Complications of Intravenous Therapy UMM AL- QURA UNIVERSITY FACULTY OF APPLIED MEDICAL SCIENCES NURSING DEPARTMENT Complications of Intravenous Therapy Prepared By Dr. Nahed Said El-nagger Assistant Professor of Nursing 1430-1431 H

Unit . 2 Lecture No. 3.B

Learning Outcomes: Differentiate between local and systemic complications. Describe the signs and symptoms of local complications. Identify prompt treatment for local and systemic complications. Identify International 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 systemic complications.

I. Local complications 1. Hematoma: Formations resulting from the infiltration of blood into the tissues at the Venipuncture site. Causes: Rupture 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.

1. 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. Document: The observable ecchymotic areas.

2. Thrombosis Catheter-related obstructions can be categorized as mechanical or non-thrombotic ( 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.

2. Thrombosis (cont.) Documentation: Document the change of infusion rate. The steps taken to solve the problem, and the end result. Chart new IV sites. It’ s patency, and the size of the catheter used.

An inflammation of the vein. 3.phlebitis An inflammation of the vein. Signs/symptoms: Redness at site. Site warm to touch and local swelling. Palpable cord along the vein. Sluggish infusion rate. Increase in basal temperature of 1 °C or more.

3. Phlebitis (cont.) Nursing Interventions: Apply warm soaks. Remove IV device. Apply warm soaks. Notify primary care provider. Restart IV infusion in a different extremity. Document your actions.

Thrombosis and inflammation. 4.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 Venipuncture site. Diminished arterial pulses. Mottling and Cyanosis of the extremities.

5. Infiltration Accidental administration of a non vesicant solution into surrounding tissue. Signs/symptoms: Coolness of skin around site, and tight skin. Dependent edema and absence of blood backflow. A pinkish blood return. Infusion rate slows but the fluid 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. Infiltration (cont.) Documentation: assessment findings. any written and verbal communications. nursing and medical interventions. client response patterns.

6. Extravasations The accidental administration of a vesicant solution into surrounding tissue. Signs/symptoms: Complaints of pain or burning; swelling proximal or distal to the IV site. puffiness of the dependent part of the limb; skin tightness at the Venipuncture site; and coolness of the skin. Slow or stopped infusion; damp or wet 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. Extravasations (cont.) Documentation: Document assessment and interventions. Include the vascular access device type, insertion site, name of medication or solution, and how it was infused.

7. Local infection Microbial contamination of the cannula or infusate Signs/symptoms: Redness and swelling at the site; possible exudates of purulent material. Increased quantity of white blood cells; and elevated temperature.

7. Local infection (cont.) Documentation: Assessment of site. culture technique & sources of culture. physician notification and any treatment initiated.

8. 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 acute flow of fluid that irritates the vein wall; slowing of the infusion

8. Venous spasms (cont.) Documentation: client complaints, duration of complaints, treatment, and length of time to resolve the problem.

II. Systemic Complication 1. Septicemia: A febrile disease process that results from the presence of microorganisms or their toxic products in the circulatory system. Signs and Symptoms: Fluctuating fever, tremors, little cold sweat, nausea and vomiting, diarrhea, abdominal pain. Tachycardia, increased respirations or hyperventilation, altered mental status, and hypotension

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. Septicemia (cont.) Documentation: Document S/S assessed; physician notification, all treatments instituted.

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

2. Fluid overload & Pulmonary edema (cont;) S/S: Restlessness, headache, tachycardia, weight gain over a short period of time, cough, and presence of edema. Hypertension, wide variance between intake and output, distended neck veins.

2. Fluid overload & Pulmonary edema (cont.) Documentation: client assessment, notification of physician, and treatments instituted by physician order.

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

3. Air embolism(cont.) complaints of palpitations, and weakness. Pulmonary findings: dyspnea, cyanosis, tachypnea, expiratory, wheezes, cough, and pulmonary edema. Cardiovascular: murmur; weak, thready pulse; tachycardia; substernal chest pain; hypotension; and jugular venous distention. Neurologic findings: change in mental status, confusion, coma, anxiousness, and seizures.

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: Client assessment, nursing interventions, physician notification, and treatment.

4. 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.

4. Speed shock (cont.) Documentation: medication or fluid administered and the signs and symptoms the pt reported, physician notification, treatment initiated and the client response.

5. 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.

THANK YOU