Intravenous Therapy Complications Teresa Peck RN, BSN

Integumentary Infiltration Extravasation S/S Treatment Infiltration and Extravasation Infiltration of the IV occurs when the tip becomes dislodged from the vessel lumen. This complication should be suspected when the intravenous fluid flows poorly, if the line is difficult to flush, if the automated pump sounds an alarm, or if the patient complains of pain. (Liu 2004, Weinstein 2001) Infiltration-pain, ededma, coolness at site   Infiltration can become a serious situation if toxic fluids are being administered through the line. These include hypertonic agents, cytotoxic agents, and vasopressors. Vasopressors, such as norepinephrine or dopamine extravasate into local tissues from an infiltrative line, severe tissue necrosis may result. This can be treated by injecting five cc phentolamine mixed with five cc of saline into the subcutaneous tissues with a small gauge needle. (Liu 2004) It can be difficult at times to confirm that an intravenous catheter is actually within the lumen. Backflow of blood into the intravenous tubing upon the application of negative pressure (e.g. withdrawing on a syringe attached to the catheter) is not a reliable indicator, as the tip of the catheter may be partially in and partially out of the vessel lumen. Conversely, the absence of backflow does not necessarily indicate catheter malposition, as the tip of the needle may intraluminal but adjacent to a valve or vessel wall. The most reliable method to confirm intraluminal placement, and to exclude infiltration, is to apply tourniquet proximal to the catheter site tight enough to restrict venous flow. A catheter in the appropriate position will cease to flow in this situation, whereas an infiltrated line may continue to flow. (Weinstein 2001) Infiltration-D/C IV. Elevate, warm compresses, move extremity to promote reabsorption

Vascular Phlebitis Thrombosis Air embolis Catheter fracture or embolis S/S Treatment Pulmonary embolism symptoms can vary greatly, depending on how much of your lung is involved, the size of the clot and your overall health — especially the presence or absence of underlying lung disease or heart disease. Common signs and symptoms include: Shortness of breath. This symptom typically appears suddenly, and occurs whether you're active or at rest. Chest pain. You may feel like you're having a heart attack. The pain may become worse when you breathe deeply, cough, eat, bend or stoop. The pain will get worse with exertion but won't go away when you rest. Cough. The cough may produce bloody or blood-streaked sputum. Other signs and symptoms that can occur with pulmonary embolism include: Wheezing Leg swelling, usually in only one leg Clammy or bluish-colored skin Excessive sweating Rapid or irregular heartbeat Weak pulse Lightheadedness or fainting

Phlebitis May be red, warm, painful. May follow path of vein. D/C IV, warm compresses, antibiotics

Cardiac and Respiratory CHF related to fluid overload S/S Treatment SOB, crackles, JVD, peripheral edema, low O2 sat, cyanosis- Check rate, assess lung status, cardiac rate, peripheral pulse, output Decrease or stop IV-lung/cardiac assessments, diuretics. Labs like BUN

Systemic Fluid and electrolyte imbalance Sepsis Medication reaction IV fluids may have sodium, pottassium, other electrolytes. Increasing fluids will adjust electrolyte balances Check labs, I&O

Preventing Complications Check IV site every hour Check infusion rate every hour Thorough lung and cardiac assessments Check for edema/peripheral pulses Know treatments once symptoms noted Other ideas? Right fluids. Six rights Know pt history (allergies, mastectomy)