Complications of Complications of Intravenous Intravenous

TherapyTherapy

Prepared ByPrepared By

Dr. Nahed Said El-naggerDr. Nahed Said El-nagger

Assistant Professor of Assistant Professor of NursingNursing

1430-1431 H1430-1431 H

UMM AL- QURA UNIVERSITY FACULTY OF APPLIED MEDICAL SCIENCES NURSING DEPARTMENT

Unit . 2

Lecture No. 3.B

Learning Outcomes:Learning Outcomes:• Differentiate between local and systemic Differentiate between local and systemic

complications.complications.• Describe the signs and symptoms of local Describe the signs and symptoms of local

complications.complications.• Identify prompt treatment for local and Identify prompt treatment for local and

systemic complications.systemic complications.• Identify International Standards of practice Identify International Standards of practice

rating infiltration.rating infiltration.• List three risk factors for phlebitis.List three risk factors for phlebitis.• Identify organisms responsible for Identify organisms responsible for

septicemia related to infusion therapy.septicemia related to infusion therapy.• Identify prevention techniques for the Identify prevention techniques for the

systemic complications.systemic complications.

I. Local complicationsI. Local complications

1. Hematoma:1. Hematoma: Formations resulting from the infiltration of blood Formations resulting from the infiltration of blood

into the tissues at the Venipuncture site.into the tissues at the Venipuncture site.Causes: Causes: • Rupture the vein during an unsuccessful Rupture the vein during an unsuccessful Venipuncture attempt.Venipuncture attempt.• Discontinuing the I.V. cannula or needle withoutDiscontinuing the I.V. cannula or needle without pressure. pressure. • Applying a tourniquet too tightly above a Applying a tourniquet too tightly above a previously attempted Venipuncture site.previously attempted Venipuncture site.

1. Hematoma1. Hematoma (cont.) (cont.)

Signs/symptoms:Signs/symptoms: • Discoloration of the skin.Discoloration of the skin.• Site swelling and discomfort. Site swelling and discomfort. • Inability to advance the cannula all Inability to advance the cannula all

the the way into the vein during insertion.way into the vein during insertion.• Resistance to positive pressure during Resistance to positive pressure during the lick flushing procedure.the lick flushing procedure.Document:Document: • The observable ecchymotic areas.The observable ecchymotic areas.

2. Thrombosis2. Thrombosis • Catheter-related obstructionsCatheter-related obstructions can be can be

categorized as categorized as mechanical or non-mechanical or non-thrombotic thrombotic ( 42% of all obstructions)( 42% of all obstructions)

or or thromboticthrombotic (58% of all obstructions), (58% of all obstructions),

Signs/symptoms:Signs/symptoms:

• Fever and malaise. Fever and malaise.

• Slowed or stopped infusion rate.Slowed or stopped infusion rate.

• Inability to flush licking device.Inability to flush licking device.

2. Thrombosis (cont.)2. Thrombosis (cont.)

Documentation:Documentation:

• Document the change of infusion Document the change of infusion rate.rate.

• The steps taken to solve the The steps taken to solve the problem, problem,

and the end result. and the end result.

• Chart new IV sites.Chart new IV sites.

• It’ s patency, and the size of the It’ s patency, and the size of the catheter used.catheter used.

3.phlebitis3.phlebitisAn inflammation of the vein. An inflammation of the vein.

Signs/symptoms:Signs/symptoms:

• Redness at site.Redness at site.

• Site warm to touch and local swelling.Site warm to touch and local swelling.

• Palpable cord along the vein.Palpable cord along the vein.

• Sluggish infusion rate.Sluggish infusion rate.

• Increase in basal temperature of 1 °C or Increase in basal temperature of 1 °C or more.more.

3. Phlebitis 3. Phlebitis (cont.)(cont.)

Nursing Interventions:

• Remove IV device.

•Apply warm soaks.

•Notify primary care provider.

•Restart IV infusion in a different extremity.

•Document your actions.

4.Thrombophlebitis4.Thrombophlebitis

Thrombosis and inflammation.Thrombosis and inflammation.Signs/symptoms:Signs/symptoms:

• Sluggish flow rate, edema in the limbs.Sluggish flow rate, edema in the limbs.

• Tender and cordlike vein, site warm to Tender and cordlike vein, site warm to

touch. touch.

• Visible red line above Venipuncture site.Visible red line above Venipuncture site.

• Diminished arterial pulses.Diminished arterial pulses.

• Mottling and Cyanosis of the Mottling and Cyanosis of the extremities.extremities.

5. Infiltration5. Infiltration Accidental administration of a non vesicant Accidental administration of a non vesicant

solution into surrounding tissue.solution into surrounding tissue.Signs/symptoms:Signs/symptoms: • Coolness of skin around site, and Coolness of skin around site, and

tight skin.tight skin.• Dependent edema and absence of Dependent edema and absence of

blood backflow.blood backflow.• A pinkish blood return.A pinkish blood return.• Infusion rate slows but the fluid Infusion rate slows but the fluid

continues to infuse.continues to infuse.

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.

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!).

5. Infiltration5. Infiltration (cont.)(cont.)

Documentation:Documentation:

• assessment findings.assessment findings.

• any written and verbal any written and verbal communications.communications.

• nursing and medical interventions.nursing and medical interventions.

• client response patterns.client response patterns.

6. Extravasations6. Extravasations

The accidental administration of The accidental administration of a vesicant a vesicant solutionsolution into surrounding tissue. into surrounding tissue.

Signs/symptoms: Signs/symptoms: • Complaints of pain or burning; swelling Complaints of pain or burning; swelling

proximal or distal to the IV site.proximal or distal to the IV site.• puffiness of the dependent part of the limb; puffiness of the dependent part of the limb;

skin tightness at the Venipuncture site; and skin tightness at the Venipuncture site; and coolness of the skin.coolness of the skin.

• Slow or stopped infusion; damp or wet Slow or stopped infusion; damp or wet dressing.dressing.

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).

6. Extravasations6. Extravasations (cont.)(cont.)

Documentation:Documentation:

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

7. Local infection7. Local infection

Microbial contamination of the cannula or Microbial contamination of the cannula or infusateinfusate

Signs/symptoms:Signs/symptoms:

• Redness and swelling at the site; Redness and swelling at the site; possiblepossible

exudates of purulent material.exudates of purulent material.

• Increased quantity of white blood cells; Increased quantity of white blood cells;

and elevated temperature.and elevated temperature.

7. Local infection7. Local infection (cont.)(cont.)

Documentation:Documentation:

• Assessment of site.Assessment of site.

• culture technique & sources of culture technique & sources of culture.culture.

• physician notification and any physician notification and any treatment initiated.treatment initiated.

8. Venous spasm8. Venous spasm

A sudden involuntary contraction of a vein A sudden involuntary contraction of a vein or an artery resulting in temporary or an artery resulting in temporary

cessation of blood flow through a vessel.cessation of blood flow through a vessel.

Signs/symptoms:Signs/symptoms:

• sharp pain at the IV site that travels up sharp pain at the IV site that travels up the arm, which is caused by acute flow the arm, which is caused by acute flow of fluid that irritates the vein wall; of fluid that irritates the vein wall; slowing of the infusionslowing of the infusion

8. Venous spasms8. Venous spasms (cont.)(cont.)

Documentation:Documentation:

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

II. Systemic ComplicationII. Systemic Complication1. Septicemia:1. Septicemia: A febrile disease process that results A febrile disease process that results

from the presence of microorganisms or from the presence of microorganisms or their toxic products in the circulatory their toxic products in the circulatory system.system.

Signs and Symptoms:Signs and Symptoms:

• Fluctuating fever, tremors, little cold sweat, Fluctuating fever, tremors, little cold sweat, nausea and vomiting, diarrhea, abdominal pain.nausea and vomiting, diarrhea, abdominal pain.

• Tachycardia, increased respirations or Tachycardia, increased respirations or hyperventilation, altered mental status, and hyperventilation, altered mental status, and hypotensionhypotension

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.

1. Septicemia1. Septicemia (cont.)(cont.)

Documentation:Documentation:

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

2. Fluid overload & Pulmonary2. Fluid overload & Pulmonary edema edema

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

2. Fluid overload & Pulmonary2. Fluid overload & Pulmonary edema (cont;) edema (cont;)

S/S:S/S:• Restlessness, headache, Restlessness, headache,

tachycardia, weight gain over a tachycardia, weight gain over a short period of time, cough, and short period of time, cough, and presence of edema.presence of edema.

• Hypertension, wide variance Hypertension, wide variance between intake and output, between intake and output, distended neck veins.distended neck veins.

2. Fluid overload & Pulmonary 2. Fluid overload & Pulmonary edema (cont.)edema (cont.)

Documentation:Documentation:

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

3. Air embolism3. Air embolism

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

3. Air embolism(cont.)3. Air embolism(cont.)S/S:S/S: • complaints of palpitations, and complaints of palpitations, and

weakness.weakness.• Pulmonary findingsPulmonary findings: dyspnea, : dyspnea,

cyanosis, tachypnea, expiratory, cyanosis, tachypnea, expiratory, wheezes, cough, and pulmonary wheezes, cough, and pulmonary edema.edema.

• CardiovascularCardiovascular: murmur; weak, : murmur; weak, thready pulse; tachycardia; thready pulse; tachycardia; substernal chest pain; hypotension; substernal chest pain; hypotension; and jugular venous distention. and jugular venous distention.

• Neurologic findingsNeurologic findings: change in : change in mental status, confusion, coma, mental status, confusion, coma, anxiousness, and seizures.anxiousness, and seizures.

3. Air embolism (cont.)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:Documentation: – Client assessment, nursing interventions, Client assessment, nursing interventions,

physician notification, and treatment. physician notification, and treatment.

4. Speed shock4. Speed shock

Occurs when a foreign substance Occurs when a foreign substance usually a medication is rapidly usually a medication is rapidly introduced into the circulationintroduced into the circulation

• S/S:S/S: dizziness, facial flushing, dizziness, facial flushing, headache, tightness in the chest, headache, tightness in the chest, hypotension, irregular pulse, hypotension, irregular pulse, progression of shock.progression of shock.

4. Speed shock (cont.)4. Speed shock (cont.)

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

5. Catheter embolism5. Catheter embolism

A piece of the catheter breaks off and A piece of the catheter breaks off and travels through the vascular system.travels through the vascular system.

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