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13 terms

Complications of IV Therapy

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Hematoma
DEFINITION: a localized mass of blood outside the blood vessel; local complication

CAUSES: nicking vein during unsuccessful insertion, discontinuing an IV line without holding pressure over site, or applying tourniquet too tightly above a previously attempted venipuncture site

S/S: ecchymosis, localized mass, discomfort

NURSING RESPONSE: be gentle with venipuncture technique, apply pressure when discontinuing IV
Infiltration
DEFINITION: seepage of nonvesicant solution or medication into surrounding tissues; local complication

CAUSES: IV catheter dislodges or tip penetrates vessel wall

S/S: slowed or stopped flow; swelling, tenderness, pallor, hardness & coolness at site; pt may report burning sensation in area

NURSING RESPONSE: stop infusion immediately; restart IV infusion in different vein, high in extremity or in another extremity; elevate affected arm on a pillow to promote absorption of excess fluid
Extravasation
DEFINITION: seepage of vesicant substance into the tissues; local complication

CAUSES: IV catheter dislodges or tip penetrates vessel wall

S/S: slowed or stopped flow; pain, burning, swelling at IV site, blanching and coolness of surrounding skin; blistering is a late sign; if due to vasoconstricting medication, may see necrosis of dermis

NURSING RESPONSE: tx depends on severity of infiltration; stop IV infusion immediately; administer antidote if one is available; apply cold compresses and elevate extremity
vesicant
solution that causes formation of blisters and susequent tissue sloughing and necrosis
Phlebitis
DEFINITION: inflammation of the vein; local complication

CAUSES: may be due to mechanical irritation, infusion of solutions that are irritating to vessel, or sepsis; dextrose solutions, potassium chloride, antibiotics, and vitamin C are associated with a higher risk; trauma to vessel, compression of line by client movement, or a low flow rate

S/S: redness, pain, & warmth at site, local swelling, palpable cord along vein, sluggish infusion rate, elevated temperature; slowed or stopped infusion, localized warmth at site, inability to restart flow of IV

NURSING RESPONSE: Discontinue IV infusion & restart in new location; initially, apply cold compresses to site & thereafter use warm compresses; consult primary care provider if there is streaking or erythema along vein or a palpable cord; assess for circulatory impairment

PREVENTION MEASURES: Use smallest catheter practical; use polyurethane catheters instead of Teflon; stabilize & secure catheter to minimize movement in vein; rotate site at least every 96 hours
Thrombophlebitis
DEFINITION: thrombosis & inflammation; local complication

CAUSES: use of veins in the legs for infusion, use of a hypertonic or highly acidic solution; can be result of untreated phlebitis

S/S: sluggish flow rate, edema, tender & cordlike veins, warmth & erythema at site

NURSING RESPONSE: discontinue IV infusion & restart in opposite extremity, using all new equipment; apply warm, moist compresses; consult primary care provider
Local infection
DEFINITION: microbial contamination of cannula or IV site; local complication

CAUSES: using poor technique when inserting catheter, leaving catheter in place for longer than 72 hours, or direct contamination

S/S: redness, swelling, exudate, elevated temperature

NURSING RESPONSE: remove IV line; apply sterile dressing over site; administer antibiotics if necessary
Nerve injury
DEFINITION: nerve is inadvertently injured during venipuncture or is compressed; local complication

CAUSES: using veins on inner surface of wrist & forearm; not anchoring vein for puncture; using large needle; advancing needle across instead of with vein; "probing" (excessive redirection of needle at insertion); inserting too deeply and through the back wall of the vein; too many venipuncture attempts; infiltration, extravasation, tourniquet too tight or left on too long

S/S of direct injury: sharp, acute pain at site or up & down arm; pins and needles or electric shock sensation; pain, numbness, tingling in fingers; pain that persists after needle is removed

S/S of compression injury: pain & tingling typically appear 24-96 hours after venipuncture

NURSING RESPONSE: do not make more than 2 venipuncture attempts;

If pt complains of symptoms: stop procedure & withdraw catheter, apply pressure to prevent hematoma; report to supervisor and physician; do not start a new IV in affected arm; treat infiltration if it occurs; fasciotomy is the usual treatment; or fluid may be expressed
fasciotomy
incisions are made around area to let blood or fluid seep out
Septicemia
DEFINITION: presence of microorganisms or their toxic products in circulatory system; systemic complication

CAUSES: break in aseptic technique, or contaminated IV solution

S/S: fluctuating fever, chills, tachycardia, confusion, hypotension, altered mental status, elevated WBC count

NURSING RESPONSE: discontinue IV infusion immediately; consult primary care provider; tx often involves antibiotics, fluids, and meds to support VS
Fluid overload
CAUSES: infusing excessive amounts of IV fluids or administering fluid too quickly

S/S: weight gain, edema, hypertension, shortness of breath, crackles, distended neck veins

NURSING RESPONSE: slow IV flow rate; place client in high-Fowler's position; monitor VS; administer oxygen, if needed; if severe, diuretics may be ordered
Air embolus
DEFINITION: rare complication involving introduction of air into vascular system; systemic complication

CAUSES: loose connections, adding a new IV bag to a line that has run dry without clearing the line of air; air in tubing cassette of infusion pump

S/S: palpitations, chest pain, lightheadedness, dyspnea, cough, hypotension, tachycardia, sudden change in mental status

NURSING RESPONSE: call for help; place client in Trendelenburg's position on left side; administer O2; have emergency equipment available
Catheter embolus
DEFINITION: a piece of catheter breaks off and travels through vascular system; systemic complication

CAUSES: reinserting a catheter used in an unsuccessful insertion; removing and reinserting a stylet, causing shearing of catheter; placing catheter in a joint flexion

S/S: sharp, sudden pain at IV site, jagged catheter end on removal, dyspnea, chest pain, tachycardia, hypotension

NURSING RESPONSE: apply tourniquet above site; notify physician and radiologist; start new IV line; prepare pt for radiographic examination