IV admixtures

THERAPY
Nazia Tabassum (Assistant professor)
Faculty Of Pharmacy, UCP, Lahore.
Hazards of IV THERAPY
Indications for IV therapy

• Establish or maintain a fluid or electrolyte balance

• Administer continuous or intermittent medication
• Administer bolus medication
• Administer blood or blood components
• Administer intravenous anesthetics
• Maintain or correct a patient's nutritional state
• Administer diagnostic reagents
• Monitor hemodynamic functions
COMPLICATIONS OF INTRAVENOUS THERAPY

1. LOCAL COMPLICATIONS
Hematoma
Phlebitis
Bruising
Thrombosis
Thrombophlebitis
Infiltration
Phlebothrombosis
2. SYSTEMIC COMPLICATIONS
Septicemia
Pulmonary Embolism
Fluid overload and pulmonary edema
Air Embolism
Catheter Embolism
Pulmonary Edema
Speed Shock
3. BACTERIAL, FUNGAL AND PARTICULATE CONTAMINATION
4. I.V. ASSOCIATED INFECTIONS:
 1. Local Complications
• Infiltration/Extravasation
o Happens when the needle or catheter
in which the product is entering the
blood vessel (vein) is dislodged from
the vein.
o If the cannula is insecurely anchored
or the site allows too much movement,
the cannula tip may penetrate the
wall of the vein causing extravasation
of fluid into surrounding tissues.
o It is characterized by swelling, redness
and pain. If irritant drugs are infused
then necrosis can occur. This is an
extremely serious complication of
intravenous therapy requiring prompt
and specific treatment.
o Remedy: Product should be
administered in another site.
 1. Local Complications continued………..

• Extravasation

It occurs when the venipuncture device is dislodged from the vein.

• Extravasation is the accidental administration of IV infused medicinal drugs into the

surrounding tissue which are caustic to these tissues, either by leakage (e.g. because of
brittle veins in very elderly patients), or directly (e.g. because the needle has punctured
the vein and the infusion goes directly into the arm tissue).

• Signs and symptoms of extravasation include swelling at and above the limb,
discomfort, burning or pain at the site, tightness at the site, cooler temperature at the
site.

• Treatment includes stopping the infusion, delivery of a local antidote (if appropriate),
and ice initially and warm soaks.
 1. Local Complications continued………..

• Phelibitis
o Inflammation of vein caused by mechanical, bacterial or chemical irritation.
o Characterized by redness, swelling and pain at the administration site.
o Remedy: Solution should be administered in another site and application of
warm soaks.
1. Local Complications continued………..

• Thrombosis
o Occurs when blood flow through a
vein is obstructed by a local
thrombus.
o Remedy: remove IV device, restart
infusion, apply warm soaks.

• Thrombolphlebitis
o Similar to phlebitis but a clot
(thrombus) is involved.
o At times, the IV cannula staying
inside the body can cause
irritation which can trigger
clotting mechanisms.
• Bruising 1. Local Complications continued………..
o A type of minor hematoma of
tissue in which capillaries and
sometimes venules are damaged
due to trauma allowing blood to
collect to the surrounding tissues.

• Hematoma
o Collection of blood caused by
internal bleeding. This can
happen when a catheter
punctures through the vein and
cause bleeding.
o The patient will have tenderness at the
site, a bruise may be evident at the
site, and the infusion will not flow.

• Remedy: The IV catheter must be removed

and restarted elsewhere.

• Additionally, you should apply pressure

until the bleeding stops and warms soaks
to aid in the absorption of the blood
 1. Local Complications continued………..

Occlusion occurs when fluid or medication cannot enter the vein.

• The IV flow is interrupted and blood may be backed up in the tubing or heparin or
saline lock.

• Treatment: Remove the IV and start a new one in a new site.

Vein irritation occurs due to solutions with high or low pH and high osmolarity (such as
potassium chloride, phenytoin, vancomycin, erythromycin, and nafcillin).

• Signs and symptoms of vein irritation include the patient’s report of pain at the site,
red skin over the vein during infusion, and quickly developing signs of phlebitis.

• Treatment includes decreasing the flow rate and diluting the infusions.

Venous spasm occurs due to severe vein irritation, administration of cold fluids or blood,
and a very rapid flow rate. The patient will experience pain at the IV site. Treatment
includes warm soaks over the vein and reduction in the flow rate of the infusate.
 1. Local Complications continued………..

Contributing Factors to Local Complications

 Duration of the Infusion: Increase length of the infusion time., increase incidence of
degree of inflammation.
 Composition of solution: pH balance of IV solution or drug additive can cause
irritability to veins and surrounding tissue.
 Site of infusion: Irritation of vein over joints, veins of lower extremities (stasis of
peripheral circulation) small veins.
 Technique: use sterile technique.
 Method: Over the needle cannula causes decrease in infection rate.

Preventative Measures in Local Complication

i. Refrain from veins lower extremities.
ii. Large veins selected, particularly using irritating substances.
iii. Use armboards when placing cannulas over joints.
iv. Anchor cannulas securely to prevent motion.
v. When removing cannula, remove at angle nearly flush with skin.
vi. Hold pressure.
2. Systemic Complications

• Septicemia
o A febrile disease process that
resulted from the presence of
microorganisms or their toxic
products in the circulatory system.
o Bacteria invades bloodstream
(chills, fever, general malaise,
H/A). Must be detected in early
stages – entire infusion set and
site should be discarded and
possible cultured

Treatment: Use of Sterile Solution

Check for cloudiness, particulate
matter. Discard after 24 hours.
2. Systemic Complications continued………..

• Fluid Overload and

Pulmonary edema
o Excessive administration of intra- venous
fluids is the main cause – usually in
elderly or those with cardiac or renal
function.
o Cause: High blood pressure may result
due to increased fluid volume.
o Also, pulmonary edema may also
happen due to abnormal fluid
accumulation in the lungs.
o Signs and Symptoms:
w/ edema Shortness of breath
coughing
Engorged neck veins
High blood pressure
o Treatment:
Normal Lower I.V. rate to keep open.
Elevate head of bed.
Notify M.D.
Be prepared to administer diuretics I.V.
 2. Systemic Complications continued………..

• Air embolism
o Results when a sizeable volume of air enters the circulatory
system.
o This may happen when air from the intravenous administration set
enters the bloodstream.
o Generally associated with central rather than
peripheral lines. Usually occurs when fluids run or with poor
handling of tubings, etc. Check all connection sites for any loose
fittings, use a syringe to remove any air in tubing; keep unused
ports clamped.
o Signs and Symptoms– May take up to 20 minutes to become
evident. Hypotension (low blood pressure) Cyanotic Weak, rapid
pulse Loss of consciousness.
o Treatment: Emergency situation; notify physician; turn patient on
left side with head down (air will rise in right atrium
preventing it from entering pulmonary artery) oxygen.
 2. Systemic Complications continued………..

• Catheter embolism
o Happens when a piece of the catheter
breaks off and travel through the
circulatory system.
o Prevention:
i. Good taping.
ii. Do not rethread needle into cannula.
iii. Catheter pieces can puncture walls of
veins, heart– causes hemorrhage.
Cardiac tamponade, can sometimes
retrieve fragments of cathter in
peripheral veins.
o Note: Always check tip of catheter
after disconnect.
 2. Systemic Complications continued………..
• Speed Shock
o Occurs when a foreign substance (e.g medication) is rapidly infused or introduced into
the circulation.
o Medications in plasma reaches toxic level.
Symptoms: Syncope, shock, cardiac arrest.
Treatment/ Prevention:
Use micro tip.
Electronic controllers
Check line before adjusting rate
Monitor patient closely following insertion of anY type of scubclavian or TLC
(Pneumothorax)

Remember:

“Early detection and good communication between patient

and healthcare provider are both important in minimizing
IV therapy complications.”
3. BACTERIAL, FUNGAL AND PARTICULATE
CONTAMINATION
Sources of Bacteria
Air – flying particles of bacteria are especially high in patient areas and
hospitals.
Skin – main source of bacteria responsible for IV infections. Some are normal
– touch contamination increase hazard
Blood – precautions adhered to due to increase in deadly blood related
illnesses.
Factors Influencing Survival of Bacteria
Types of organisms.
Number of organisms.
Host resistance – due to illnesses or drugs, patients may not be able to “fight
off” bacteria.
Environmental factors: Ph, temperature, nutrition for the bacteria to survive on
(blood keeps at 16o c).
 3. BACTERIAL, FUNGAL AND PARTICULATE CONTAMINATION continued…………….

Factors Contributing to Contamination and Infection

i. Phlebitis
ii. Infection
iii. Equipment and addition of meds or equipment (changing fluids)
iv. Faulty handling (cracked equipment or fluid containers)
v. Airborne Contamination: particularly with bottles; decrease air
flow
vi. Discard outdated I.V. solution:
a. Change fluids at least every 24 hours
b. Tubing per agencies recommendations
vii.Admixtures caution when mixing drugs
viii.Manipulation of in use I.V. equipment; disconnecting for pump,
etc.
 3. BACTERIAL, FUNGAL AND PARTICULATE CONTAMINATION continued…………….
ix. Injection ports:
a. Injection port should be scrubbed one minute with alcohol
prior to
use or 30 minutes with betadine
b. Place needle completely in port and tape securely
x. 3Way stopcock – keep unused port with sterile cap and change
after each use
xi. Small vein needles – recommend using small gauge needle – decrease
trauma and likelihood of infection.
xii. Plastic Cannulas: Sometimes increased infection occurs –
cannula can touch skin when being maneuvered in.
xiii.Skin preparation:
a. Wash hands
b. thoroughly cleanse skin .
c. clip hair when necessary
d. use new tourniquet for each patient
 4. I.V. Associated infections:

If contamination is suspected, culture may be obtained notify Infection Control

Nurse.

Sources of Contamination .

i. Medication additives
ii. Glass ampules
iii. I.V. fluids
iv. Blood; check expiration dates

Reducing Levels of Contamination

1. Filters – remove particulates, bacteria and air

2. Not a substitute for sterile techniques
 Remember:

“Early detection and good communication between patient

and healthcare provider are both important in minimizing
IV therapy complications.”