Complications of Intravenous Therapy

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Complications of Intravenous Therapy
UMM AL- QURA UNIVERSITY FACULTY OF APPLIED
MEDICAL SCIENCES NURSING DEPARTMENT

• Prepared By
• Dr. Nahed Said El-nagger
• Assistant Professor of Nursing
• 1430-1431 H

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Unit . 2

• Lecture No. 3.B

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Learning Outcomes

• Differentiate between local and systemic
  complications.
• Describe the signs and symptoms of local
  complications.
• Identify prompt treatment for local and systemic
  complications.
• Identify International Standards of practice
  rating infiltration.
• List three risk factors for phlebitis.
• Identify organisms responsible for septicemia
  related to infusion therapy.
• Identify prevention techniques for the systemic
  complications.

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I. Local complications

• 1. Hematoma
• Formations resulting from the infiltration of
  blood into the tissues at the Venipuncture site.
• Causes
• Rupture the vein during an unsuccessful
• Venipuncture attempt.
• Discontinuing the I.V. cannula or needle without
• pressure.
• Applying a tourniquet too tightly above a
• previously attempted Venipuncture site.

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1. Hematoma (cont.)

• Signs/symptoms
• Discoloration of the skin.
• Site swelling and discomfort.
• Inability to advance the cannula all the
• way into the vein during insertion.
• Resistance to positive pressure during
• the lick flushing procedure.
• Document
• The observable ecchymotic areas.

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2. Thrombosis

• Catheter-related obstructions can be categorized
  as mechanical or non-thrombotic ( 42 of all
  obstructions)
• or thrombotic (58 of all obstructions),
• Signs/symptoms
• Fever and malaise.
• Slowed or stopped infusion rate.
• Inability to flush licking device.

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2. Thrombosis (cont.)

• Documentation
• Document the change of infusion rate.
• The steps taken to solve the problem,
• and the end result.
• Chart new IV sites.
• It s patency, and the size of the catheter
  used.

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3.phlebitis

• An inflammation of the vein.
• Signs/symptoms
• Redness at site.
• Site warm to touch and local swelling.
• Palpable cord along the vein.
• Sluggish infusion rate.
• Increase in basal temperature of 1 C or more.

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3. Phlebitis (cont.)

• Nursing Interventions
• Remove IV device.
• Apply warm soaks.
• Notify primary care provider.
• Restart IV infusion in a different extremity.
• Document your actions.

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4.Thrombophlebitis

• Thrombosis and inflammation.
• Signs/symptoms
• Sluggish flow rate, edema in the limbs.
• Tender and cordlike vein, site warm to
• touch.
• Visible red line above Venipuncture site.
• Diminished arterial pulses.
• Mottling and Cyanosis of the extremities.

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5. Infiltration

• Accidental administration of a non vesicant
  solution into surrounding tissue.
• Signs/symptoms
• Coolness of skin around site, and tight skin.
• Dependent edema and absence of blood backflow.
• A pinkish blood return.
• Infusion rate slows but the fluid continues to
  infuse.

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Treatment of Infiltration

• Discontinue the infusion.
• Apply warm, moist heat to ?edema.
• Elevate the extremity.
• Restart the infusion at another site, preferable
  the other arm.

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Prevention of Infiltration

• Select site over long bone to act as a splint.
• Avoid sites over joints.
• Use arm board to stabilize (as a last resort!).

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5. Infiltration (cont.)

• Documentation
• assessment findings.
• any written and verbal communications.
• nursing and medical interventions.
• client response patterns.

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6. Extravasations

• The accidental administration of a vesicant
  solution into surrounding tissue.
• Signs/symptoms
• Complaints of pain or burning swelling proximal
  or distal to the IV site.
• puffiness of the dependent part of the limb
  skin tightness at the Venipuncture site and
  coolness of the skin.
• Slow or stopped infusion damp or wet dressing.

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Extravasations Interventions

• Stop the infusion, and elevate extremity.
• Remove the cannula.
• Call physician.
• Administer antidote (if appropriate) intradermaly
  into infiltrated tissue.
• Apply warm moist compresses for 20 minutes every
  4 hours (see hospital policy).

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6. Extravasations (cont.)

• Documentation
• Document assessment and interventions. Include
  the vascular access device type, insertion site,
  name of medication or solution, and how it was
  infused.

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7. Local infection

• Microbial contamination of the cannula or
  infusate
• Signs/symptoms
• Redness and swelling at the site possible
• exudates of purulent material.
• Increased quantity of white blood cells
• and elevated temperature.

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7. Local infection (cont.)

• Documentation
• Assessment of site.
• culture technique sources of culture.
• physician notification and any treatment
  initiated.

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8. Venous spasm

• A sudden involuntary contraction of a vein or an
  artery resulting in temporary cessation of blood
  flow through a vessel.
• Signs/symptoms
• sharp pain at the IV site that travels up the
  arm, which is caused by acute flow of fluid that
  irritates the vein wall slowing of the infusion

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8. Venous spasms (cont.)

• Documentation
• client complaints, duration of complaints,
  treatment, and length of time to resolve the
  problem.

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II. Systemic Complication

• 1. Septicemia
• A febrile disease process that results from
  the presence of microorganisms or their toxic
  products in the circulatory system.
• Signs and Symptoms
• Fluctuating fever, tremors, little cold sweat,
  nausea and vomiting, diarrhea, abdominal pain.
• Tachycardia, increased respirations or
  hyperventilation, altered mental status, and
  hypotension

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Septicemia Interventions

• Notify physician immediately.
• Symptomatic care.
• Identify other sources of infection.
• Remove IV device.
• Culture the IV cannula, tubing, or solution if it
  is suspect.
• Return fluid to pharmacy.
• Establish a new IV site for medication or fluid
  administration.

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1. Septicemia (cont.)

• Documentation
• Document S/S assessed physician notification,
  all treatments instituted.

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2. Fluid overload Pulmonary edema

• Caused by infusing excessive amounts of isotonic
  or hypertonic crystalloid solutions to rapidly,
  failure to monitor the IV infusion or too-rapid
  infusion of any fluid in a patient compromised by
  cardiopulmonary or renal disease.

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2. Fluid overload Pulmonary edema (cont)

• S/S
• Restlessness, headache, tachycardia, weight gain
  over a short period of time, cough, and presence
  of edema.
• Hypertension, wide variance between intake and
  output, distended neck veins.

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2. Fluid overload Pulmonary edema (cont.)

• Documentation
• client assessment, notification of physician,
  and treatments instituted by physician order.

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3. Air embolism

• Air entering the central vein, which is
  quickly trapped in the blood as it flows forward.
  Prevention is the key.

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3. Air embolism(cont.)

• S/S
• complaints of palpitations, and weakness.
• Pulmonary findings dyspnea, cyanosis,
  tachypnea, expiratory, wheezes, cough, and
  pulmonary edema.
• Cardiovascular murmur weak, thready pulse
  tachycardia substernal chest pain hypotension
  and jugular venous distention.
• Neurologic findings change in mental status,
  confusion, coma, anxiousness, and seizures.

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3. Air embolism (cont.)

• Nursing Interventions
• Immediately clamp the tubing.
• Turn client to left, head down (to allow air to
  enter right atrium and be dispersed via pulmonary
  artery)
• Monitor vital signs.
• Administer O2.
• Notify physician.
• Document actions.
• Documentation
• Client assessment, nursing interventions,
  physician notification, and treatment.

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4. Speed shock

• Occurs when a foreign substance usually a
  medication is rapidly introduced into the
  circulation
• S/S dizziness, facial flushing, headache,
  tightness in the chest, hypotension, irregular
  pulse, progression of shock.

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4. Speed shock (cont.)

• Documentation medication or fluid administered
  and the signs and symptoms the pt reported,
  physician notification, treatment initiated and
  the client response.

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5. Catheter embolism

• A piece of the catheter breaks off and travels
  through the vascular system.
• S/S sharp sudden pain at the IV site, minimal
  blood return, rough and uneven catheter noted on
  removal, cyanosis, chest pain, tachycardia,
  hypotension.

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THANK YOU