Download Management of IV Complications: Local and

Management of IV Complications: Local and Systemic
Local Complications On / During / After Cannulation
Signs & Symptoms
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Possible Causes
Vein punctured through
ventral wall at time of veni
puncture. Leakage of blood
from needle displacement.
HEMATOMA
Tenderness at venipuncture
site
Bruising around site
Inability to advance or flush
I.V line
VENOUS SPASM
 Pain along vein. Sluggish
flow rate when clamp is
completely open
 Blanched skin over vein
THROMBOSIS
 Painful, reddened and
swollen vein sluggish or
stopped I.V flow.
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Severe vein irritation from
irritating drugs or fluids
Administration of cold fluids or
blood. Very rapid flow rate (with
fluids at room temperature)
Injury to endothelial cells of vein
wall, allowing platelets to adhere
and thrombus to form
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Apply warm soaks over and surrounding area
Slow flow rate
Prevention: Use blood warmer for blood or
packed red blood cells when appropriate
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Remove device: restart infusion in opposite
limb if possible. Apply warm soaks. Watch
for I.V therapy – related infection
Prevention: Use proper venipuncture
techniques to reduce injury to vein.
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PHLEBITIS
Severe discomfort
reddened, swollen and
hardened vein.
There are mainly 3 reasons
1. Infusion related
2. Infection related
3. Mechanical related
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Extravasation
The infiltration of a vesicant
drug from an I.V. line into
surrounding tissue can occur
with either a peripheral or a
central venous catheter.
Extravasation occurs when a
peripheral catheter erodes through
the vessel wall at a second point,
when increased venous pressure
causes leakage around the original
venipuncture site, or when a needle
pulls out of the vein.
Nursing interventions
Remove venipuncture device.
Apply pressure and warm soaks to
affected area and recheck for bleeding
Document patient’s condition and your
interventions
Prevention: Choose a vein that can
accommodate size of intended venous
access device. Release tourniquet as soon
as successful insertion is achieved.
Remove device; restart infusion in opposite
limb if possible.
Apply warm soaks. Watch for I.V therapy
related infection.
Prevention: Check site frequently. Remove
device at first sign of redness and tenderness.
To reduce the risk of phlebitis in adults, the
Centers for Disease Control and Prevention’s
guidelines recommend changing peripheral
I.V sites every 72-96 hours.
Check for the detailed sign and symptoms
and management above in the
troubleshooting section.
Nerve, Tendon or Ligament
Damage
 Extreme pain numbness and
muscle contraction
 Delayed effects
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Improper venipuncture
technique, resulting in injury to
surrounding nerves, tendons,
ligaments.
Tight taping or improper
splinting with arm board.
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Stop procedure
Prevention: Don’t repeatedly penetrate tissues
with venipuncture device. Don’t apply
excessive pressure when taping or encircle the
limb (with tape). Pad the tape securing the
arm board.
SYSTEMIC COMPLICATIONS
Signs & Symptoms
Circulatory Overload
 Discomfort.
 Neck vein engorgement
 Respiratory distress
 Increased B.P
 Crackle
 Large positive fluid balance.
Possible causes
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Air Embolism
Unequal breath sounds
Respiratory distress
Weak pulse
Increased CVP
Decreased BP
Loss of consciousness
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Systemic infection
 Fever, chills and malaise for
no apparent reason
 Contaminated I.V site, usually
with no visible signs of
infection at site
Roller clamp loosened to allow run
on infusion: Flow rate too rapid
Miscalculation of fluid requirements
Nursing interventions
Failure to maintain aseptic
technique during insertion or site
care
Severe phlebitis, which can set up
ideal conditions for organism
growth.
Poor taping that permits access
device to move, which can
introduce organisms into blood
stream
Prolonged indwelling time of device
Immuno compromised patient
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Raise the head of the head.
Administer oxygen and medications as per the
order.
Prevention: use pump controller or rate minder
for elderly or compromised patients.
Recheck calculations of fluid requirements
Monitor infusions frequently
Monitor vital signs
Notify doctor
Administer medications as prescribed
Culture site and device
Prevention: Use scrupulous aseptic technique
when handling solutions and tubings, inserting
venipuncture device, and discontinuing infusion
Secure all connections
Change I.V solutions, tubing and access device at
recommended times
Use I.V filters.