

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Pain

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Warmth

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Edema

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Induration

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Red streaking on skin

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Peau d'orange

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Vesicles

Cellulitis: Signs and Symptoms 2 of 2

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Abscess formation with pus

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Ulceration

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Fever

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Chills

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Malaise

Cellulitis: Interventions 

Discontinue IV and start elsewhere

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Physician may need to incise and drain an abscess

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Limb may be elevated to reduce edema

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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

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Tingling

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Numbness

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Loss of sensation

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Loss of movement

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Cyanosis

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Pallor

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Deformity

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Paralysis

Nerve, Tendon, Ligament and Limb Damage: Interventions 

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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: 

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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

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Malaise

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Fever

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Elevated leukocyte count

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Normal appearance of IV site

Contamination and Infection: Interventions 

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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

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Chills

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Malaise

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Altered mental status

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Fever

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Tachycardia

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Tachypnea

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Leukocytosis

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Hypotension

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Flushing

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Sepsis: Signs and Symptoms 2 of 2

S/S of Toxic Shock Syndrome: −

Malaise with generalized myalgia and arthralgia

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Vertigo

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Nausea with vomiting

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Edema of hands and feet

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Desquamation of hands and feet

Sepsis: Interventions 

Keep patient flat with legs elevated

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Provide oral fluids

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Keep warm

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Medications as necessary to support blood pressure, circulation, and promote comfort

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Conserve strength

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Administer oxygen

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Analgesics and antipyretics may be given

Hypersensitivity: Info 

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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

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Facial edema

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Generalized edema

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Erythema along veins

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Palpitations

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Hypotension

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Cardiac arrest

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Dysphagia

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Gastric cramping

Hypersensitivity: Signs and Symptoms 2 of 5

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Intestinal cramping

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Nausea

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Vomiting

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Flushing

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Red flare

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Rash

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IV site edema

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Pruritis

Hypersensitivity: Signs and Symptoms 3 of 5

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Urticaria (hives)

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Agitation

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Anxiety

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Confusion

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Disorientation

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Headache

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Paresthesias

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Vertigo

Hypersensitivity: Signs and Symptoms 4 of 5

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Nasal congestion

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Rhinorrhea (runny nose)

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Cough

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Sensation of tightness in throat

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Mucous membrane edema

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Wheezing

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Bronshospasm

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Respiratory obstruction

Hypersensitivity: Signs and Symptoms 5 of 5

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Respiratory arrest

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Watery eyes

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Scratchy throat

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Tinnitus

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Buzzing sound in ears

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Throbbing sensation in ears

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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 

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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 

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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

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Dyspnea

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Tachypnea

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Cardiac arrhythmia

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Hypotension

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Diaphoresis

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Anxiety

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Substernal pressure

Embolism: Signs and Symptoms 2 of 2

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Chest pain with inhalation and exhalation

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Localized decreased breath sounds

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Pleural friction rub

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Cough (often with hemoptysis)

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Blood clot

Embolism: Interventions 1 of 2

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Low dose heparin or oral anti-coagulants

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Plan activity and movement

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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

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Embolism: Interventions 2 of 2

Air embolism −

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Mostly preventative and supportive

Catheter embolism −

Apply tourniquet above IV site

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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 

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Flow control clamp is inadvertently left completely open EID (electronic infusion device) programmed incorrectly

Speed Shock: Signs and Symptoms 

Flushing of head and neck

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Feeling of apprehension

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Hypertension

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Pounding headache

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Dyspnea

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Chest pain

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Chills

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Loss of consciousness

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Cardiac arrest

Speed Shock: Interventions 

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Best intervention is prevention. Do not give a medication without reading and following the manufacturer's guidelines. When it occurs: −

Slow or stop infusion

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Notify physician

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Observe for cardiac arrest