INFILTRATION Causes Dislodgement of the intravenous cannula from the vein which results in infusion of fluid into the

surrounding tissues. Clinical Manifestations Swelling, blanching, and coolness of surrounding skin and tissue. Discomfort, depending on nature of solution. Fluid flowing more slowly or ceasing. Absence of blood backflow in intravenous catheter and tubing. Nursing Interventions: 1.) Stop the infusion immediately and remove the intravenous needle or catheter. 2.) Restart the intravenous in the other arm. 3.) If infiltration is moderate to severe, apply warm, moist compresses and elevate the limb. 4.) If a vasoconstrictor agent (eg, norepinephrine bitartrate, dopamine) or vesicant has infiltrated, initiate emergency local treatment as directed. Serious tissue injury, necrosis, and sloughing may result if actions are not taken. 5.) Document interventions and assessments. Preventive Measures Make sure that the intravenous and the distal tubing are secured sufficiently with tape to prevent movement. Splint the patients arm or hand as necessary. Check the intravenous site frequently for complications.

THROMBOPHLEBITIS Causes Injury to vein during venipuncture, largebore needle or catheter use, or prolonged needle or catheter use. Clinical Manifestations Preventive Measures

Tenderness at first, Anchor the needle or catheter securely at then pain along the the insertion site. vein. Change the insertion site every 72hours Swelling, warmth, in adult patients (it may not be feasible to and redness at remove short-term catheters in neonates infusion sites; the and pediatric patients every 72 hours; Irritation to vein due vein may appear as however, they should be removed to rapid infusions or a red streak above immediately if contamination or

irritating solutions the insertion site. (eg, hypertonic glucose solutions, cytotoxic agents, strong acids or alkalis, potassium, and others); smaller veins are more susceptible. Clot formation at the end of the needle or catheter due to slow infusion rate. More commonly seen with synthetic catheters than steel needles. Nursing Interventions:

complications are suspected). Peripheral (short-term) catheters placed during an emergency where aseptic techniques could have been compromised should be removed no later than 48 hours. Use large veins for irritating fluid because of higher blood flow, which rapidly dilutes the irritant. Sufficiently dilute irritating agents before infusion.

1.) Apply cold compresses immediately to relieve pain and inflammation. 2.) Follow the moist, warm compresses to stimulate circulation and promote absorption. 3.) Document interventions and assessment.

BACTEREMIA Causes Underlying phlebitis. Clinical Manifestations Elevated temperature, chills Preventive Measures Follow the same measures as outlines for thrombophlebitis. Use strict sterile technique when inserting the intravenous or changing the intravenous dressing. Solutions should never hang longer than 24 hours. Change the insertion site every 72 hours in an adult patient and within 48 hours if catheter was placed in an emergent situation.

Contaminated Nausea, vomiting equipment or Elevated white infused solutions blood cell (WBC) Prolonged count placement of an intravenous device Malaise, increased (catheter or needle, pulse tubing, solution Backache, container) headache

Nonsterile intravenous insertion or dressing change. Crosscontamination by the patient with other infected areas if the body. A critically ill or immunosuppressed patient is at greatest risk of bacteremia.

May progress to Change continuous intravenous septic shock with administration sets no more frequently than profound every 72 hours and intermittent intravenous hypotension administration sets every 24 hours. Possible signs of Change intravenous dressing on a routine local infection at basis and immediately if it becomes intravenous compromised. insertion site (eg, a.) Gauze dressing that prevents redness, pain, foul visualization of the site should be drainage) changed every 48 hours. b.) Transparent semipermeable dressing on peripheral short-term site should be changed at site change or if the dressing loses its integrity. c.) Transparent semipermeable dressing on central line sites should be changed at least every 7 days. Maintain skin integrity of the infusion set.

Nursing Interventions: 1.) Discontinue infusion and intravenous cannula. 2.) Intravenous device should be removed and the tip cut off with sterile scissors, placed in a dry sterile container, and immediately sent to the laboratory for analysis. 3.) Check vital signs; reassure the patient. 4.) Obtain WBC count, as directed, and assess for the other sites of infection (urine, sputum, wound). 5.) Start appropriate antibiotic therapy immediately after receiving orders. 6.) Document interventions and assessments.

CIRCULATORY OVERLOAD Clinical Causes Manifestations Delivery excessive amounts of Increased pulse of Increased BP

Preventive Measures and Know whether patient has existing heart or kidney condition. Be particularly vigilant in the high-risk patient. CVP,

intravenous fluid (greater risk exists for elderly patients, infants, or patients with cardiac or renal insufficiency)

venous distension (engorged jugular Closely monitor the infusion flow rate. Keep accurate intake and output records. veins) Headache, anxiety Shortness of breath, tachypnea, coughing Pulmonary crackles Chest pain (if history of coronary artery disease) Splint the arm or hand if the intravenous flow rate fluctuates too widely with movement.

Nursing Interventions: 1.) Slow infusion to a keep-open rate and notify the health care provider. 2.) Monitor closely for worsening condition. 3.) Raise the patients head to facilitate breathing.

AIR EMBOLISM Causes A greater risk exists in central venous lines, when air enters catheter during tubing changes (air sucked in during inspiration due to negative intrathoracic pressure) Clinical Manifestations Preventive Measures

Drop in BP, Clear all air from tubing before infusion to elevated heart rate patient. Cyanosis, tachypnea Rise in CVP Change solution containers before they run dry.

Ensure that all connections are secure. Always use luerlock connections on Changes in mental central lines. status, loss of consciousness Use precipitate and air-eliminating filters unless contraindicated. Air in tubing delivered by Change intravenous tubing during intravenous push or expiration. infused by infusion pump. Nursing Interventions: 1.) Immediately turn the patient on his left side and lower the head of the bed; in this

2.) 3.) 4.) 5.)

position, air will rise to right atrium. Notify the health care provider immediately. Administer oxygen as needed. Reassure the patient. Document interventions and assessments.

MECHANICAL FAILURE (SLUGGISH INTRAVENOUS FLOW) Causes Clinical Manifestations Preventive Measures Needle lying against Check the intravenous often for the side of the vein, Sluggish intravenous patency and kinking. cutting off fluid flow flow Secure the intravenous well with tape Clot at the end of the Alarm of flow and an arm board, if necessary. catheter or needle regulator sounding Infiltration of May be signs of local intravenous cannula irritationswelling, coolness of skin Kinking of the tubing or catheter Nursing Interventions: 1.) Remove tape and check for kinking of tubing or catheter. 2.) Pull back the cannula because it may be lying against wall of vein, vein valve, or vein bifurcation. 3.) Elevate or lower needle to prevent occlusion of bevel. 4.) Move the patients arm to new position. 5.) Lower the solution container to below the level of patients heart and observe for blood backflow. 6.) If an electronic flow-rate regulator is in use, check its integrity. 7.) If none of the preceding steps produces the desired flow, remove the needle or catheter and restart infusion.

HEMORRHAGE Causes Clinical Manifestations Preventive Measures Cap all central lines with luer-lock adapters and connect luer-lock tubing to the capnot directly to the line. Tape all catheters securelyuse

Loose connection of Oozing or trickling of tubing or injection port blood from intravenous site or Inadvertent removal of catheter peripheral or central

catheter Hematoma Anticoagulant therapy

transparent dressing when possible for peripheral and central catheters. Tape the remaining catheter lumens and tubing in a loop so tension is not directly on the catheter. Keep pressure on sites where catheters have been removed (a minimum of 10 minutes for a patient taking anticoagulants).

VENOUS THROMBOSIS Clinical Causes Manifestations Infusion irritating solutions

Preventive Measures

of Slowing of Ensure proper dilution of irritating substances. intravenous infusion or inability to draw Ensure superior vena cava catheter tip blood from the placement for irritating solutions. Infection along central line catheter may preclude this Swelling and pain in syndrome the area of catheter or in the extremity Clot formation proximal to the around the intravenous line. catheter (This clot will eventually occlude the vein.) Nursing Interventions: 1.) Stop fluids immediately and notify health care provider. 2.) Reassure the patient and institute appropriate therapy: a.) Anticoagulants b.) Heat c.) Elevation of affected extremities d.) Antibiotics