This article covers IV complications. This series follows along with our Pharmacology Basics and Safe Medication Administration Flashcards for Nursing Students, which are intended to help RN and PN nursing students build a strong foundation going into pharmacology and as preparation for the ATI, HESI, and NCLEX.
Phlebitis
Phlebitis is an inflammation of the veins. Remember that when a word ends in "-itis," it means inflammation of the part of the body referenced in the first part of the word. Here, "phleb-" is Greek for "vein," hence, “phlebitis,” inflammation of the veins. We created ourMedical Terminology flashcards to make breaking down words into their parts easy, so you never have to be confused by an unfamiliar word on an exam!
The causes of phlebitis include mechanical irritation, for example, a catheter rubbing against the vein, causing irritation and inflammation. Phlebitis may also be caused due to the pH or osmolality (the concentration of dissolved particles of chemicals and minerals) of the medication that's being infused.
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Phlebitis symptoms
The signs and symptoms of phlebitis include erythema (redness of the skin), edema (swelling), warmth, and pain. The vein may be indurated (hardened). Or you might observe a red streak that follows the superficial vein.
Phlebitis nursing care
If the patient is exhibiting these symptoms, discontinue the IV, elevate the extremity, and apply warm, moist compresses. If indicated, obtain a specimen for a culture to determine if there is an infection.
Infiltration
Infiltration is when IV fluids or medications leak out of the vein and into the surrounding tissue.
Infiltration symptoms
Symptoms of infiltration include swelling, coolness, dampness, and a slowed rate of IV infusion. Additionally, fluid may leak from the IV site itself.
A real-life example features a patient hospitalized during pregnancy, who was receiving IV fluids. The nurse was very busy, too busy to notice that the IV had infiltrated to the point that the patient's arm was twice as big as her other arm. The affected arm was swollen, it was cool to the touch, and it felt damp — all indications that the IV had infiltrated. The patient, not knowing what was causing her discomfort, sat there and waited until someone eventually noticed and took out the IV.
Infiltration nursing care
In the event of infiltration, discontinue the IV, elevate the extremity, and apply warm or cold compresses, depending on what was infusing. Use warm compresses for normal- or high-pH solutions, and use cold compresses for low-pH solutions.
Extravasation
Extravasation is another type of infiltration, but with a vesicant agent, meaning a medication that can cause serious tissue damage.
Extravasation symptoms
Signs and symptoms of extravasation can include erythema, pain, edema, and the formation of blisters. Necrotic tissue, such as slough or eschar, may be observed, as well as ulceration.
Extravasation nursing care
First, stop the infusion and aspirate (pull back on the syringe plunger) to remove any residual medication from the IV line. Then, administer antidote per facility policy.
Following the administration of antidote, discontinue the IV (remove it), elevate the extremity, and apply a warm or cold compress, depending on the solution's pH, as noted above in the previous section.
Catheter embolus
A catheter embolus is when an IV catheter fragment breaks off into the patient's venous system. Any time an IV is discontinued, it is important to look at the catheter tip to make sure it is fully intact. “Embolus” is another word for something that causes a blockage — a blood clot (thrombus), an air bubble, or another object that enters the bloodstream.
Catheter embolus symptoms
If a piece of the catheter tip is missing, that is a sign that there may be a catheter embolus present in the patient's venous system.
Other symptoms of a catheter embolus include pain along the vein, which can be severe, as well as a weak, thready pulse and hypotension (low blood pressure).
Catheter embolus nursing care
Place a tourniquet high on the extremity and prepare the patient for surgery to remove the catheter fragment.
Air embolus
An air embolus is when air enters the venous system from the IV catheter and causes a blockage.
Air embolus symptoms
Symptoms can include hypotension, tachycardia, tachypnea (abnormally rapid breathing), and cyanosis.
Air embolus nursing care
If the patient experiences an air embolism, clamp the catheter, then place the patient in a Trendelenburg position, which is when their head is lower than their feet. Administer oxygen and notify the provider. Trendeleburg and other patient positions that you need to know are covered in our Fundamentals of Nursing Flashcards.
Thrombosis
A thrombosis is a blood clot. During the administration of an IV — and despite the flushing of peripheral IVs and central venous catheters to help prevent the formation of a thrombosis — a vein may become occluded with a thrombosis anyway.
Thrombosis symptoms
Symptoms of thrombosis include slowed IV flow, the inability to draw blood from a central line, and swelling and/or pain at the site.
When attempting to draw blood or give medications to a patient with a PICC line, and you aspirate but there is no blood return, that is a sign of a possible thrombosis. Note that providers often issue standing orders for a thrombolytic agent such as alteplase to be used in patients with PICC lines, in the event that a blood clot occurs.
Thrombosis nursing care
In a peripheral IV, discontinue the IV, apply a cold compress, and elevate the extremity.
For a central line, administer thrombolytics, such as alteplase, as ordered. Let it instill in the area for about 30 minutes, then check the patency of the line.
Fluid overload
Fluid overload is when too much volume is introduced into the circulatory system.
Fluid overload symptoms
Signs of fluid overload include shortness of breath, crackles (in the lungs), hypertension, jugular vein distention, edema, and tachycardia.
Fluid overload nursing care
If the patient experiences fluid overload, raise the head of the bed to make it easier for them to breathe. Slow the infusion rate so as not to overwhelm the patient's circulatory system. Monitor the patient's oxygen and vital signs. It needed, administer diuretics as ordered by the provider.
IV Infection
An IV infection occurs when there is an invasion of microorganisms at the insertion site.
IV infection symptoms
Symptoms can be local or systemic.
Local symptoms include pain, warmth, edema, induration (hardness), and malodorous drainage.
Systemic symptoms include fever, chills, malaise, and an elevated white blood cell count.
IV infection nursing care
In terms of nursing care, discontinue the IV and send the catheter tip for a culture (if requested). Administer antibiotics, analgesics, or antipyretics as ordered.