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Risk and complications of IV. Therapy

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by

Ryanjames Gaspar

on 19 April 2013

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Transcript of Risk and complications of IV. Therapy

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. Are such complications occuring at a confined, particular and specific organ or body part. Local Complications Systemic Complication Kinds of I.V.Risks and Complications Objectives Differentiate between local and systemic complications.
Describe the signs and symptoms of local complications.
Identify prompt treatment for local and systemic complications.
Identify Standards of nursing practice.
List three risk factors for phlebitis.
Identify organisms responsible for septicemia related to infusion therapy.
Identify prevention techniques for the systemic complications. Risks and Complications of Intravenous
Therapy 1. Hematoma:
Formations resulting from the infiltration of blood into the tissues at the Venipuncture site. 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. Treatment:
Apply direct, light pressure for 2-3 minutes after needle removed
Have patient elevate extremity
Apply Ice Prevention:
Apply tourniquet just before venipuncture
Use a small needle in the elderly and patients on steriods, or patients with thin skin.
Use blood pressure cuff to apply pressure
Be gentle Trauma to the endothelial cells of the venous wall causes red blood cells to adhere to the vein wall, forms a clot. 2. Thrombosis Catheter-related obstructions can be categorized as mechanical or non-thrombotic ( 42% of all obstructions)
or thrombotic (58% of all obstructions), Signs and Symptoms:

Fever and malaise.
Slowed or stopped infusion rate.
Inability to flush licking device. Thrombosis
Types of Thrombus or occlusion Persistent withdrawal occlusion
Partial occlusion
Complete occlusion
Fibrin tail
Fibrin sheath
Mural thrombosis Goal Patient Care Excellence
and competence
Prepared By
Erlie F. Gaspar RN
E.R. Dept. Head Nurse Prevention
Use pumps and controllers to manage flow rate
Microdrip tubing for rate below 50mL/hr
Avoid areas of flexion
Use filters
Avoid lower extremeties -An inflammation of the vein. 3. Phlebitis Mechanical:
Too large catheter for the size of the vein
Manipulation of the catheter: improper stabilization
Chemical: vein becomes inflamed by irritating or vessicant solutions or medication
Irritation medication or solution
Improperly mixed or diluted
Too-rapid infusion
Presence of particulate matter Pyrogens stimulate the hypothalamus to raise body temperature Pyrogens stimulate bone marrow to release more leukocytes Redness and tenderness increase Immune system causes leukocytes to gather at the inflamed site The more acidic the IV solution the greater the risk
Additives: Potassium
Type of material
Length of dwell:
30% by day 2, 39-40% by day 3 (Macki and Ringer)
The slower the rate of infusion the less irritation Bacterial
Also called Septic phlebitis: least common
Inflammation of the intima of the vein
Contributing factors
Poor aseptic technique
Failure to detect breaks in the integrity of the equipment
Poor insertion technique
Inadequate stabilization
Failure to perform site assessment
Aseptic preparation of solutions
Hand washing and preparing the skin Phlebitis Postinfusion:
Inflamation of the vein 48-96 hr after discontinued
Factors that contribute:
Insertion technique
Condition of the vein used
Type, compatibility, pH of solution used
Gauge, size, length, and material
Dwell time
Infrequent dressing change
Host factors: age, gender, age
and presence of disease 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. Nursing Interventions:
Remove IV device.
Apply warm soaks.
Notify primary care provider.
Restart IV infusion in a different extremity.
Document your actions. Prevention
Use larger veins for hypertonic solutions
Central lines for Infusions lasting longer than 5 days Thrombophlebitis denotes a twofold injury: thrombosis and inflammation
Related to:
Use of veins in the lower extremity
Use of hypertonic or highly acidic infusion solutions
Causes similar to those leading to phlebitis 4.Thrombophlebitis 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. Prevention
Use veins in the forearm rather than the hands
Do not use veins in a joint
Assess site q 4 hr in adults, q 2 hr in children
Catheter securment
Infuse at rate prescribed
Use the smallest size catheter to do the job
Proper dilution Septic thrombophlebits can be prevented:
Appropriate skin preparation
Aseptic technique in the maintance of infusion
Proper hand hygiene
60% from patients skin
35% from the line itself
5% from hands Accidental administration of a non vesicant solution into surrounding tissue.
Dislodgment of the catheter from the vein
Second to phlebitis as a cuase of IV therapy morbidity 5. Infiltration 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. Discontinue the infusion.
Apply warm, moist heat to ↓edema.
Elevate the extremity.
Restart the infusion at another site, preferable the other arm. Treatment of Infiltration Select site over long bone to act as a splint.
Avoid sites over joints.
Use arm board to stabilize (as a last resort!). Prevention of Infiltration The accidental administration of a vesicant solution into surrounding tissue.
Vesicant is a fluid or medication that causes the formation of blisters, with subsequent sloughing of tissues occurring from the tissue necrosis
Related Factors:
Puncture of the distal wall
Mechanical friction
Dislodgement of the catheter 6. Extravasations 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. Stop the infusion, and elevate extremity.
Remove the cannula.
Call physician.
Administer antidote (if appropriate) intradermally into infiltrated tissue.
Apply warm moist compresses for 20 minutes every 4 hours (see hospital policy). Extravasations Interventions Prevention:

Use of skilled practitioners
Knowledge of vesicants
Condition of the patients veins
Drug administration technique
If continuous give in CVAD
Only with brisk blood return of 3-5 cc
Use of a free flow IV
Do not use a pump on vesicants given peripherally
Assess for blood return frequently 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. 7. Local infection 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 8. Venous spasm 1. Septicemia:
A febrile disease process that results from the presence of microorganisms or their toxic products in the circulatory system. Signs and Symptoms:
Fluctuating fever, tremors, little cold sweat, nausea and vomiting, diarrhea, abdominal pain.
Tachycardia, increased respirations or hyperventilation, altered mental status, and hypotension 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. Septicemia Interventions Caused by infusing excessive amounts of isotonic or hypertonic crystalloid solutions to rapidly, failure to monitor the IV infusion or too-rapid infusion of any fluid in a patient compromised by cardiopulmonary or renal disease. 2. Fluid overload & Pulmonary
edema
S/S:
Restlessness, headache, tachycardia, weight gain over a short period of time, cough, and presence of edema.
Hypertension, wide variance between intake and output, distended neck veins. Air entering the central vein, which is quickly trapped in the blood as it flows forward. Prevention is the key. 3. Air embolism S/S:
complaints of palpitations, and 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. Nursing Interventions:
Immediately clamp the tubing.
Turn client to left, head down (to allow air to enter right atrium and be dispersed via pulmonary artery)
Monitor vital signs.
Administer O2.
Notify physician.
Document actions.
, and treatment. Occurs when a foreign substance usually a medication is rapidly introduced into the circulation 4. Speed shock S/S: dizziness, facial flushing, headache, tightness in the chest, hypotension, irregular pulse, progression of shock. 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. 5. Catheter embolism On the Client's
Core Concerns
Regarding IVT I. Safety of the procedure II. Therapeutic effect of the procedure on client's condition III. Maximum Possible comfort On the part of the health care provider,
one of the most important concern aside from excellence and competency in performing the procedure is safety.... Therefore, the one must have the knowledge and skills to avoid such risks inevitably accompanied by performing the procedure. Risks associated with IVT I. Needle stick injury -Percutaneous piercing of wound typically set by a needle or any other sharp object/instrument. Prevention Avoid the use of needles where safe and effective alternatives are available.
Avoid recapping of needles
Report all needlestick and other sharps-related injuries to ensure that you received ap't follow-up care.
create / maintain a safe comprehensive disposal system. II. Infectious organism exposure -The time from the movement of exposure to an infection. Prevention Do proper hand hygiene
Do not reuse tourniquets
Wear gloves
Cleanse insertion sites w/ the recommended sol'n.
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