Complication of Intravenous Therapy

Chapter 9 Nursing 105

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

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 tourniquet too tightly above a previously attempted venipuncture site

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

Thrombosis
Catheter-related obstructions can be
categorized as mechanical or nonthrombotic ( 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

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

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 inflammationinduced phlebitis Types
Mechanical Chemical bacterial Post-infusion

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

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

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

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

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

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 infused.

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

Local infection cont

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

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

Venous spasms cont

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

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

Septicemia cont
Documentation: document s/s assessed;
physician notification, all treatments instituted.

Fluid overload & Pulmonary edema

Caused by infusing excessive amounts of

isotonic or hypertonic crystalloid solutions tot rapidly, failure to monitor the IV infusion or toorapid 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 of edema, hypertension, wide variance between intake and output, distended neck veins, SOB

Fluid overload & Pulmonary edema cont

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

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

Air embolism cont

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

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

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