Common complications of IV therapy

Common complications of IV therapy

• Infiltration
• Thrombophlebitis
• Bacteremia
• Circulatory Overload
• Air Embolism
• Mechanical Fail
• Hemorrhage
• Venous Thrombosis

INFILTRATION

Causes

• Dispossession of the IV cannula from the vein results in infusion of fluid into the surrounding tissues.

Clinical manifestations

• Swelling, blanching, and coolness of surrounding skin and tissues.
• Discomfort, according to the nature of the solution.
• Fluid running more slowly or ceasing.
• There is no blood backflow in the IV catheter and tubing.

Preventive Measures

• Confirm that the IV and distal tubing are properly secured with tape to prevent movements.
• Splint the patient's hand or arm if required.
• Observe the IV site frequently for complications

Nursing Interventions

• Holed infusion immediately remove the IV needle or catheter.
• Change and restart the IV in the other hand.
• If infiltration is moderate to severe, provide moist, warm compresses and elevate the limb.
• If a vasoconstrictor agent or vesicant ( chemotherapy agents) has infiltrated, initiate emergency local treatment as directed. Serious tissue injury, sloughing, and necrosis may result if actions are not taken.
• Document interventions and assessments.

THROMBOPHLEBITIS

Causes

• Damage to the vein during venipuncture, large-bore needle or catheter use, or prolonged catheter use.
• Inflammation to vein due to fast infusions or irritating solutions ( eg. cytotoxic agents, strong acids or alkalis, potassium and others); narrow veins are more susceptible.
• Clot develop at the tip of the needle or catheter due to slow infusion rates.
• Most commonly seen with synthetic catheters than steel needles.

Clinical Manifestation

• Tenderness and pain along the vein.
• Redness, swelling and warmth at the infusion area; the vein may present as a red streak above the insertion site.

Preventive Measure

• Attach the needle or catheter properly at the insertion site.
• Change the catheter site every 72 hours in adult patients ( it may not be suitable to remove catheters in pediatric and neonates patients every 72 hours; however, they should be removed urgently if complications are suspected).
• Select large veins for irritating fluid because of higher blood flow, which immediately dilutes the irritant.
• Properly dilute irritating agents before infusion.

Nursing Interventions

• Provide cold compresses immediately to reduce pain and inflammation.
• Follow with warm, moist compresses to stimulate circulation and improve absorption.
• Document interventions and assessments.
• Participate in facility quality improvement activities regarding phlebitis occurrence rates. One formula that can be used is:.             

          Number of phlebitis incidents

          ________________________________×100

    Total number of IV peripheral catheters=

          = % peripheral phlebitis

BACTEREMIA

Causes

• Contaminated equipment or infused solutions.
• Prolonged placement of an IV device ( catheter or needle solution container tubings)
• Nonsterile IV insertion and dressing change
• Cross-contamination by the patient with other infected areas of the body.
• A critically ill or immunosuppressed patient is at greatest risk of bacteria.

Clinical Manifestations

• Elevated temperature, chills
• Nausea, vomiting
• Elevated white blood cell (WBC)? Count
• Malaise, increased pulse
• Backache, headache.
• Possible signs of local infection at the IV insertion site.

Preventive Measures

• Follow the same measures as outlined for thrombophlebitis.
• Maintain strict sterile technique when inserting the IV or changing IV dressing.
• Solutions should never hange longer than 24 hours.
• Change the insertion site every 96 hours in an adult patient and within 48 hours if catheter was placed in an emergency situation.
• Change continuous IV administration sets no more frequently than every 96 hours and intermittent IV administration sets every 24 hours.
• Change the IV dressing on a routine basis and immediately if it becomes compromised.
• Gauze dressing that prevents visualization of the site should be changed every 48 hours.
• Transparent semipermeable dressing on a peripheral short-term site should be changed at site change or if the dressing loses its integrity.
• Transparent semipermeable dressing on central line sites should be changed at least every 7days and sos.
• Maintain the integrity of the infusion system.

Nursing interventions

• Discontinue infusion and IV cannula.
• IV device should be removed and the tip cut off with sterile scissors; placed in a dry; sterile container, and immediately sent to the laboratory for analysis.
• Check vital signs; reassure the patient.
• Obtain WBC count, as directed, and assess for other sites of infection. (Sputum, Urine, Wound)
• Start appropriate antibiotic therapy immediately after receiving orders.
• Document interventions and assessments.

How can find a Nurse Fluid volume deficit and Fluid volume excess

CIRCULATORY OVERLOAD 

Causes

• Delivery of excessive amount of IV fluid 

Clinical Manifestations

• Increased BP and pulse.
• Increased CVP, venous distension ( engorged jugular veins).
• Headache, anxiety.
• Shortness of breath, tachypnea, coughing
• Pulmonary crackles
• Chest pain

Preventive measures

• Know whether the patient has an existing heart or kidney condition. Be particularly vigilant in high-risk patients.
• Closely monitor the infusion flow rate. Keep accurate intake and output records.
• Splint the arm or hand if the IV flow rate fluctuates too widely with movement.

Nursing Interventions

• Slow infusion to a "keep-open" rate and notify the health care provider.
• Monitor closely for worsening condition.
• Raise the patient's head to facilitate breathing.
• Document interventions and assessments.

AIR EMBOLISM

Causes

• A greater risk exists in central venous line when air enters catheter during tubing changes ( air sucked in during inspiration due to negative intrathoracic pressure).
• Air in tubing delivered by IV push or infused by infusion pump.

Clinical Manifestations

• Low BP, elevated heart rate.
• Cyanosis, tachypnea
• Rise in CVP.
• Changes in mental status, loss of consciousness.

Preventive Measures

• Clear all air from tubing before infusion to patient.
• Change solution containers before they run dry.
• Ensure that all connections are secure. Always use Luer-lock connections on central lines.
• Use precipitate and air-eliminating filters unless contraindicated.
• Change IV tubing during expiration.

Nursing interventions

• Immediately turn the patient on left side and lower the head of the bed; in this position, air will rise to right atrium.
• Notify the health care provider immediately.
• Administer oxygen as needed.
• Reassure the patient.
• Document interventions and assessments.

MECHANICAL FAILURE (SLUGGISH IV FLOW)

Causes

• Needle lying against the side of the vein, cutting off fluid flow.
• Clot at the end of the catheter or needle.
• Infiltration of IV cannula.
• Kinking of the catheter or tubing.

Clinical Manifestations

• Sluggish IV flow.
• Alarm of flow regulator sounding.
• May be signs of local- irritation-swelling, coolness of skin.

Preventive Measures

• Check the IV often for patency and kinking.
• Secure the IV well with tape and an armboard, if necessary.

Nursing Interventions

• Remove tape and check for kinking of tubing or catheter.
• Pull back the cannula because it may be lying against the wall of vein or vein bifurcation.
• Elevate or lower needle to prevent occlusion of bevel.
• Move the patient's arm to new position.
• Lower the solution container to below the level of patient's heart and observe for blood backflow.
• If an electronic flow-rate regulator is in use, check it's integrity.
• If none of the preceding steps produces the desired flow, remove the needle or catheter and restart infusion.

Major Fluid and Electrolyte imbalance: signs and symptoms by nurses note

HEMORRHAGE

Causes

• Loose connection of tubing or injection port.
• Inadvertent removal of peripheral or central catheter.
• Anticoagulant therapy.

Clinical Manifestations

• Oozing or trickling of blood from IV site or catheter.
• Hematoma.

Preventive Measures

• Cap all central lines with Luer-lock adapters and connect Luer-lock tubing to the cap- not directly to the line.
• Tape all catheters securely- use transparent dressing when possible for peripheral and central catheters. Tape the remaining catheter lumens and tubing in a loop so tension is not directly on the catheter.
• Keep pressure on sites where catheters have been removed-a minimum of 10 minutes for a patient taking anticoagulants.

VENOUS THROMBOSIS

Causes

• Infusion of irritating solutions
• Infection along catheter may preclude this syndrome.
• Fibrin sheath formation with eventual clot formation around the catheter. (This clot will eventually occlude the vein).

Clinical Manifestations

• Slowing of IV infusion or inability to draw blood from the central line.
• Swelling and pain in the area of catheter or in the extremity proximal to the IV line.

Preventive Measures

• Ensure proper dilution of irritating substances.
• Ensure superior vena cava catheter tip placement for irritating solutions.

Nursing Interventions

• Stop fluids immediately and notify the health care provider.
• Reassure the patient and institute appropriate therapy:
• Anticoagulants.
• Heat.
• Elevation of the affected extremity.
• Antibiotics.

Crystalloids: Uses, Types, Routes of administration by Nursesnote

Reference: Lippincott Manual Nursing Practise