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SIGN OF COMPLICATION OF INTRAVENOUS THERAPY
1. Air embolism :- it is define as a bolus of air enter the vein through an inadequately primed IV line, from a loose connection, during tubing change, or during removal of the IV.
Prevention and intervention -
• prime tubing with fluid before use, and monitor for any air bubbles in the tubing.
• secure all connections.
• replace the IV fluid before the bag or bottle is empty.
• monitor for sign of air embolism, if suspected clamp the tubing, turn the client on the left side with head of the bed lowered ( Trendelenburg position ) to trap the air on the right atrium and notify the senior staff or doctor.
2. Catheter embolism :- it is define as an obstruction that results from breakage of the catheter tip during IV line insertion or removal.
Prevention and intervention :-
• remove the catheter carefully.
• inspect the catheter when removed.
• if the catheter tip has broken off, place a tourniquet as proximally as possible to the IV site on the affected limb, notify the senior or doctor immediately, prepare to obtain a radiograph, and prepare the client for surgery to remove the catheter piece if necessary.
3. Circulatory overload :- it is also known as FLUID OVERLOAD, result from the administration of fluid too rapidly, especially in a client at risk for fluid overload
Prevention and intervention :-
•identity client at risk for circulatory overdose.
• calculate and monitor the drip ( flow) rate frequently.
• use an electronic IV infusion device and frequently check the drip rate or setting at least every hours.
• add a time label to the IV bag or bottle next to the volume markings.
• . Monitor for sign of circulatory overdose. If circulatory overdose occur, decrease the flow rate to a minimum, at a keep vein open rate, elevate the head of the bed, keep the client warm, assess lung sounds, assess for edema, and notify the senior or doctor.
Client with respiratory, cardiac, renal or liver disease, older client and very young person's are at the for circulatory overdose and cannot tolerate excessive fluid volume.
4. Electrolyte overdose :- it is define as an electrolyte imbalance is caused by too rapid or excessive infusion or by use of an inappropriate IV solution.
Prevention and intervention :-
• assess laboratory value reports.
• verify the correct solution.
• calculated and monitor the flow rate.
•place a red medication sticker on the bag or bottle if a medication has been added to the IV solution.
• monitor for sign of an electrolyte imbalance, and notify the senior.
Lactated Ringer's solution contains potassium and should not be administered to client with acute kidney injury or chronic kidney disease.
5. Hematoma :- the collection of blood in the tissue after an unsuccessful vein puncture or after the vein puncture site is discontinued and blood continues to ooze the tissue.
Prevention and intervention :-
• when starting an IV, avoid piercing the posterior wall of the vein.
• do not apply a tourniquet to the extremity immediately after an unsuccessful vein puncture.
• when discontinuing an IV, apply pressure to the site for 2 to 3 minutes and elevate the extremity.
• if a hematoma develops, elevate the extremity and apply pressure and ice.
6. Infection :- infection occurs from the entry of microorganisms into the body through the vein puncture site.
prevention and intervention :-
- maintain asepsis when caring IV site.
- monitor for sign of local or systemic infection.
- monitor WBC count
- change IV tubing every 96 hours in according agency policy
- label the IV site bag, bottle and tubing with date to ensure that these are changed.
- ensure that IV solution is not hanging for more than 24 hours.
a client with diabetes mellitus usually does not receive dextrose (glucose) solution because the solutions can increase the blood glucose level.7. Infiltration :- infiltration is seepage of the IV fluid out of the vein and into the surrounding interstitial spaces.
prevention and intervention :-
- avoid vein puncture over an flexion.
- anchors the cannula and a loop of tubing securely with tape.
- use an arm board or splint as needed if the client is restless or active.
- evaluate the IV site for infiltration by occluding the vein proximal to the IV site.
- if the infiltrations has occurs remove the IV device immediately.
8. Phlebitis and thrombophlebitis :- phlebitis is an inflammation of the vein that can occurs from mechanical or chemical trauma or from local infection.
phlebitis can cause the development of a clot (thrombophlebitis).
prevention and intervention:-
- use the IV cannula smaller than the vein and avoid using very small vein when administering irritating solutions.
- avoid using the lower extremity( leg and feet) as an access area for the IV.
- change vein puncture site every 72 to 92 hours in according to agency policy.
- if phlebitis occurs remove IV devices.
9. tissue damage :- tissues are most common damaged include skin, veins and subcutaneous tissues.
extravasation is a from of tissues damage caused by the seepage of vesicants or irritating solutions into the tissues.
prevention and intervention :-
- use a careful and rental approach when applying a tourniquet.
- avoid tapping the skin over the vein when starting an IV.
- monitor ecchymosis when penetrating the skin with the cannula,.
- monitor skin color change, sloughing of the skin or discomfort at the IV sites.
always documentation the occurrence of a complication assessment finding action taken and client response.
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Complication
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sign
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Air embolism
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Tachycardia
Chest pain or dyspnea
Hypotension
Cyanosis’
Decreased level of consciousness
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Catheter embolism
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Decreased in blood pressures
Pain along the vein
Weak, rapid pulse
Cyanosis of the nail beds
Loss of consciousness
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Circulatory overload
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Increase blood pressure
Distended jugular vein
Rapid breathing
Dyspnea
Moist cough and crackles
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Electrolyte overload
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Sign depend on the specific electrolyte overload
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hematoma
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Ecchymosis, immediate swelling and leakage of blood at the site,
Hard and painful lumps at the
site
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infection
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Local – redness, swelling and drainage at the site
Systemic – chills ,fever, malaise, headache, nausea , vomiting,
backache, tachycardia
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Infiltration
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Edema, pain, numbness and coolness at the sites; may or may not have
a blood return
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Phlebitis
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Heat, redness, tenderness at the sites
Not swollen or hard
Intravenous infusion sluggish
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thrombophlebitis
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Hard and cordlike vein , heat, redness, tenderness at the sites
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Tissues damage
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Skin color changes, sloughing of the skin,
Discomfort at the sites
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do not rub the an infiltration area , which can cause hematoma.
