Hazards/Complications of IV Therapy
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
1) Phlebitis
Is the inflammation of vein. If it is associated with clot formation as well , it is known as thrombophlebitis.
Signs and symptoms
Redness
Swelling
Pain
Edema at the insertion site and or along the vein
Causes
Poor blood blow around the venipuncture device
Friction from catheter movement in the vein.
Cannula too large for vein
Cannula inserted near a joint, creating piston motion against vein wall when patient moves
Inadequate dressing and securement
Clotting at the catheter tip
Remedy
Removal of the catheter
Use smallest gauge cannula in largest vein possible
Apply warm moist compress (ie. body temperature) to site for 20 mins, 6 hourly for 24 hours
2) Extravasation
Occurs when the venipuncture device is dislodged from the vein.
It is the accidental administration of IV infused drugs into the surrounding tissues which are caustic to these tissues either by leakage or directly
This occurs more frequently with chemotherapeutic agents and people who have tuberculosis
Signs and symptoms
Swelling at and above the limb
Discomfort, burning or pain at the site
Tightness at the site
Treatment
Stop the infusion, delivery of a local antidote
3) Catheter dislodgement
Occurs when the catheter backs out of the vein
The IV solution may infiltrate.
Treatment
Treating the infiltration, Dressing old site.
4) Occlusion
Occurs when fluid or medication cannot enter the vein
The IV flow is interrupted, and blood may be backed up in the tubing/heparin or saline lock
Treatment
Flush with mild pressure
Remove the IV and start the new line
5) Vein irritation
Occurs due to solution with high or low pH, high osmolarity (such as potassium chloride, phenytoin, vancomycin, erythromycin and nafcillin).
Signs and symptoms
Pain at the site
Red skin over the vein
Phlebitis
Treatment
Decreasing the flow rate
Diluting the infusions
6) Hematomas
Means blood clotting in the extravascular space
- Occurs when the blood leaks into the extravascular space
- Patient will have tenderness at the site
- Bruise may be evident at the site
- Infusion will not flow
Treatment
The IV catheter must be removed and restarted elsewhere
Pressure should be applied unless the bleeding stops
Warm soaks to aid in the absorption of blood
7) Venous spasms
Occurs due to severe vein irritation, administration of cold fluids or blood and a very rapid flow rate.
Symptoms
Pain at the IV site
Flow rate will become sluggish
Treatment
Warm soaks over the vein
Reduction in flow rate of infusate
8) Vasovagal reactions
- Occurs when the patient experiences vasospasms from anxiety or pain.
- The vein suddenly collapses during the venipuncture and causes the patient to become pale, diaphoretic, faint, dizzy and nauseated.
- The patient may also have sudden drop in blood pressure…….
Treatment
Lower the head of the bed and have the patient take slower breathing while you monitor vital signs.
The reactions should resolve quickly.
9) Thrombosis
Occurs when the platelets adhere to the tunica intima of the vein due to vessel injury during venipuncture.
The vein will appear painful, red and swollen.
The I/V infusate will not run quickly.
Treatment
Remove I/V catheter
Start I/V line in the other arm
Warms soaks can also be applied
10) Nerve, Tendon, or ligament damage
It occurs due to improper venipuncture technique, tight taping, or improper arm band application
The patient will experience extreme pain at the insertion site, numbness, muscle contraction and eventually may exhibit paralysis, numbness, or paralysis.
11) Circulatory overload
It occurs when the I/V roller clamp is loosened and the I/V infusate run quickly through the vein.
The patient may become anxious, experience respiratory distress, increased blood pressure and neck engorgement.
Treatment includes raising the head of the bed, administer oxygen and I/V furosemide and prompt notification of the physician.
12) Systemic infection or Bacteremia
It occurs as a result of phlebitis, poor taping that allows the venipuncture device to move in and out of the vein, prolong dwell time of the catheter and failure to maintain aseptic technique during insertion or site care.
The patient may experience malaise, fever, and chills.
Treatment includes contacting the physician, culturing the site and device, administering antibiotics and hemodynamic support.
13) Air Embolism
A blood clot, a solid mass or an air bubble can be delivered into the circulation through an I/V and end up blocking a vessel.
This is called embolism
o It occurs when the solution container runs empty, and air is pushed down into the patient vein.
o The patient will experience respiratory distress, unequal breath sounds, a weak pulse, increased central venous pressure, loss of consciousness.
o If air embolism is suspected, discontinue the infusion, place the patient in Trendelenburg, administer oxygen and notify the physician.
14) Allergic reaction
It may occur when the patient is allergic to catheter that has been inserted or the medications being administered.
The patient will itch, develop watery eyes and nose, experience bronchospasm, wheezing and possibly anaphylaxis.
If a reaction does occur, stop the infusion, or discontinue the catheter.
Notify the physician.
Maintain airway.
Administration of anti-histamine, steroid or epinephrine may help