IV Therapy

IV therapy

1. IV Therapy: Indications and Complications MICHELLE ANTIMANO, RN

2. INTRODUCTION It is estimated that over 85% of hospitalized patients have an IV therapy during their stay in the hospital. At least 2% of medical lawsuits involve a complication from a peripheral IV line.

3. Vein Anatomy

4. Site Selection Type of solution to be infused Condition of vein Catheter size Patient age Patient activity Presence of disease or previous surgery Presence of shunts or graft V.I.P VEIN INFUSION PATIENT

5. Vein dilation techniques Tourniquet . Gravity . Fist clenching Tapping vein Warm compresses Blood pressure cuff Multiple tourniquet technique

6. Indications Fluid and electrolyte maintenance, restoration and replacement To establish a lifeline for rapidly needed medications Blood and blood products administration Medication and nutrition administration

7. Complications Local Complications Systemic Complications Occur at the insertion site of an IV device or close at an IV site Assessing and monitoring are the key components to early intervention. Occur within the vascular system, remote from the IV site Can be life threatening.

8. Infiltration Occurs when I.V. fluid or medications leak into the surrounding tissue. Infiltration can be caused by improper placement or dislodgment of the catheter. Patient movement can cause the catheter to slip out or through the blood vessel lumen.  Signs & symptoms: -swelling -pallor - cool skin temperature -discomfort -tenderness -sluggish flow

9. Infiltration Possible Causes : Puncture of the distal vein during access Dislodgement of the catheter from the intima of the vein Poor securement Over manipulation Nursing Interventions : Stop infusion immediately and remove IV catheter Elevate extremity Cold /warm compress application Document findings and actions Restart IV in an alternative location

10. Phlebitis Phlebitis is inflammation of a vein. Signs & symptoms : Redness Swelling Warmth Pain along vein route Vein is hard Sluggish flow

11. Mechanical Phlebitis Possible causes: Cannula too large for vein Cannula inserted near a joint creating a piston motion against vein wall when patients moves Inadequate dressing and securement Chemical Phlebitis Possible causes: Infusion of Alkaline solutions Infusion of hyper/hypotonic solutions Speed and method of infusion delivery Bacterial Phlebitis Possible causes: Break in aseptic technique during insertion or routine care Inadequate skin preparation Use of contaminated supplies, solutions or medications Cannula in situ passed date of expiry Management: Remove IV cannula and reinsert in new location Apply warm compress Notify Physician Notify Over-all Nursing Supervisor Document assessments and actions

12. Visual Infusion Phlebitis Score (VIP)

13. H ematoma Hematoma occur when blood leaks into the extravascular space. Possible causes: Related to venipuncture technique Trauma to the vein during insertion Discontinuing IV without applying adequate pressure Signs and symptoms: Discoloration or bruising of the skin around site Site swelling and discomfort Inability to advance or flush IV line Management: Remove venipuncture device. Apply pressure and warm soaks to affected area and recheck for bleeding Document patient’s condition and your interventions

14. Extravasation Inadvertent administration of a vesicant solution into surrounding tissue. Signs and symptoms : Swelling Burning or pain at the insertion site Slow or stopped infusion Vesicant- is a fluid or medication that causes formation of blisters, with subsequent sloughing of tissues occurring from the tissue necrosis.

15. Examples of Vesicants Vancomycin Nafcillin Calcium Chloride Potassium Chloride Sodium Chloride Calcium Gluconate Dobutamine Diazepam Dopamine Norepinephrine Phenytoin Promethazine Propofol Vasopressin Radiologic contrast agents Chemotherapeutic agents

16. E xtravasation STOP the infusion immediately but leave the cannula in place. Elevate extremity. Aspirate fluid as much as possible through the cannula, try to draw back 3-5ml of blood. Mark and measure the extravasated area. Notify Physician immediately. Notify Over-all Nursing Supervisor. Complete an OVR. Document. MANAGEMENT:

17. Air Embolism An air embolism takes place when a bubbles of air introduced into the circulating blood . Occurs most frequently with central venous devices Signs and symptoms : Dyspnea, cyanosis, hypotension Weak, rapid pulse Chest pain Loss of consciousness Management: Immediate corrective action for suspected Air embolism includes: Stop infusion by clamping the line Place patient on left trendelenburg position. Administer oxygen. Notify your immediate supervisor and physician immediately. Document assessments and interventions.

18. Fluid Overload An excess of fluid disrupting homeostasis caused by an infusion at a rate greater than the patient’s system is able to accommodate. Signs and symptoms : Tachypnea, dyspnea Tachycardia Hypertension Raised CVP measurement and distended neck veins Management: Stop the infusion. Notify physician. Administer treatment as ordered. Document assessments and actions.

19. Septicemia Systemic infection can occur as a result of phlebitis, poor securement of venipuncture, prolonged dwell time of catheter and failure to maintain aseptic technique during insertion or site care. Signs and symptoms : Redness, swelling and pain at site Fever, chills and malaise Tachycardia Management: Notify the physician. Monitor vital signs. Administer medications as prescribed. Culture the site and the device.