Complication of Intravenous Therapy

1
Complication of Intravenous Therapy

• Chapter 9
• Nursing 200

2
objectives

• Differentiate between local and systemic
  complications
• Describe the signs and symptoms of eight local
  complications
• Identify prompt treatment for local and systemic
  complications
• Identify INS 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 six
  systemic complications

3
Local complication

• Hematoma formations resulting from the
  infiltration of blood into the tissues at the
  venipuncture site
• Causes nicking the vein during an unsuccessful
  venipuncture attempt, discontinuing the I.V.
  cannula or needle without pressure, applying a
  tourniqet too tightly above a previously
  attempted venipuncture site

4
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
• Prevention and treatment refer to page 360
• Document observable ecchymotic areas

5
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
• Prevention/treatment refer to page 362

6
Thrombosis

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

7
phlebitis

• An inflammation of the vein in which the
  endothelial cells of the venous wall become
  irritated and cells roughen, allowing platelets
  to adhere and predispose the vein to
  inflammation-induced phlebitis
• Types
• Mechanical
• Chemical
• bacterial
• Post-infusion

8
Phlebitis cont

• Signs/symptoms redness at site, site warm to
  touch, local swelling, palpable cord along the
  vein, sluggish infusion rate, increase in basal
  temperature of 1 degree C or more
• Prevention/treatment refer to pages 367 to 369
• Documentation site assessment, phlebitis rating
  (1,2,3 or 4), physician notification, and
  treatment

9
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 venipunture site,
  diminished arterial pulses, and mottling and
  cyanosis of the extremities
• Prevention/treatment refer to page 370

10
Infiltration

• Inadvertent administration of a nonvesicant
  solution into surrounding tissue
• Signs/symptoms coolness of skin around site,
  taut skin, dependent edema, absence of blood
  backflow, a pinkish blood return, infusion rate
  slows but the fluid continues to infuse

11
Infiltration cont

• Prevention/treatment refer to pages 372 to374
• Documentation assessment findings, any written
  and verbal communications, nursing and medical
  interventions, and patient response patterns

12
Extravasation

• The inadvertent administration of a vesicant
  solution into surrounding tissue
• Signs/symptoms complaints of pain or burning
  swelling proximal to or distal to the IV site
  puffiness of the dependent part of the limb skin
  tightness at the venipuncture site blanching and
  coolness of the skin slow or stopped infusion
  damp or wet dressing

13
Extravasation cont

• Prevention/treatment refer to pages 376 to 378
• Documentation document assessment and
  interventions. Include the vascular access device
  type, insertion site, name of medication or
  solution, and how it was infuded.

14
Local infection

• Microbial contamination of the cannula or
  infusate
• Signs/symptoms redness and swelling at the site
  possible exudate of purulent material increased
  quantity of white blood cells elevated
  temperature
• Prevention/treatment refer to pages 384 385

15
Local infection cont

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

16
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 a piercing
  stream of fluid that irritates or shocks the vein
  wall slowing of the infusion
• Prevention/treatment refer to pages 385 386

17
Venous spasms cont

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

18
Systemic Complication

• Septicemia a febrile disease process that
  results from the presence of microorganisms or
  their toxic products in the circulatory system
• S/S fluctuating fever, tremors, chattering
  teeth, profuse cold sweat, nausea and vomiting,
  diarrhea, abdominal pain, tachycardia, increased
  respirations or hyperventilation, altered mental
  status, hypotension
• Prevention/treatment refer to pages 387 388

19
Septicemia cont

• Documentation document s/s assessed physician
  notification, all treatments instituted.

20
Fluid overload Pulmonary edema

• Caused by infusing excessive amounts of isotonic
  or hypertonic crystalloid solutions tot rapidly,
  failure to monitor the IV infusion or too-rapid
  infusion of any fluid in a patient compromised by
  cardiopulmonary or renal disease
• S/S restlessness, headache, increased in pulse
  rate, weight gain over a short period of time,
  cough, presence od edema, hypertension, wide
  variance between intake and output, distended
  neck veins, SOB

21
Fluid overload Pulmonary edema cont

• Prevention/treatment refer to pages 390 391
• Documentation pt assessment, notification of
  physician, and treatments instituted by physician
  order

22
Air embolism

• Air entering the central vein, which is quickly
  trapped in the blood as it flows forward.
  Prevention is the key.
• S/S complaints of palpitations, lightheadedness
  and weakness, pulmonary findings dyspnea,
  cyanosis, tachypnea, expiratory, wheezes, cough,
  and pulmonary edema. Cardiovascular mill wheel
  murmur weak, thready pulse tachycardia
  substernal chest pain hypotension and jugular
  venous distention. Neurologic findings change in
  mental status, confusion, coma, anxiousness, and
  seizures

23
Air embolism cont

• Prevention/treatment refer to pages 391 392
• Documentation pt assessment, nursing
  intervention, physician notification, and
  treatment

24
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.
• Prevention/treatment refer to page 393
• Documentation medication or fluid administered
  and the signs and symptoms the pt reported,
  physician notification, treatment initiated and
  the patient response

25
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
• Prevention/treatment refer to pages 394 395