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Management of IV Complications: Local and Systemic Local Complications On / During / After Cannulation Signs & Symptoms 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. 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 Apply warm soaks over and surrounding area Slow flow rate Prevention: Use blood warmer for blood or packed red blood cells when appropriate 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. PHLEBITIS Severe discomfort reddened, swollen and hardened vein. There are mainly 3 reasons 1. Infusion related 2. Infection related 3. Mechanical related 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 Improper venipuncture technique, resulting in injury to surrounding nerves, tendons, ligaments. Tight taping or improper splinting with arm board. 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 Air Embolism Unequal breath sounds Respiratory distress Weak pulse Increased CVP Decreased BP Loss of consciousness 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 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.