1. Infiltration

2. Extravasation

3. Local Infection

4. Venous Spasm

What are causes of infiltration?

5

Puncture of the distal vein wall during venipuncture.

- Dislodgement of the catheter or needle from the intima of the vein.

- Poorly secured infusion device.

- High delivery rate or pressure from an electronic infusion device.

- Overmanipulation.

Coolness of skin around the site.

- Taut skin.

- Edema at, above or below the insertion site.

- Absence of blood backflow.

Do not use veins that have had previous punctures or veins that are very fragile due to seeping.

- Turn pts carefully.

- Choose smallest IV catheter.

- Stabilize insertion site.

Use warm or cold compresses.

- Elevation of the infiltrated extremity.

- Check infiltration scale. (pg 565)

What causes extravasation?

5

Puncture of the distal vein wall during venipuncture.

- Dislodgement of the catheter or needle from the intima of the vein.

- Poorly secured infusion device.

- High delivery rate or pressure from an electronic infusion device.

- Overmanipulation.

What are s/s of extravasation?

6

Complaints of pain, tenderness or discomfort.

- Edema at, above or below the insertion site.

- Blanching at the area around the insertion site.

- Change in temperature of the skin at the site.

- Burning at the insertion site or along the venous pathway.

- Feeling of tightness below the site.

How can extravasation be prevented?

3

Knowledge of s/s of extravasation.

- Give continuous vesicant administration into a long-term VAD.

- Assess site for blood flow every hour and assess site for tenderness. 

T/F

It is ok for a nurse to photograph a pt injury from extravasation?

True

a nurse is to Photograph the area.

 Discontinue catheter.

- May use thermal manipulations, heat/cold depending on solutions.

- Elevate arm slightly, as tolerated.

- Use of antidotes if controversial:

Sodium bicarbonate

Regitine for vasopressors

Lack of hand hygiene.

- Inappropriate technique to swab needle-free port before access.

- Catheter left in place more than 72hrs.

- Poor technique.

Redness, swelling, induration at the site.

- Temperature changes.

- Possible exudates of purulent material.

- Increased quantity of white blood cells.

- Elevated temperature.

How to prevent local infections?

4

Perform hand hygiene.

- Choose the catheter type, insertion site and technique appropriate for the pt, situation and solution.

- Maintain dressing.

- Maintain aseptic technique during cannula insertion and therapy.

- Notify the physician.

- Culture site as ordered.

- Apply a sterile dressing at site.

- Warm moist compresses.

- Antibiotics as ordered.

Administration of cold infusates.

- Mechanical or chemical irritation of the intima of the vein.

Sharp pain at the IV site that travels up the arm.

- Slowing of the infusion.

How could you prevent a venous spasm?

3

Dilute the medication additive adequately.

- Keep the IV solution at room temperature.

- Deliver the solution at the prescribed rate.

Apply warm compresses to extremity, decrease flow rate until the spasm subsides.

- If the spasm is unrelieved, remove the catheter.

What are the 4 types of SYSTEM COMPLICATIONS

Fluid Overload (pulmonary Edema)

Septicemia

Venous Air Embolism

Speed Shock

What are the causes of Fluid Overload ?

2

 Fluids infused to rapidly

Compromised cardiovascular or renal systems

·         restlessness, HA

·         increase in pulse rate

·         weight gain

·         cough

·         presence of edema

·         hypertension

·         wide variance between I and O

      JVD

What can a nurse do to pevent Fluid Overload?

5

·         Monitor infusion especially NS

·         right flow rate

·         monitor I/O

·         Review client hx.

      Use electronic infusion devices

How to treat Fluid Overload

5

·         Drug therapy:  diuretics, vasodilators

·         oxygen therapy

·         position the patient in semi –fowlers position

·         decrease flow rate

        monitor vital signs

what are the causes of Septicemia?

Patient risk factors:

what are the causes of Septicemia?

practitioner:

·         fluctuating fever, tremors,

·         profuse cold seat

·         nausea and vomiting

·         diarrhea

·         elevated WBC

·         tachycardia

·         evidence of decreased perfusion to organs

reduced urine output

What can a nurse do to prevent Septicemia

4

·         Good hand hygiene

·         Inspect solutions

·         Use luer-lok connections

·         cover infusion sites with a sterile dressing

·         Restart IV

·         Obtain cultures

administer antibiotics, oxygen, fluid, as ordered

what are the causes of a Venous Air Embolism

4

·         Allowing solution container to run dry.

·         Hanging new IV over tubing that has run dry

·         loose connection

·         poor technique in changing lines and dressing for central lines

·         patient complaints of palpitations

·         lightheadedness and weakness

·         dyspnea, cyanosis, tachypnea, pulmonary edema

·         mumur, thread pulse, tachycardia, hypotension

confusion, coma, seizures

How can a nurse prevent a Venous Air Embolism?

3

Vent all air from administration sets

Hang new IV’s before they run dry

Occlusive dressings

·         Notify physician

·         Place patient in trendelenburg position on the left side with the head down.

·         100 % Oxygen

·         Monitor vital signs

CPR as needed

What are the causes of Speed Shock

4

IV medications or solutions are administered at a rapid rate due to inadequate dilution

Control clamp is left open

EID programmed incorrectly

Bolus of medication given too rapidly

dizziness

facial and neck flushing

 tightness in the chest

hypotension

irregular pulse

Use and electronic flow control with high-risk drugs.

Administer bolus medication as recommended.

·         Call for help

·         Give antidote or resuscitation medications as needed

·         Have naloxone available if giving IV narcotics

Begin CPR as needed