COMPLICATIONS ASSOCIATED WITH INTRAVENOUS THERAPY

Hematoma

Local complication
Hematoma :A hematoma is a collection of blood caused by internal bleeding. This happens when the catheter punctures through the vein and causes a hematoma. Hematomas generally occur with unsuccessful IV insertion but can also happen when an IV is taken out. This is why pressure must be applied to the insertion site, to try to make the hematoma as small as possible. A hematoma may appear as a visible bruise or a lump. Signs/symptoms: discoloration of the skin, site swelling and discomfort, inability to advance the cannula all the way into the vein during insertion, resistance to positive pressure during the lick flushing procedure Prevention and treatment: A hematoma can be controlled with direct pressure and will resolve over the course of 2 weeks.

Document observable ecchymotic areas

DEEP VEIN THROMBOSIS

*Thrombosis
Thrombosis occurs when an imbalance in the blood coagulation system causes a blood clot, or thrombus, to form. When a thrombus blocks the flow of blood through a vein or artery, it poses serious health risks, including venous thrombosis (VTE) and deep vein thrombosis (DVT). The thrombus can also detach from the blood vessel wall to form a life-threatening pulmonary embolus (PE) when it lodges in the lungs.Signs/symptoms: fever and malaise, slowed or stopped infusion rate, inability to flush licking device Prevention/treatment: To prevent deep venous thrombosis and its possible complications, the following should be observed: Patients should wear elastic compression stockings. Patients should observe special body positioning and perform indicated exercise. Patients should use intermittent pneumatic compression. In surgical patients, subcutaneous unfractioned or low molecular weight heparin is administered. Documentation: document the change of infusion rate, the steps taken to solve the problem, and the end result. Chart new IV sites. It patency, and the size of the catheter used

PHLEBITIS

phlebitis
Phlebitis is a term that means inflammation of a blood vessel. Phlebitis occurs quite commonly after the insertion of intravenous catheters. The exact frequency of phlebitis is anywhere from 2.5 to 45% or more. The frequency depends on how phlebitis is defined, the site of IV insertion, the duration that the IV has been in place, the type of material that the IV is made of, the length of the IV catheter, and on the existence of other disorders as diabetes. In phlebitis the inflammation causes localised redness and warmth at the IV insertion site and perhaps a short distance along the course of the vein in which the IV has been placed. Most times, phlebitis is no more than a minor inconvenience.

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

Prevention/treatment:While patients have to rely on conventional medicine to resolve major blood clots in the veins, alternative therapies help prevent future blood clots and bring relief from pain due to superficial thrombophlebitis. To prevent phlebitis, people should eat a high-fiber, heart-healthy diet and engage in regular physical exercises such as walking, bicycling, or running. If temporarily bedridden, they should stretch their arms and legs frequently and try to become mobile as soon as possible.
Documentation: site assessment, phlebitis rating (1,2,3 or 4), physician notification, and treatment

Thrombophlebitis

Thrombophlebitis
Thrombophlebitis is similar to phlebitis but a thrombus (or clot) is in addition involved. As the IV cannula stays inside your body, it may irritate the vein leading the body to trigger its clotting mechanisms.
You may notice a hardened area corresponding to where a clot has formed in the vein. This kind of small clot does not have the same potentially life-threatening consequences as blood clots in the deeper and larger veins in the body. Thrombophlebitis is not usually associated with infection. Treatment - Treatment of phlebitis and thrombophlebitis is aimed at relief of the symptoms including: anti-inflammatory medicine, such as ibuprofen, acetaminophen for pain, or local heat. If the condition worsens, especially if pain or the area of redness increases, medical attention should definitely be sought. If you are in the hospital, your doctor should change your intravenous (IV) lines regularly. Depending on your condition and other factors, he or she might also give you medications that are designed to help prevent this condition.

Septic Thrombophlebitis
In more serious cases the vein can become infected. This is a rare condition, known as septic phlebitis or septic thrombophlebitis, which can spread infection throughout the body via the bloodstream. One sign of infection is the presence of enlarged lymph nodes under the arm on the affected side. This can occur with simple phlebitis but should cause you to seek medical attention, especially if you have a fever and feel generally unwell.

Treatment - If you suspect an infected vein, see your healthcare provider immediately. Hospitalization may be needed and antibiotics will be used to control the bacterial infection.

INFILTRATION

Infiltration
This occurs when the catheter unintentionally enters the tissue surrounding the blood vessel. In this case the IV fluid and associated medications will go into the tissues and there will be a lump where the IV has been inserted. It would be cool to touch (this differentiates it from inflammation due to infection, which is warm to the touch). Treatment - If you notice this inform your healthcare professional and they will administer appropriate care immediately. Infiltrated IVs are not a big problem usually unless the medication being administered is very irritant, such as certain chemotherapy and circulatory medicines. The intravenous infusion must be stopped, obviously, to avoid putting any more fluid or medication into the tissues. Another IV may need to be started elsewhere. Documentation: assessment findings, any written and verbal communications, nursing and medical interventions, and patient response patterns

Extravasation

Extravasation
An extravasation occurs when there is accidental infiltration of a vesicant or chemotherapeutic drug into the surrounding IV site. Vesicants can cause tissue destruction and / or blistering. Irritants can result in pain at the IV site and along the vein and may or may not cause inflammation. Extravasation can result in tissue sloughing, pain, loss of mobility in the extremity and infection. The treatment for extravasation will vary depending on the antidote for the infiltrated medication and your facility policy. The inadvertent administration of a vesicant solution into surrounding tissue Signs/symptoms: complaints of pain or burning; swelling proximal to or distal to the IV site; puffiness of the dependent part of the limb; skin tightness at the venipuncture site; blanching and coolness of the skin; slow or stopped infusion; damp or wet dressing Prevention/treatment: if extravasation occurs, the site should be monitored every 2 hours for 24 hours, every 8 hours for 72 hours, and then daily for erythema, blanching, necrosis, swelling, drainage, pain, and temperature. The affected extremity should be elevated for 24 to 48 hours and assessed every 8 hours for sensation, movement, and pulses. If there is any deterioration of the affected area (continued pain, necrosis, ulceration, suspected compartment syndrome), surgery should be consulted immediately. Documentation: document assessment and interventions. Include the vascular access device type, insertion site, name of medication or solution, and how it was infused.

Local infection
In any case where there is an open wound on the body, disrupting the protective lining of skin, an infection can occur. A microscopic organism may use the tiny hole in the skin created by the IV catheter to find its way into the body, and cause an infection. Common signs of local infection ("abscess") include a large lump that is painful and hot to touch. Treatment - If you suspect an infection, see your healthcare provider immediately. Antibiotics may be used to control the bacterial infection.

Signs/symptoms: redness and swelling at the site; possible exudate of purulent material; increased quantity of white blood cells; elevated temperature
Documentation: assessment of site; culture technique; sources of culture; physician notification; and any treatment initiated

Venous spasm
A sudden involuntary contraction of a vein or an artery resulting in temporary cessation of blood flow through a vessel. Signs/symptoms: sharp pain at the IV site that travels up the arm, which is caused by a piercing stream of fluid that irritates or shocks the vein wall; slowing of the infusion Prevention/treatment: Symptoms can sometimes be relieved by the use of medications that help relax the blood vessels or avoiding substances (such as cocaine) that cause the spasms Documentation: patient complaints, duration of complaints, treatment, and length of time to resolve the problem

Systemic Complication
Septicemia: a febrile disease process that results from the presence of microorganisms or their toxic products in the circulatory system
S/S: fluctuating fever, tremors, chattering teeth, profuse cold sweat, nausea and vomiting, diarrhea, abdominal pain, tachycardia, increased respirations or hyperventilation, altered mental status, hypotension

Prevention/treatment: Antibiotics to treat the infection

Fluids and medicines by IV to maintain the blood pressure Oxygen Plasma or other blood products to correct any clotting problems Documentation: document s/s assessed; physician notification, all treatments instituted.

Fluid overload & Pulmonary edema

Caused by infusing excessive amounts of isotonic or hypertonic crystalloid solutions tot rapidly, failure to monitor the IV infusion or too-rapid infusion of any fluid in a patient compromised by cardiopulmonary or renal disease S/S: restlessness, headache, increased in pulse rate, weight gain over a short period of time, cough, presence of edema, hypertension, wide variance between intake and output, distended neck veins, SOB

Prevention/treatment:Control your blood pressure, Watch your

blood cholesterol, Don't smoke, Eat a heart-healthy diet, Limit salt, Exercise regularly, Maintain a healthy weight, Consider taking baby aspirin, Manage stress

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

AIR EMBOLISM

Air embolism
Air entering the central vein, which is quickly trapped in the blood as it flows forward. S/S: complaints of palpitations, lightheadedness and weakness, pulmonary findings: dyspnea, cyanosis, tachypnea, expiratory, wheezes, cough, and pulmonary edema. Cardiovascular: mill wheel murmur; weak, thready pulse; tachycardia; substernal chest pain; hypotension; and jugular venous distention. Neurologic findings: change in mental status, confusion, coma, anxiousness, and seizures Prevention/treatment: Oxygen administration,Hyperbaric chamber - for divers Symptomatic measures e.g. medications for seizures, reduced blood pressure Documentation: pt assessment, nursing intervention, physician notification, and treatment

Speed shock
Occurs when a foreign substance usually a medication is rapidly introduced into the circulation S/S: dizziness, facial flushing, headache, tightness in the chest, hypotension, irregular pulse, progression of shock. Prevention/treatment: to avoid speed shock and possible cardiac arrest, give most I.V. push medication over 3 to 5 mins. Documentation: medication or fluid administered and the signs and symptoms the pt reported, physician notification, treatment initiated and the patient response

CATHETER EMBOLISM

Catheter embolism
A piece of the catheter breaks off and travels through the vascular system S/S: sharp sudden pain at the IV site, minimal blood return, rough and uneven catheter noted on removal, cyanosis, chest pain, tachycardia, hypotension Prevention/treatment: Using x-ray imaging and a contrast material to visualize the blood vessel, the interventional radiologist inserts a catheter through the skin into a blood vessel and advances it to the treatment site. A synthetic material or medication called an embolic agent is then inserted through the catheter and positioned within the blood vessel or malformation where it will remain permanently.

SEPTICEMIA

Septicemia
Septicemia: a febrile disease process that results from the presence of microorganisms or their toxic products in the circulatory system
S/S: fluctuating fever, tremors, chattering teeth, profuse cold sweat, nausea and vomiting, diarrhea, abdominal pain, tachycardia, increased respirations or hyperventilation, altered mental status, hypotension

*Nursing Assessment
Assess VS and LOC. Assess for internal bleeding. Assess for DIC. Assess for pressure sore areas.

Do regular head-to-toe, system-by-system assessment for septic shock.

*Nursing Management

Care is directed toward supporting the client as symptoms develop. These include but are not limited to the following:

Aggressive measures to prevent septic shock and death

Antibiotics, analgesics, and antipyretics administration as ordered

Oral hydration IV hydration and antibiotic administration using strict aseptic technique. Prevent chilling

Pressure and cool compresses to sites of bleeding

Blood or blood product replacement Protection from injury Promotion of self-care, within limitations Encourage therapeutic communication

Support for client to conserve strength and allow for rest

Emotional and psychological support for client and family

 Presented by: Angelica Del Rosario Jeanne Mendegorin

BSN II