i.v.

essentials

Complications of
peripheral I.V. therapy

IF YOUR PATIENT is receiving peripheral ■ Stay with your patient for 5 to 10 min-
I.V. therapy, you’ll need to watch for signs utes to detect early signs and symptoms of
and symptoms of complications, such as: hypersensitivity, such as sudden fever, joint
■ hypersensitivity swelling, rash, urticaria (hives), broncho-
Sometimes, I
■ infiltration spasm, and wheezing.
can get a bit
■ extravasation ■ If he’s receiving the drug for the first or
complicated... ■ phlebitis second time, check him every 5 to 10 min-
■ infection. utes or according to your facility’s policy.
We’ll fill you in on how to recognize these An immediate, severe reaction is life-
complications and walk you through how to threatening, so prompt recognition and
treat them, with an eye on prevention. treatment are imperative.
At the first sign of hypersensitivity:
You’re so sensitive ■ Discontinue the infusion and notify the
Before you adminis-
ter an I.V. medica-
tion, take steps to
Running down the infiltration scale
Use these classifications when documenting instances of infiltration.
find out if your pa-
tient may be prone Degree Description
to hypersensitivity: 0 • No symptoms
■ Ask him if he has 1+ • Skin blanched
any allergies, in- • Edema less than 1 inch (2.5 cm) in any direction
cluding allergies to • Cool to touch
food or pollen. • With or without pain
■ Ask if he has a 2+ • Skin blanched
family history of al- • Edema 1 to 6 inches (2.5 to 15 cm) in any direction
lergies; if he does, • Cool to touch
• With or without pain
he’s more likely to
3+ • Skin blanched, translucent
develop a drug hy-
• Gross edema more than 6 inches in any direction
persensitivity. • Cool to touch
■ If your patient is • Mild to moderate pain
an infant less than • Possible numbness
age 3 months, ask 4+ • Skin blanched, translucent, tight, leaking, discolored, bruised,
the mother about swollen
her allergy history • Gross edema more than 6 inches in any direction
because maternal • Deep, pitted tissue edema
antibodies may still • Circulatory impairment
be present. • Moderate to severe pain
• Infiltration of any blood product, irritant, or vesicant
After giving an
I.V. medication, fol-
Source: Infusion Nurses Society, Infusion Nursing Standards of Practice, Journal of Infusion
low through with Nursing, January/February 2006.
these precautions:

14 Nursing made Incredibly Easy! January/February 2008

health care provider immediately.
■ Administer medications as ordered.
■ Monitor the patient’s vital signs and pro-
vide emotional support.
Just say no to infiltration
Infiltration occurs when I.V. fluid leaks into
surrounding tissue. It’s commonly caused
by improper placement or dislodgment of
the catheter. When the tip of the catheter is
positioned near a flexion area, patient
movement may cause the catheter to slip
out or through the lumen of the vessel. The
risk of infiltration increases in older patients
because their veins are thin and fragile.
Signs and symptoms of infiltration
include:
■ swelling
■ discomfort
■ burning
■ tightness
■ cool skin
■ blanching.
If only a small amount of an isotonic solu-
tion or nonirritating drug infiltrates, the
patient usually experiences only mild dis-
comfort. Here’s what you need to do:
■ Stop the infusion and remove the device
(unless the medication is a vesicant; consult
the health care provider and pharmacy).
■ Elevate the limb to increase patient com-
fort.
■ Check the patient’s pulse and capillary
refill time.
■ Counteract the effects of the drug as or-
dered.
■ Perform venipuncture in a different loca-
tion and restart the infusion.
■ Check the site frequently.
■ Document your findings using the infil-
tration scale (see Running down the infiltra-
tion scale).
Extra! Extra! Extravasation
suspected!
Extravasation, the leaking of vesicant drugs
(such as antineoplastics) into surrounding
tissue, 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:
memory ■ Strictly adhere to
jogger proper administra-
As soon as you spot tion techniques.
Get to know
infiltration, think of ■ Avoid using the
the three C’s: back of the hand
the signs and
Cut off (the infusion) where tendon and symptoms to
Counteract (the
nerve damage is watch out for.
effects of the drug)
more likely.
Contain (the affect-
■ Avoid using the
ed area).
wrist and fingers be-
cause they’re hard
to immobilize and
areas with previous
damage or poor circulation.
■ Give vesicants last when multiple drugs
are ordered.
Signs and symptoms of extravasation
include:
■ blanching, burning, or discomfort at the
I.V. site
■ cool skin around the I.V. site
■ swelling at or above the I.V. site.
If you suspect extravasation, follow your
facility’s protocol. Take these essential steps:
■ Stop the I.V. flow and remove the I.V.
line, unless the catheter should remain in
place to administer the antidote.
■ Estimate the amount of extravasated so-
lution and notify the health care provider.
■ Instill the appropriate antidote according
to your facility’s protocol.
■ Elevate the extremity.
■ Record the extravasation site, your pa-
tient’s symptoms, the estimated amount of
extravasated 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 a
common complication of peripheral I.V.
therapy that’s associated with acidic or al-
kaline solutions or those that have a high
osmolarity. Other factors include:
■ vein trauma during insertion
■ using a vein that’s too small
■ using a vascular access device that’s too
large
■ prolonged use of the same I.V. site.
Phlebitis can follow any infusion, but it’s
January/February 2008 Nursing made Incredibly Easy! 15
 i.v. essentials

most common after continuous infusions, Use a transparent

Together,
developing 2 to 3 days after the vein is memory semipermeable
we can keep exposed to the drug or solution. It develops jogger dressing so you can
I.V. therapy more rapidly in distal veins than in veins Here’s a handy tip: see the skin distal
complication close to the heart. Phenytoin and diazepam When administering to the tip of the
free! can produce phlebitis after one or more vesicants I.V., think catheter as well as
injections at the same I.V. site. Large doses hands off! Avoid the insertion site.
the back of the hand
of potassium chloride, amino acids, dextrose If you suspect
(where damage from
solutions, and multivitamins can cause phlebitis, follow
extravasation is
phlebitis as well. Certain irritating I.V. drugs these steps:
more likely) and the
are also likely to cause phlebitis when pig- wrist and fingers ■ At the first sign
gybacked, including: (which are hard to of redness or ten-
■ erythromycin immobilize). derness, stop the
■ tetracycline infusion.
■ nafcillin ■ To ease your
■ vancomycin patient’s discomfort, apply warm packs.
■ amphotericin B. ■ Document your patient’s condition and
Take these steps to prevent phlebitis: interventions.
■ Use proper venipuncture technique. ■ If indicated, insert a new catheter at a
■ If necessary, dilute drugs correctly. different site, preferably on the opposite
■ Monitor administration rates. arm, using a larger vein or a smaller device
■ Observe the I.V. site frequently. and restart the infusion.
■ Change the infusion site regularly ac-
cording to your facility’s policy. Infection detection
Signs and symptoms of phlebitis include: A patient receiving I.V. therapy may de-
■ redness or tenderness at the tip of the velop a local or systemic infection. Monitor
catheter your patient for signs and symptoms of in-
■ puffy area over the vein fection, such as redness and discharge at
■ elevated temperature. the I.V. site or an elevated temperature. If
To detect phlebitis, inspect the I.V. site the infection is systemic:
several times a day (see Classifying phlebitis). ■ Stop the infusion.
■ Notify the health care provider.
■ Remove the device.
Classifying phlebitis ■ Culture the site and device as ordered.
Use these classifications when documenting phlebitis. ■ Administer medications as prescribed.
■ Monitor the patient’s vital signs.
Degree Description
0 • No signs and symptoms
1+ • Erythema with or without pain
Let’s not get too complicated
Complications of peripheral I.V. therapy
2+ • Erythema with pain
• Edema may or may not be present.
can be serious, but with your careful atten-
3+ • Erythema with pain tion and eye on prevention, you can help
• Edema may or may not be present. your patient avoid these pitfalls. ■
• Streak formation
• Palpable cord Learn more about it
4+ • Erythema with pain Infusion Nurses Society. Infusion Nursing Standards of
• Edema may or may not be present. Practice. Journal of Infusion Nursing. 29(1, Suppl.):S1-S92,
January/February 2006.
• Streak formation
I.V. Therapy: An Incredibly Easy Pocket Guide. Philadelphia,
• Palpable cord longer than 1 inch (2.5 cm) Pa., Lippincott Williams & Wilkins, 2006:174-177.
• Purulent drainage I.V. Therapy Made Incredibly Easy!, 3rd edition. Philadel-
phia, Pa., Lippincott Williams & Wilkins, 2006:187-189.
Source: Infusion Nurses Society, Infusion Nursing Standards of Practice, Journal of Infusion Smeltzer SC, et al. Brunner and Suddarth’s Textbook of
Nursing, January/February 2006.
Medical-Surgical Nursing, 11th edition. Philadelphia, Pa.,
Lippincott Williams & Wilkins, 2007:350-351.

18 Nursing made Incredibly Easy! January/February 2008