Nur 105 Complication of Intravenous Therapy Ch9

Complication of Complication of Intravenous Intravenous

TherapyTherapy

Chapter 9Chapter 9

Nursing 105Nursing 105

objectivesobjectives

• Differentiate between local and systemic Differentiate between local and systemic complicationscomplications

• Describe the signs and symptoms of eight local Describe the signs and symptoms of eight local complicationscomplications

• Identify prompt treatment for local and systemic Identify prompt treatment for local and systemic complicationscomplications

• Identify INS Standards of practice rating infiltrationIdentify INS Standards of practice rating infiltration• List three risk factors for phlebitisList three risk factors for phlebitis• Identify organisms responsible for septicemia related Identify organisms responsible for septicemia related

to infusion therapyto infusion therapy• Identify prevention techniques for the six systemic Identify prevention techniques for the six systemic

complicationscomplications

Local complicationLocal complication

• Hematoma: formations resulting from Hematoma: formations resulting from the infiltration of blood into the tissues the infiltration of blood into the tissues at the venipuncture siteat the venipuncture site

• Causes: nicking the vein during an Causes: nicking the vein during an unsuccessful venipuncture attempt, unsuccessful venipuncture attempt, discontinuing the I.V. cannula or needle discontinuing the I.V. cannula or needle without pressure, applying a tourniquet without pressure, applying a tourniquet too tightly above a previously too tightly above a previously attempted venipuncture siteattempted venipuncture site

Hematoma contHematoma cont

• Signs/symptoms: discoloration of the Signs/symptoms: discoloration of the skin, site swelling and discomfort, skin, site swelling and discomfort, inability to advance the cannula all the inability to advance the cannula all the way into the vein during insertion, way into the vein during insertion, resistance to positive pressure during the resistance to positive pressure during the lick flushing procedurelick flushing procedure

• Prevention and treatment: refer to page Prevention and treatment: refer to page 360360

• Document observable ecchymotic areasDocument observable ecchymotic areas

Thrombosis Thrombosis

• Catheter-related obstructions can be Catheter-related obstructions can be categorized as mechanical or non-categorized as mechanical or non-thrombotic ( 42% of all obstructions) or thrombotic ( 42% of all obstructions) or thrombotic (58% of all obstructions),thrombotic (58% of all obstructions),

• Signs/symptoms: fever and malaise, Signs/symptoms: fever and malaise, slowed or stopped infusion rate, slowed or stopped infusion rate, inability to flush licking deviceinability to flush licking device

• Prevention/treatment: refer to page 362Prevention/treatment: refer to page 362

ThrombosisThrombosis

• Documentation: document the Documentation: document the change of infusion rate, the steps change of infusion rate, the steps taken to solve the problem, and the taken to solve the problem, and the end result. Chart new IV sites. It’ end result. Chart new IV sites. It’ patency, and the size of the catheter patency, and the size of the catheter usedused

phlebitisphlebitis

• An inflammation of the vein in which the An inflammation of the vein in which the endothelial cells of the venous wall become endothelial cells of the venous wall become irritated and cells roughen, allowing platelets irritated and cells roughen, allowing platelets to adhere and predispose the vein to to adhere and predispose the vein to inflammation-induced phlebitisinflammation-induced phlebitis

• TypesTypes– MechanicalMechanical– Chemical Chemical – bacterialbacterial– Post-infusionPost-infusion

Phlebitis contPhlebitis cont

• Signs/symptoms: redness at site, site warm Signs/symptoms: redness at site, site warm to touch, local swelling, palpable cord along to touch, local swelling, palpable cord along the vein, sluggish infusion rate, increase in the vein, sluggish infusion rate, increase in basal temperature of 1 degree C or morebasal temperature of 1 degree C or more

• Prevention/treatment: refer to pages 367 to Prevention/treatment: refer to pages 367 to 369369

• Documentation: site assessment, phlebitis Documentation: site assessment, phlebitis rating (1,2,3 or 4), physician notification, rating (1,2,3 or 4), physician notification, and treatmentand treatment

Thrombophlebitis Thrombophlebitis

• Thrombosis and inflammation.Thrombosis and inflammation.

• Signs/symptoms: sluggish flow rate, Signs/symptoms: sluggish flow rate, edema in the limbs, tender and cordlike edema in the limbs, tender and cordlike vein, site warm to touch, visible red line vein, site warm to touch, visible red line above venipunture site, diminished above venipunture site, diminished arterial pulses, and mottling and arterial pulses, and mottling and cyanosis of the extremitiescyanosis of the extremities

• Prevention/treatment: refer to page 370Prevention/treatment: refer to page 370

Infiltration Infiltration

• Inadvertent administration of a Inadvertent administration of a nonvesicant solution into surrounding nonvesicant solution into surrounding tissuetissue

• Signs/symptoms: coolness of skin Signs/symptoms: coolness of skin around site, taut skin, dependent around site, taut skin, dependent edema, absence of blood backflow, a edema, absence of blood backflow, a pinkish blood return, infusion rate pinkish blood return, infusion rate slows but the fluid continues to infuseslows but the fluid continues to infuse

Infiltration contInfiltration cont

• Prevention/treatment: refer to pages Prevention/treatment: refer to pages 372 to374372 to374

• Documentation: assessment findings, Documentation: assessment findings, any written and verbal any written and verbal communications, nursing and communications, nursing and medical interventions, and patient medical interventions, and patient response patternsresponse patterns

ExtravasationExtravasation

• The inadvertent administration of a The inadvertent administration of a vesicant solution into surrounding tissuevesicant solution into surrounding tissue

• Signs/symptoms: complaints of pain or Signs/symptoms: complaints of pain or burning; swelling proximal to or distal to burning; swelling proximal to or distal to the IV site; puffiness of the dependent the IV site; puffiness of the dependent part of the limb; skin tightness at the part of the limb; skin tightness at the venipuncture site; blanching and venipuncture site; blanching and coolness of the skin; slow or stopped coolness of the skin; slow or stopped infusion; damp or wet dressinginfusion; damp or wet dressing

Extravasation contExtravasation cont

• Prevention/treatment: refer to pages Prevention/treatment: refer to pages 376 to 378376 to 378

• Documentation: document Documentation: document assessment and interventions. assessment and interventions. Include the vascular access device Include the vascular access device type, insertion site, name of type, insertion site, name of medication or solution, and how it medication or solution, and how it was infused.was infused.

Local infectionLocal infection

• Microbial contamination of the cannula Microbial contamination of the cannula or infusateor infusate

• Signs/symptoms: redness and swelling Signs/symptoms: redness and swelling at the site; possible exudate of at the site; possible exudate of purulent material; increased quantity of purulent material; increased quantity of white blood cells; elevated temperaturewhite blood cells; elevated temperature

• Prevention/treatment: refer to pages Prevention/treatment: refer to pages 384 & 385384 & 385

Local infection contLocal infection cont

• Documentation: assessment of site; Documentation: assessment of site; culture technique; sources of culture; culture technique; sources of culture; physician notification; and any physician notification; and any treatment initiatedtreatment initiated

Venous spasmVenous spasm

• A sudden involuntary contraction of a vein A sudden involuntary contraction of a vein or an artery resulting in temporary or an artery resulting in temporary cessation of blood flow through a vessel.cessation of blood flow through a vessel.

• Signs/symptoms: sharp pain at the IV site Signs/symptoms: sharp pain at the IV site that travels up the arm, which is caused by that travels up the arm, which is caused by a piercing stream of fluid that irritates or a piercing stream of fluid that irritates or shocks the vein wall; slowing of the infusionshocks the vein wall; slowing of the infusion

• Prevention/treatment: refer to pages 385 & Prevention/treatment: refer to pages 385 & 386386

Venous spasms contVenous spasms cont

• Documentation: patient complaints, Documentation: patient complaints, duration of complaints, treatment, duration of complaints, treatment, and length of time to resolve the and length of time to resolve the problemproblem

Systemic ComplicationSystemic Complication

• Septicemia: a febrile disease process that results Septicemia: a febrile disease process that results from the presence of microorganisms or their from the presence of microorganisms or their toxic products in the circulatory systemtoxic products in the circulatory system

• S/S: fluctuating fever, tremors, chattering teeth, S/S: fluctuating fever, tremors, chattering teeth, profuse cold sweat, nausea and vomiting, profuse cold sweat, nausea and vomiting, diarrhea, abdominal pain, tachycardia, increased diarrhea, abdominal pain, tachycardia, increased respirations or hyperventilation, altered mental respirations or hyperventilation, altered mental status, hypotensionstatus, hypotension

• Prevention/treatment: refer to pages 387 & 388Prevention/treatment: refer to pages 387 & 388

Septicemia contSepticemia cont

• Documentation: document s/s Documentation: document s/s assessed; physician notification, all assessed; physician notification, all treatments instituted.treatments instituted.

Fluid overload & Pulmonary Fluid overload & Pulmonary edemaedema

• Caused by infusing excessive amounts of Caused by infusing excessive amounts of isotonic or hypertonic crystalloid solutions tot isotonic or hypertonic crystalloid solutions tot rapidly, failure to monitor the IV infusion or rapidly, failure to monitor the IV infusion or too-rapid infusion of any fluid in a patient too-rapid infusion of any fluid in a patient compromised by cardiopulmonary or renal compromised by cardiopulmonary or renal diseasedisease

• S/S: restlessness, headache, increased in S/S: restlessness, headache, increased in pulse rate, weight gain over a short period of pulse rate, weight gain over a short period of time, cough, presence of edema, time, cough, presence of edema, hypertension, wide variance between intake hypertension, wide variance between intake and output, distended neck veins, SOBand output, distended neck veins, SOB

Fluid overload & Pulmonary Fluid overload & Pulmonary edema contedema cont


• Documentation: pt assessment, Documentation: pt assessment, notification of physician, and notification of physician, and treatments instituted by physician treatments instituted by physician orderorder

Air embolismAir embolism

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

• S/S: complaints of palpitations, S/S: complaints of palpitations, lightheadedness and weakness, pulmonary lightheadedness and weakness, pulmonary findings: dyspnea, cyanosis, tachypnea, findings: dyspnea, cyanosis, tachypnea, expiratory, wheezes, cough, and pulmonary expiratory, wheezes, cough, and pulmonary edema. Cardiovascular: “mill wheel” murmur; edema. Cardiovascular: “mill wheel” murmur; weak, thready pulse; tachycardia; substernal weak, thready pulse; tachycardia; substernal chest pain; hypotension; and jugular venous chest pain; hypotension; and jugular venous distention. Neurologic findings: change in distention. Neurologic findings: change in mental status, confusion, coma, anxiousness, mental status, confusion, coma, anxiousness, and seizuresand seizures

Air embolism contAir embolism cont


• Documentation: pt assessment, Documentation: pt assessment, nursing intervention, physician nursing intervention, physician notification, and treatmentnotification, and treatment

Speed shockSpeed shock

• Occurs when a foreign substance usually a Occurs when a foreign substance usually a medication is rapidly introduced into the medication is rapidly introduced into the circulationcirculation

• S/S: dizziness, facial flushing, headache, S/S: dizziness, facial flushing, headache, tightness in the chest, hypotension, irregular tightness in the chest, hypotension, irregular pulse, progression of shock.pulse, progression of shock.

• Prevention/treatment: refer to page 393Prevention/treatment: refer to page 393• Documentation: medication or fluid Documentation: medication or fluid

administered and the signs and symptoms administered and the signs and symptoms the pt reported, physician notification, the pt reported, physician notification, treatment initiated and the patient responsetreatment initiated and the patient response

Catheter embolismCatheter embolism

• A piece of the catheter breaks off and A piece of the catheter breaks off and travels through the vascular systemtravels through the vascular system

• S/S: sharp sudden pain at the IV site, S/S: sharp sudden pain at the IV site, minimal blood return, rough and uneven minimal blood return, rough and uneven catheter noted on removal, cyanosis, catheter noted on removal, cyanosis, chest pain, tachycardia, hypotensionchest pain, tachycardia, hypotension


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Nur 105 Complication of Intravenous Therapy Ch9