IF YOUR PATIENTis receiving peripheralI.V. therapy, you’ll need to watch for signsand symptoms of complications, such as:
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hypersensitivity
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infiltration
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extravasation
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phlebitis
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infection.We’ll fill you in on how to recognize thesecomplications and walk you through how totreat them, with an eye on prevention.
You’re so sensitive
Before you adminis-ter an I.V. medica-tion, take steps tofind out if your pa-tient may be proneto hypersensitivity:
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Ask him if he hasany allergies, in-cluding allergies tofood or pollen.
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Ask if he has afamily history of al-lergies; if he does,he’s more likely todevelop a drug hy-persensitivity.
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If your patient isan infant less thanage 3 months, askthe mother abouther allergy history because maternalantibodies may still be present.After giving anI.V. medication, fol-low through withthese precautions:
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Stay with your patient for 5 to 10 min-utes to detect early signs and symptoms ofhypersensitivity, such as sudden fever, jointswelling, rash, urticaria (hives), broncho-spasm, and wheezing.
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If he’s receiving the drug for the first orsecond time, check him every 5 to 10 min-utes or according to your facility’s policy.An immediate, severe reaction is life-threatening, so prompt recognition andtreatment are imperative.At the first sign of hypersensitivity:
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Discontinue the infusion and notify the
14Nursing made Incredibly Easy!
January/February 2008
Complications of peripheral I.V. therapy
Sometimes, Ican get a bitcomplicated...
Running down the infiltration scale
Use these classifications when documenting instances of infiltration.Degree01+2+3+4+
Source: Infusion Nurses Society, Infusion Nursing Standards of Practice,
Journal of InfusionNursing
,January/February 2006.
Description•No symptoms•Skin blanched•Edema less than 1 inch (2.5 cm) in any direction•Cool to touch•With or without pain•Skin blanched•Edema 1 to 6 inches (2.5 to 15 cm) in any direction•Cool to touch•With or without pain•Skin blanched, translucent•Gross edema more than 6 inches in any direction•Cool to touch•Mild to moderate pain•Possible numbness•Skin blanched, translucent, tight, leaking, discolored, bruised,swollen•Gross edema more than 6 inches in any direction•Deep, pitted tissue edema•Circulatory impairment•Moderate to severe pain•Infiltration of any blood product, irritant, or vesicant
i.v.
essentials
health care provider immediately.
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Administer medications as ordered.
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Monitor the patient’s vital signs and pro-vide emotional support.
Just say no to infiltration
Infiltration occurs when I.V. fluid leaks intosurrounding tissue. It’s commonly caused by improper placement or dislodgment ofthe catheter. When the tip of the catheter ispositioned near a flexion area, patientmovement may cause the catheter to slipout or through the lumen of the vessel. Therisk of infiltration increases in older patients because their veins are thin and fragile.Signs and symptoms of infiltrationinclude:
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swelling
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discomfort
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burning
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tightness
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cool skin
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blanching.If only a small amount of an isotonic solu-tion or nonirritating drug infiltrates, thepatient usually experiences only mild dis-comfort. Here’s what you need to do:
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Stop the infusion and remove the device(unless the medication is a vesicant; consultthe health care provider and pharmacy).
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Elevate the limb to increase patient com-fort.
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Check the patient’s pulse and capillaryrefill time.
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Counteract the effects of the drug as or-dered.
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Perform venipuncture in a different loca-tion and restart the infusion.
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Check the site frequently.
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Document your findings using the infil-tration scale (see
Running downthe infiltra-tion scale
).
Extra! Extra! Extravasationsuspected!
Extravasation, the leaking of vesicant drugs(such as antineoplastics) into surroundingtissue, can cause severe local tissue damage,resulting in delayed healing, infection, tis-sue necrosis, disfigurement, loss of function,and even amputation.To help prevent extravasation when giv-ing vesicants:
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Strictly adhere toproper administra-tion techniques.
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Avoid using the back of the handwhere tendon andnerve damage ismore likely.
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Avoid using thewrist and fingers be-cause they’re hardto immobilize andareas with previousdamage or poor circulation.
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Give vesicants last when multiple drugsare ordered.Signs and symptoms of extravasationinclude:
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blanching, burning, or discomfort at theI.V. site
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cool skin around the I.V. site
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swelling at or above the I.V. site.If you suspect extravasation, follow yourfacility’s protocol. Take these essential steps:
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Stop the I.V. flow and remove the I.V.line, unless the catheter should remain inplace to administer the antidote.
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Estimate the amount of extravasated so-lution and notify the health care provider.
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Instill the appropriate antidote accordingto your facility’s protocol.
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Elevate the extremity.
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Record the extravasation site, your pa-tient’s symptoms, the estimated amount ofextravasated solution, and the treatment.Follow the manufacturer’s recommenda-tions to apply either ice packs or warm com-presses to the affected areas.
Fighting phlebitis
Phlebitis, or inflammation of a vein, is acommon complication of peripheral I.V.therapy that’s associated with acidic or al-kaline solutions or those that have a highosmolarity. Other factors include:
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vein trauma during insertion
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using a vein that’s too small
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using a vascular access device that’s toolarge
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prolonged use of the same I.V. site.Phlebitis can follow any infusion, but it’s
January/February 2008
Nursing made Incredibly Easy!15
memory jogger
As soon as you spotinfiltration, think ofthe three C’s:
C
ut off (the infusion)
C
ounteract (theeffects of the drug)
C
ontain (the affect-ed area).
Get to know the signs andsymptoms towatch out for.
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