1. Intravenous Complications

2. Objectives Enumerate the kinds of intravenous therapy complications. Identify the types of each kind of intravenous therapy complications and describe them according to the following: Definition Causes Signs & Symptoms Nursing Interventions

3. Intravenous Therapy Complications LOCAL COMPLICATIONS Infiltration Extravasation Thrombosis Thrombophlebitis Phlebitis SYSTEMIC COMPLICATIONS Embolism Pulmonary embolism Air embolism Catheter embolism Hematoma Systemic infection Speedshock Circulatory overload Allergic reaction

4. Infiltration Extravasation Thrombosis Thrombophlebitis Phlebitis

6. Discomfort, burning, pain at site

7. Feeling of tightness at site

8. Decreased skin temperature around site

9. Blanching at site

10. Absent backflow of blood

12. Nursing Interventions Remove the device Apply warm soaks to aid absorption Elevate the limb Notify the doctor if severe Assess circulation Restart the infusion Document the patient's condition and your interventions

13. Prevention Check the I.V site frequently Don't obscure area above site with tape Teach the patient to report discomfort, pain, swelling

17. Discomfort

18. Burning

19. Tightness

20. Coolness in the adjacent skin

23. Elevate the affected limb

24. Apply cold compress to decrease edema and pain

26. Calcium chloride Various

27. Calcium gluconate Various

28. Dacarbazine DTIC

29. DactinomycinCosmogen

30. DaunorubicinCerubidine

31. Dopamine Various

32. Doxorubicin Adriamycin

33. IdarubicinIdamycin

34. MechlorethamineMustargen

35. Mitomycin C Mutamycin

36. PlicamycinMithracin

37. StreptozocinZanosar

38. TeniposideVumon

39. Vancomycin Various

40. VinblastineVelban

41. VincristineOncovin

44. Cause Injury to endothelial cells of vein wall, allowing platelets to adhere and thrombus form

45. Nursing Interventions Remove the device; restart the infusion in the opposite limb if possible Apply warm soaks Watch for I.V therapy – related infection

46. Prevention Use proper venipuncture techniques to reduce injury to the vein

48. Infusions allowed to continue after thrombophlebitis develops will slow and eventually stop, indicating progression to an obstructive thrombophlebitis.

50. Swelling

51. Induration

55. Prolonged use of the same IV site

56. irritating./incompatible IV additives

57. Use of vein that is too small for the flow rate

59. Vein that is sore, hard, cord like and warm to touch

60. Red line above the site

63. Diazepam

64. Erythromycin

65. Tetracycline

66. Vancomycin

67. Amphothericin B

69. Avoid multiple insertion

70. Application of warm compress

72. Pulmonary Embolism It associated with venous access devices is usually the result of a thrombus that has become detached from the wall of the vein. It is carried by the venous circulation to the right side of the heart and then into the pulmonary artery. Circulatory and cardiac abnormalities are caused by full or partial obstruction of the pulmonary artery, with possible progression to pulmonary hypertension and right-sided heart failure.

73. Air Embolism Occurs most frequently with the use of central venous access devices. Occur with the insertion of an IV catheter, during manipulation of the catheter or catheter site when the device is removed, or when IV lines associated with the catheter are disconnected.

74. Catheter Embolism This can occur during the insertion of a catheter if appropriate placement techniques are not strictly adhered to. The tip of the needle used during the placement of the catheter can shear off the tip of the catheter. The catheter tip then becomes a free-floating embolus. This can occur with both over-the-needle and through-the-needle catheters. If this happens, cardiac catheterization may be required to remove the embolus.

75. Signs & Symptoms Sudden vascular collapse with the hallmark symptoms of cyanosis, hypotension, increased venous pressures, and rapid loss of consciousness. Respiratory distress Unequal breath sounds Weak pulse

76. Causes Empty solution container Solution container empties; next container pushes air down line Tubing disconnected from venous access device or I.V bag

77. Nursing Interventions Discontinue the infusion Place the patient in Trendelenburg position on his left side to allow air to enter the right atrium and disperse through the pulmonary artery. Administer oxygen Notify the doctor Document the patient's condition and your interventions.

80. Inappropriate use of tourniquet

81. Unsuccessful insertion attempts

82. Little pressure upon removal of cannula

84. Upon insertion, slowly advance the needle to prevent puncturing both vein walls

85. Discontinue therapy if with edema

87. Major hazard - can be local or systemic (septicemia)‏

89. Causes Failure to maintain aseptic technique during insertion or site care Severe phlebitis, which can set up ideal conditions for organisms growth Poor taping Prolonged indwelling time of device Immunocompromised patient

90. Nursing Interventions Notify the doctor. Administer medications as prescribed Culture the site and the device Monitor the patient's vital signs

91. Prevention Use scrupulous aseptic technique Secure all connections Change I.V solutions, tubing and venous access device at recommended times Use I.V filters

93. Accurately document visual inspection and palpation data.

94. Refer to physician for any suspected infection.

95. Use maximal sterile-barrier precautions during insertion (sterile technique)‏

97. Remove at first sign of infection

98. Replace site, tubings and bags per policy example: change set= 72 hours, TPN and single use of antibiotics=24 hrs

99. Speedshock Rapid introduction of a foreign substance, usually a medication, into the circulation.

101. Headache

102. Tight feeling in the chest

104. Careful monitoring of IV flow rate and patient response. Maintain prescribed rate.

107. Elevated blood pressure

108. Bounding pulse

109. Jugular vein distention

110. Increased Respiratory rate

111. Edema

113. Nursing Interventions Raise the head of the bed Slow the infusion rate Administer oxygen as needed Notify the doctor Administer medications as ordered

115. Tearing

116. Bronchospasm

117. Wheezing

119. Redness

121. Maintain a patent airway.

122. Notify the doctor.

123. Administer antihistaminic steroid, anti – inflammatory, & antipyretic drugs, as ordered.

125. Identify a local complication and describe according to the following: Definition Causes Signs & symptoms Nursing Interventions

126. Identify a systemic complication and describe according to the following: Definition Causes Signs & symptoms Nursing Interventions

127. Questions?