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Complications of
Intravenous
Therapy
Prepared By
Dr. Nahed Said El-nagger
Assistant Professor of Nursing
1430-1431 H
Unit . 2
Lecture No. 3.B
Learning Outcomes:
Differentiate between local and systemic
complications.
Describe the signs and symptoms of local
complications.
Identify prompt treatment for local and
systemic complications.
Identify International Standards of practice
rating infiltration.
List three risk factors for phlebitis.
Identify organisms responsible for
septicemia related to infusion therapy.
Identify prevention techniques for the
systemic complications.
I. Local complications
1. Hematoma:
Formations resulting from the infiltration of blood
into the tissues at the Venipuncture site.
Causes:
Rupture the vein during an unsuccessful
Venipuncture attempt.
Discontinuing the I.V. cannula or needle without
pressure.
Applying a tourniquet too tightly above a
previously attempted Venipuncture site.
1. Hematoma (cont.)
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.
Document:
The observable ecchymotic areas.
2. Thrombosis
Catheter-related obstructions can be
categorized as mechanical or nonthrombotic ( 42% of all obstructions)
or thrombotic (58% of all obstructions),
Signs/symptoms:
Fever and malaise.
Slowed or stopped infusion rate.
Inability to flush licking device.
2. Thrombosis (cont.)
Documentation:
Document the change of infusion
rate.
The steps taken to solve the problem,
and the end result.
Chart new IV sites.
It s patency, and the size of the
catheter used.
3.phlebitis
An inflammation of the vein.
Signs/symptoms:
Redness at site.
Site warm to touch and local swelling.
Palpable cord along the vein.
Sluggish infusion rate.
Increase in basal temperature of 1 C or
more.
3. Phlebitis (cont.)
Nursing Interventions:
Remove IV device.
4.Thrombophlebitis
Thrombosis and inflammation.
Signs/symptoms:
Sluggish flow rate, edema in the limbs.
Tender and cordlike vein, site warm to
touch.
Visible red line above Venipuncture site.
Diminished arterial pulses.
Mottling and Cyanosis of the
extremities.
5. Infiltration
Accidental administration of a non vesicant
solution into surrounding tissue.
Signs/symptoms:
Coolness of skin around site, and
tight skin.
Dependent edema and absence of
blood backflow.
A pinkish blood return.
Infusion rate slows but the fluid
continues to infuse.
Treatment of Infiltration
Discontinue the infusion.
Apply warm, moist heat to
edema.
Elevate the extremity.
Restart the infusion at another
site, preferable the other arm.
Prevention of Infiltration
5. Infiltration (cont.)
Documentation:
assessment findings.
any written and verbal
communications.
nursing and medical interventions.
client response patterns.
6. Extravasations
The accidental administration of a vesicant
solution into surrounding tissue.
Signs/symptoms:
Complaints of pain or burning; swelling
proximal or distal to the IV site.
puffiness of the dependent part of the limb;
skin tightness at the Venipuncture site; and
coolness of the skin.
Slow or stopped infusion; damp or wet
dressing.
Extravasations Interventions
extremity.
Remove the cannula.
Call physician.
Administer antidote (if appropriate)
intradermaly into infiltrated tissue.
Apply warm moist compresses for 20
minutes every 4 hours (see hospital
policy).
6. Extravasations (cont.)
Documentation:
Document assessment and
interventions. Include the vascular
access device type, insertion site,
name of medication or solution, and
how it was infused.
7. Local infection
Microbial contamination of the cannula or
infusate
Signs/symptoms:
Redness and swelling at the site;
possible
exudates of purulent material.
Increased quantity of white blood cells;
and elevated temperature.
8. 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 acute flow
of fluid that irritates the vein wall;
slowing of the infusion
Septicemia Interventions
Notify physician immediately.
Symptomatic care.
Identify other sources of
infection.
Remove IV device.
Culture the IV cannula, tubing, or
solution if it is suspect.
Return fluid to pharmacy.
Establish a new IV site for
medication or fluid administration.
1. Septicemia (cont.)
Documentation:
Document S/S assessed; physician
notification, all treatments instituted.
Restlessness, headache,
3. Air embolism
Air entering the central vein,
which is quickly trapped in the
blood as it flows forward.
Prevention is the key.
3. Air embolism(cont.)
S/S:
weakness.
Pulmonary findings: dyspnea, cyanosis,
tachypnea, expiratory, wheezes, cough,
and pulmonary edema.
Cardiovascular: murmur; weak,
thready pulse; tachycardia; substernal
chest pain; hypotension; and jugular
venous distention.
Neurologic findings: change in mental
status, confusion, coma, anxiousness,
and seizures.
4. 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.
5. Catheter embolism
A piece of the catheter breaks off and
travels through the vascular system.