Ivt Complications

IVT Complications PHLEBITIS - Inflammation of a vein and it can be caused by any insult to the blood vessel wall, impaired venous flow, or coagulation abnormality. - also caused by administration of irritating medications SUPERFICIAL PHELEBITIS - Affects nerves on skin surface - Usually caused by local trauma to a vein. - Superficial phlebitis is most often caused by an intravenous catheter (IV) placed in a vein, and the vein becomes irritated THROMBOPHLEBITIS - One or more blood clots in the vein that causes inflammation - Mostly occurs in leg veins COMPLICATION: DVT RISK FACTORS: Hormone therapy, pregnancy, birth control pills, obesity, cigarette smoking

Preventions 

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Careful placement of catheter Early mobilization after surgery (if permitted) Wear compression stockings Stretching your arms and legs Oral antiinflammatory (Ibuprofen: Advil, Diclofenac: Voltaren)

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Signs and symptoms Redness Swelling Warmth Visible red streaking on arms and legs Tenderness Itchy Low grade fever

Treatment    

Removal of IV catheter Warm compress Antibiotics Elevation of involved extremity

Nursing Responsibilities    

Sterile technique of catheter insertion Good nursing hygiene Monitor patient’s condition Promote optimal comfort

Nursing Diagnosis

INFILTRATION - Infiltration occurs when I.V. fluid or medications leak into the surrounding tissue. - Caused by improper placement or dislodgment of the catheter. - Patient movement can cause the catheter to slip out or through the blood vessel lumen. EXTRAVASATION - Leaking of vesicant drugs into surrounding tissue. Extravasation can cause severe local tissue damage, possibly leading to delayed healing, infection, tissue necrosis, disfigurement, loss of function, and even amputation.

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Select an appropriate IV site avoiding areas of flexion Use proper venipuncture technique Observe the IV site

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Avoid veins that are small and or fragile Veins with preexisting edema Be aware of vesicant medications (Doxurubicin, Vinblastine, and Vincristine, Digoxin, Dopamine)

Inflammation at insertion site Swelling Taut skin w pain Blanching and coolness of skin around IV site Slowed or stopped infusion No backflow

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Stop administration and remove catheter Elevate the limb Warm compress Check the patients pulse and capillary refill time Perform venipuncture in different location

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Advise the patient to report any swelling or tenderness at the IV site

NERVE INJURY - Caused by too much pressure , stretching, or cut

HEMATOMA - Leakage of blood from the vessels into the surrounding tissues - Caused by trauma to the vein (Usage of large cannula) - This can occur when an IV angiocatheter passes through more than one wall of a vessel or if pressure is not applied to the IV site when the catheter is removed. VENOUS SPASM - Spasm usually occurs because of severe VEIN IRRITATION from the I.V. DRUG or fluid or from COLD FLUIDS OR BLOOD PRODUCTS. It can also be due to a very rapid flow rate - Sudden involuntary contraction of a vein resulting in temporary cessation of blood flow

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Select an appropriate IV site avoiding areas of flexion Use proper venipuncture technique Advice patient to report any swelling and discoloration

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Numbness Weakness Pain

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Discoloration of the skin Site swelling and discomfort Inability to advance catheter all the way into the vein during insertion Resistance to flushing

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Sharp pain at IV site that travels up to the arm Sluggish flow rate Blanched skin over vein

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Slow and regulated infusion Use blood warmer for blood or PRBC when appropriate

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Surgical intervention Physical therapy Use of electrical stimulators

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Remove catheter Elevate extremity Apply direct pressure

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Slow and regulated infusion Use blood warmer for blood or PRBC when appropriate

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Assist in surgical procedure Careful venipuncture technique Sterile technique of catheter insertion Good nursing hygiene Monitor patient’s condition Promote optimal comfort DIRECT PRESSURE

Apply warm soaks over and surrounding area Slow flow rate

LOCAL INFECTION - Caused by: prolonged indwelling time of IV catheter - Failure to maintain aseptic technique - Severe phlebitis - Immunocompromise d patients are at risk

PNEUMOTHORAX - the presence of air or gas in the cavity between the lungs and the chest wall, causing collapse of the lung.

HEMOTHORAX - is a collection of blood in the space between the chest wall and the lung (the pleural cavity).

CHYLOTHORAX -is a type of pleural effusion. It results from

Practice of aseptic technique upon insertion  Use scrupulous aseptic technique when handling solutions and tubings, inserting venipuncture device, and discontinuing infusion  Monitor patency of IV catheter - Recognizing risk factors for difficult catheterization - Use of standardized method of CVC insertion - Assistance from experienced clinician - Select the 

optimal insertion site - Guide CVC placement with ultrasound - Remove unnecessary central lines immediately

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Fever, chills, malaise Contaminate d IV site usually with NO SIGNS AND SYMPTOMS

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Primary treatment is removal of catheter

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Monitor Vital signs Administer medications as prescribed Secure IV lines Change IV solutions, tubings, and access device at recommended times

- chest pain - shortness of breath - skin that is bluish in color - fatigue - rapid breathing - rapid heartbeat - cough

- observation - outpatient insertion of a Heimlich valve - inpatient tube thoracostomy

- maintaining chest tube drainage system - monitoring lung sounds - monitor vital signs

- dyspnea - tachypnea - chest pain - cyanosis - decreased or absent breath sounds on the affected site

- A chest tube is inserted through the chest wall between the ribs to drain the blood and air - It is left in place and attached to suction for several days to re-expand the lung - bilateral chest tube drainage - omission of oral

- Check out respiratory function, noting rapid or shallow respirations, dyspnea, reports of “air hunger,” development of cyanosis, changes in vital signs. - tell patient to report any pain -

- can be asymptomatic - dyspnea

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lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct. CATHETER MALPOSITION - malposition of a CVC means a catheter lies outside of SVC, whose tip does not lie in the ‘ideal’ position.

- chest discomfort - cough - pleuritic chest pain

feeds

- insufficient blood return at entry ports owing to the collapse of weaker vein walls on the distal port when blood drawing creates negative pressure. - chest pain

PINCH OFF SYNDROME - Occurs when the catheter is compressed between the first rib and the clavicle, causing an intermittent mechanical occlusion for both infusion and withdrawal.

SUPERIOR VENA CAVA SYNDROME THROMBOTIC OCCLUSION - the formation of

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maintain catheter patency,

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Swelling on  affective area Pain upon

Rule out mechanical dysfunction

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Assist physician in guide wire insertion and/or fibrin sheath

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a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system when catheters become occluded secondary to a thrombotic process. Drugs or parenteral nutrition preparations can also obstruct flow through the catheter.

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monitor redness, inflammation, blood recoil reduce other possible complications record the insertion date to monitor the how long catheter has been inserted flush before and after medication administration low dose heparin/warfari n as prophylaxis but may be contraindicated to other patients . Positioning of the Central Venous Catheters Maintain clean technique, keep area dry to prevent infection

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palpation  Presence of palpable cord Discoloration, including a bluish suffused color 

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“linogram” (contrast study of the catheter) to detect an intraluminal clot or fibrin sheath. Ultrasound and venogam may also be done. Administer thrombolytics as ordered into the catheter lumen with a dwell time of 30 minutes and repeated dose as needed. If catheter patency is not restored, infuse low dose alteplase over 6 to 8 hours as ordered. Once patency is restored, initiate anticoagulant prophylaxis and flush catheter with normal saline to prevent occlusion recurrence.

stripping if thrombolytic therapy is ineffective.