46272100 complications of intravenous therapy (1)

7/28/2019 46272100 Complications of Intravenous Therapy (1)

1/29

COMPLICATIONS

ASSOCIATED WITH

INTRAVENOUS

THERAPY


2/29

Hematoma


3/29

Local complication

Hematoma :A hematoma is a collection of blood caused by internalbleeding. This happens when the catheter punctures through thevein and causes a hematoma. Hematomas generally occur withunsuccessful IV insertion but can also happen when an IV is takenout. This is why pressure must be applied to the insertion site, totry to make the hematoma as small as possible.

A hematoma may appear as a visible bruise or a lump.

Signs/symptoms: discoloration of the skin, site swelling anddiscomfort, inability to advance the cannula all the way into the veinduring insertion, resistance to positive pressure during the lickflushing procedure

Prevention and treatment: A hematoma can be controlled withdirect pressure and will resolve over the course of 2 weeks.

Document observable ecchymotic areas


4/29

DEEP VEIN THROMBOSIS


5/29

*Thrombosis

Thrombosis occurs when an imbalance in the blood coagulation system causesa blood clot, or thrombus, to form. When a thrombus blocks the flow of bloodthrough a vein or artery, it poses serious health risks, including venousthrombosis (VTE) and deep vein thrombosis (DVT). The thrombus can alsodetach from the blood vessel wall to form a life-threatening pulmonaryembolus (PE) when it lodges in the lungs.Signs/symptoms: fever and malaise,

slowed or stopped infusion rate, inability to flush licking device Prevention/treatment: To prevent deep venous thrombosis and its possible

complications, the following should be observed:

Patients should wear elastic compression stockings.

Patients should observe special body positioning and performindicated exercise.

Patients should use intermittent pneumatic compression.

In surgical patients, subcutaneous unfractioned or low molecular weightheparin is administered.

Documentation: document the change of infusion rate, the steps taken tosolve the problem, and the end result. Chart new IV sites. It patency, and thesize of the catheter used


6/29

PHLEBITIS


7/29

phlebitisPhlebitis is a term that means inflammation of a blood vessel.Phlebitis occurs quite commonly after the insertion of intravenouscatheters. The exact frequency of phlebitis is anywhere from 2.5 to45% or more. The frequency depends on how phlebitis is defined,the site of IV insertion, the duration that the IV has been in place,the type of material that the IV is made of, the length of the IVcatheter, and on the existence of other disorders as diabetes.In phlebitis the inflammation causes localised redness and warmthat the IV insertion site and perhaps a short distance along thecourse of the vein in which the IV has been placed. Most times,phlebitis is no more than a minor inconvenience.


8/29

Signs/symptoms: redness at site, site warm to touch, localswelling, palpable cord along the vein, sluggish infusionrate, increase in basal temperature of 1 degree C or more

Prevention/treatment:While patients have to rely onconventional medicine to resolve major blood clots in theveins, alternative therapies help prevent future blood clotsand bring relief from pain due to superficialthrombophlebitis. To prevent phlebitis, people should eat a

high-fiber, heart-healthy diet and engage in regular physicalexercises such as walking, bicycling, or running. Iftemporarily bedridden, they should stretch their arms andlegs frequently and try to become mobile as soon aspossible.

Documentation: site assessment, phlebitis rating (1,2,3 or

4), physician notification, and treatment


9/29

Thrombophlebitis


10/29

Thrombophlebitis

Thrombophlebitis is similar to phlebitis but a thrombus (or clot) is inaddition involved. As the IV cannula stays inside your body, it mayirritate the vein leading the body to trigger its clotting mechanisms.

You may notice a hardened area corresponding to where a clot has

formed in the vein. This kind of small clot does not have the samepotentially life-threatening consequences as blood clots in thedeeper and larger veins in the body. Thrombophlebitis is not usuallyassociated with infection.

Treatment - Treatment of phlebitis and thrombophlebitis is aimed atrelief of the symptoms including: anti-inflammatory medicine, suchas ibuprofen, acetaminophen for pain, or local heat. If the condition

worsens, especially if pain or the area of redness increases, medicalattention should definitely be sought.

If you are in the hospital, your doctor should change yourintravenous (IV) lines regularly. Depending on your condition andother factors, he or she might also give you medications that aredesigned to help prevent this condition.


11/29

Septic Thrombophlebitis

In more serious cases the vein can become infected. This is

a rare condition, known as septic phlebitis or septicthrombophlebitis, which can spread infection throughout thebody via the bloodstream.

One sign of infection is the presence of enlarged lymphnodes under the arm on the affected side. This can occurwith simple phlebitis but should cause you to seek medicalattention, especially if you have a fever and feel generally

unwell. Treatment - If you suspect an infected vein, see your

healthcare provider immediately. Hospitalization may beneeded and antibiotics will be used to control the bacterialinfection.


12/29

INFILTRATION


13/29

Infiltration

This occurs when the catheter unintentionally enters thetissue surrounding the blood vessel. In this case the IV fluidand associated medications will go into the tissues andthere will be a lump where the IV has been inserted. Itwould be cool to touch (this differentiates it frominflammation due to infection, which is warm to the touch).

Treatment - If you notice this inform your healthcareprofessional and they will administer appropriate careimmediately. Infiltrated IVs are not a big problem usuallyunless the medication being administered is very irritant,such as certain chemotherapy and circulatory medicines.The intravenous infusion must be stopped, obviously, toavoid putting any more fluid or medication into the tissues.Another IV may need to be started elsewhere.

Documentation: assessment findings, any written andverbal communications, nursing and medical interventions,and patient response patterns


14/29

Extravasation


15/29

Extravasation An extravasation occurs when there is accidental infiltration of a vesicant

or chemotherapeutic drug into the surrounding IV site. Vesicants cancause tissue destruction and / or blistering. Irritants can result in pain atthe IV site and along the vein and may or may not cause inflammation.Extravasation can result in tissue sloughing, pain, loss of mobility in theextremity and infection. The treatment for extravasation will varydepending on the antidote for the infiltrated medication and your facilitypolicy.

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; skintightness at the venipuncture site; blanching and coolness of the skin;slow or stopped infusion; damp or wet dressing

Prevention/treatment: if extravasation occurs, the site should bemonitored every 2 hours for 24 hours, every 8 hours for 72 hours, andthen daily for erythema, blanching, necrosis, swelling, drainage, pain,and temperature. The affected extremity should be elevated for 24 to 48

hours and assessed every 8 hours for sensation, movement, and pulses.If there is any deterioration of the affected area (continued pain,necrosis, ulceration, suspected compartment syndrome), surgery shouldbe consulted immediately.

Documentation: document assessment and interventions. Include thevascular access device type, insertion site, name of medication orsolution, and how it was infused.


16/29

Local infection

In any case where there is an open wound on the body,disrupting the protective lining of skin, an infection canoccur. A microscopic organism may use the tiny hole in theskin created by the IV catheter to find its way into the body,and cause an infection. Common signs of local infection("abscess") include a large lump that is painful and hot totouch.

Treatment - If you suspect an infection, see your healthcareprovider immediately. Antibiotics may be used to control thebacterial infection.

Signs/symptoms: redness and swelling at the site; possibleexudate of purulent material; increased quantity of whiteblood cells; elevated temperature

Documentation: assessment of site; culture technique;sources of culture; physician notification; and anytreatment initiated


17/29

Venous spasm

A sudden involuntary contraction of a vein or an arteryresulting in temporary cessation of blood flow through avessel.

Signs/symptoms: sharp pain at the IV site that travelsup the arm, which is caused by a piercing stream of fluidthat irritates or shocks the vein wall; slowing of the

infusion

Prevention/treatment: Symptoms can sometimes berelieved by the use of medications that help relax theblood vessels or avoiding substances (such as cocaine)that cause the spasms

Documentation: patient complaints, duration ofcomplaints, treatment, and length of time to resolve theproblem


18/29

Systemic Complication

Septicemia: a febrile disease process that results from the presenceof 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: Antibiotics to treat the infection

Fluids and medicines by IV to maintain the blood pressure

Oxygen

Plasma or other blood products to correct any clotting problems

Documentation: document s/s assessed; physician notification, alltreatments instituted.


19/29

Fluid overload & Pulmonaryedema Caused by infusing excessive amounts of isotonic or

hypertonic crystalloid solutions tot rapidly, failure tomonitor the IV infusion or too-rapid infusion of any fluidin a patient compromised by cardiopulmonary or renaldisease

S/S: restlessness, headache, increased in pulse rate,

weight gain over a short period of time, cough, presenceof edema, hypertension, wide variance between intakeand output, distended neck veins, SOB

Prevention/treatment:Control your blood pressure,Watch yourblood cholesterol, Don't smoke, Eat a heart-healthy diet, Limit salt,Exercise regularly, Maintain a healthy weight, Consider taking babyaspirin, Manage stress

Documentation: pt assessment, notification of physician,and treatments instituted by physician order


20/29

AIR EMBOLISM


21/29

Air embolism

Air entering the central vein, which is quickly trapped in theblood as it flows forward.

S/S: complaints of palpitations, lightheadedness andweakness, pulmonary findings: dyspnea, cyanosis,tachypnea, expiratory, wheezes, cough, and pulmonaryedema. 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

Prevention/treatment: Oxygen administration,Hyperbaricchamber - for divers

Symptomatic measures e.g. medications for seizures,reduced blood pressure

Documentation: pt assessment, nursing intervention,physician notification, and treatment


22/29

Speed shock

Occurs when a foreign substance usually a medication israpidly introduced into the circulation

S/S: dizziness, facial flushing, headache, tightness in thechest, hypotension, irregular pulse, progression ofshock.

Prevention/treatment: to avoid speed shock and possiblecardiac arrest, give most I.V. push medication over 3 to5 mins.

Documentation: medication or fluid administered andthe signs and symptoms the pt reported, physiciannotification, treatment initiated and the patient response


23/29

CATHETER EMBOLISM


24/29

Catheter embolism

A piece of the catheter breaks off and travels through the vascularsystem

S/S: sharp sudden pain at the IV site, minimal blood return, roughand uneven catheter noted on removal, cyanosis, chest pain,tachycardia, hypotension

Prevention/treatment: Using x-ray imaging and a contrastmaterial to visualize the blood vessel, the interventional radiologistinserts a catheter through the skin into a blood vessel and advancesit to the treatment site. A synthetic material or medication called anembolic agent is then inserted through the catheter and positionedwithin the blood vessel or malformation where it will remainpermanently.


25/29

SEPTICEMIA


26/29

Septicemia

Septicemia: a febrile disease process that results fromthe presence of microorganisms or their toxic productsin the circulatory system

S/S: fluctuating fever, tremors, chattering teeth, profusecold sweat, nausea and vomiting, diarrhea, abdominalpain, tachycardia, increased respirations orhyperventilation, altered mental status, hypotension


27/29

*Nursing Assessment

Assess VS and LOC.

Assess for internal bleeding.

Assess for DIC.

Assess for pressure sore areas.

Do regular head-to-toe, system-by-system assessmentfor septic shock.


28/29

*Nursing ManagementCare is directed toward supporting the client as symptoms develop. Theseinclude but are not limited to the following:

Aggressive measures to prevent septic shock and death

Antibiotics, analgesics, and antipyretics administration as ordered

Oral hydration

IV hydration and antibiotic administration using strict aseptictechnique.

Prevent chilling Pressure and cool compresses to sites of bleeding

Blood or blood product replacement

Protection from injury

Promotion of self-care, within limitations

Encourage therapeutic communication Support for client to conserve strength and allow for rest

Emotional and psychological support for client and family


29/29

Presented by:

Angelica Del Rosario

Jeanne Mendegorin

BSN II

46272100 complications of intravenous therapy (1)

Documents