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Les complications de la voie I.V.

priphrique
Reconnatre les complications Infiltration / Paravasation
Prvention*

Appliquer les bonnes pratiques

Veine cphalique

Utiliser en priorit les veines du membre suprieur et


commencer par la plus distale possible. ponctions prcdentes.

Eviter les zones de flexion et les sites trop proches des Eviter la main, le poignet et la fosse antcubitale pour
perfuser les solutions irritantes. osmolarit > 900 mosm/l.

Ne pas administrer en routine des solutions ayant une Bien fixer le cathter laide dun pansement adapt.

Dfinitions

Linfiltration est la diffusion accidentelle dune solution hors de la veine, dans les tissus sous-cutans. Lextravasation est linfiltration dune solution irritante causant une ncrose des tissus par agression chimique ou vasoconstriction svre.
Veine basilique

Causes

Dfaut de fixation provoquant des mouvements du cathter dans lendoveine. Solution trop concentre ou au pH trop acide/basique.

Hmatome
Veine mdiane

Prvention*

Insrer toujours le cathter, biseau orient vers le haut. Attendre lhmostase avant la repose du garrot si 2me
tentative. cathter.

Dfinition Causes

Garder la peau tendue pendant toute la phase de pose du

Collection sanguine dans les tissus sous-cutans autour du point de ponction. Transfixion de la veine. Fuite depuis le point de ponction.

Relcher le garrot ds que le reflux sanguin est visible. Retirer laiguille ds que la canule est cathtrise dans la

veine.

Infection du site de ponction


Prvention*

Respecter les bonnes pratiques dantisepsie : raliser

Arcade dorsale

une dsinfection des mains, une phase de dtersion, une antisepsie cutane. vigueur.

Connecter la ligne de perfusion selon les protocoles en Surveiller au moins 1 fois par jour le point de ponction et
le pansement qui doit rester propre, sec et adhrent. privilgier lutilisation dun prolongateur.

Dfinition Causes

Contamination du site de ponction ou du sang par des agents pathognes. 3 sources de contamination : Peau du patient (depuis le point de ponction). Ligne de perfusion (depuis les connexions). Hmatogne (foyer infectieux profond distance du point de ponction).

Limiter les manipulations de lembase du cathter et

Phlbite
Prvention*

Respecter les bonnes pratiques dantisepsie cutane :


appliquer un antiseptique en solution alcoolique et attendre son schage complet.

Choisir une gauge et une longueur adaptes au diamtre

interne de la veine, la solution et au volume perfuser.

Dfinition Causes

Inflammation de la veine ou dun vaisseau lymphatique. Peut tre associe une thrombophlbite. Linflammation peut tre dorigine : Mcanique : frottement de la canule sur lendoveine. Septique : contamination bactrienne. Chimique : mauvaise hmodilution ou solution irritante trop concentre.
AV4664_07.11(HC1087)

Choisir la veine la plus accessible et facile palper. Bien fixer le cathter laide dun pansement adapt. Ne pas administrer en routine des solutions ayant

une osmolarit > 900 mosm/l.

Changer de point de ponction toutes les 72 h 96 h. Limiter les manipulations de lembase du cathter.

* Daprs SFHH - HAS Prvention des infections lies aux cathters veineux priphriques Novembre 2005

www.infusionsecurity.ch

i.v. essentials

Complications of peripheral I.V. therapy


IF YOUR PATIENT is receiving peripheral I.V. therapy, youll need to watch for signs and symptoms of complications, such as: I hypersensitivity I inltration I extravasation I phlebitis I infection. Well ll you in on how to recognize these complications and walk you through how to treat them, with an eye on prevention. I Stay with your patient for 5 to 10 minutes to detect early signs and symptoms of hypersensitivity, such as sudden fever, joint swelling, rash, urticaria (hives), bronchospasm, and wheezing. I If hes receiving the drug for the rst or second time, check him every 5 to 10 minutes or according to your facilitys policy. An immediate, severe reaction is lifethreatening, so prompt recognition and treatment are imperative. At the rst sign of hypersensitivity: I Discontinue the infusion and notify the

Sometimes, I can get a bit complicated...

Youre so sensitive
Before you administer an I.V. medication, take steps to nd out if your patient may be prone to hypersensitivity: I Ask him if he has any allergies, including allergies to food or pollen. I Ask if he has a family history of allergies; if he does, hes more likely to develop a drug hypersensitivity. I If your patient is an infant less than age 3 months, ask the mother about her allergy history because maternal antibodies may still be present. After giving an I.V. medication, follow through with these precautions:

Running down the inltration scale


Use these classications when documenting instances of inltration. Degree 0 1+ Description No symptoms Skin blanched Edema less than 1 inch (2.5 cm) in any direction Cool to touch With or without pain Skin blanched Edema 1 to 6 inches (2.5 to 15 cm) in any direction Cool to touch With or without pain Skin blanched, translucent Gross edema more than 6 inches in any direction Cool to touch Mild to moderate pain Possible numbness Skin blanched, translucent, tight, leaking, discolored, bruised, swollen Gross edema more than 6 inches in any direction Deep, pitted tissue edema Circulatory impairment Moderate to severe pain Inltration of any blood product, irritant, or vesicant

2+

3+

4+

Source: Infusion Nurses Society, Infusion Nursing Standards of Practice, Journal of Infusion Nursing, January/February 2006.

14 Nursing made Incredibly Easy! January/February 2008

health care provider immediately. I Administer medications as ordered. I Monitor the patients vital signs and provide emotional support.

Just say no to inltration


Inltration occurs when I.V. uid leaks into surrounding tissue. Its commonly caused by improper placement or dislodgment of the catheter. When the tip of the catheter is positioned near a exion area, patient movement may cause the catheter to slip out or through the lumen of the vessel. The risk of inltration increases in older patients because their veins are thin and fragile. Signs and symptoms of inltration include: I swelling I discomfort I burning I tightness I cool skin I blanching. If only a small amount of an isotonic solution or nonirritating drug inltrates, the patient usually experiences only mild discomfort. Heres what you need to do: I Stop the infusion and remove the device (unless the medication is a vesicant; consult the health care provider and pharmacy). I Elevate the limb to increase patient comfort. I Check the patients pulse and capillary rell time. I Counteract the effects of the drug as ordered. I Perform venipuncture in a different location and restart the infusion. I Check the site frequently. I Document your ndings using the inltration scale (see Running down the inltration scale).

ing vesicants: I Strictly adhere to proper administraAs soon as you spot tion techniques. inltration, think of I Avoid using the the three Cs: back of the hand Cut off (the infusion) where tendon and Counteract (the nerve damage is effects of the drug) more likely. Contain (the affectI Avoid using the ed area). wrist and ngers because theyre hard to immobilize and areas with previous damage or poor circulation. I Give vesicants last when multiple drugs are ordered. Signs and symptoms of extravasation include: I blanching, burning, or discomfort at the I.V. site I cool skin around the I.V. site I swelling at or above the I.V. site. If you suspect extravasation, follow your facilitys protocol. Take these essential steps: I Stop the I.V. ow and remove the I.V. line, unless the catheter should remain in place to administer the antidote. I Estimate the amount of extravasated solution and notify the health care provider. I Instill the appropriate antidote according to your facilitys protocol. I Elevate the extremity. I Record the extravasation site, your patients symptoms, the estimated amount of extravasated solution, and the treatment. Follow the manufacturers recommendations to apply either ice packs or warm compresses to the affected areas.

memory jogger

Get to know the signs and symptoms to watch out for.

Fighting phlebitis
Phlebitis, or inammation of a vein, is a common complication of peripheral I.V. therapy thats associated with acidic or alkaline solutions or those that have a high osmolarity. Other factors include: I vein trauma during insertion I using a vein thats too small I using a vascular access device thats too large I prolonged use of the same I.V. site. Phlebitis can follow any infusion, but its
January/February 2008 Nursing made Incredibly Easy! 15

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, tissue necrosis, disgurement, loss of function, and even amputation. To help prevent extravasation when giv-

i.v. essentials

Together, we can keep I.V. therapy complication free!

most common after continuous infusions, developing 2 to 3 days after the vein is exposed to the drug or solution. It develops more rapidly in distal veins than in veins close to the heart. Phenytoin and diazepam can produce phlebitis after one or more injections at the same I.V. site. Large doses of potassium chloride, amino acids, dextrose solutions, and multivitamins can cause phlebitis as well. Certain irritating I.V. drugs are also likely to cause phlebitis when piggybacked, including: I erythromycin I tetracycline I nafcillin I vancomycin I amphotericin B. Take these steps to prevent phlebitis: I Use proper venipuncture technique. I If necessary, dilute drugs correctly. I Monitor administration rates. I Observe the I.V. site frequently. I Change the infusion site regularly according to your facilitys policy. Signs and symptoms of phlebitis include: I redness or tenderness at the tip of the catheter I puffy area over the vein I elevated temperature. To detect phlebitis, inspect the I.V. site several times a day (see Classifying phlebitis).

Use a transparent semipermeable dressing so you can Heres a handy tip: see the skin distal When administering to the tip of the vesicants I.V., think catheter as well as hands off! Avoid the insertion site. the back of the hand If you suspect (where damage from phlebitis, follow extravasation is these steps: more likely) and the I At the rst sign wrist and ngers of redness or ten(which are hard to derness, stop the immobilize). infusion. I To ease your patients discomfort, apply warm packs. I Document your patients condition and interventions. I If indicated, insert a new catheter at a different site, preferably on the opposite arm, using a larger vein or a smaller device and restart the infusion.

memory jogger

Infection detection
A patient receiving I.V. therapy may develop a local or systemic infection. Monitor your patient for signs and symptoms of infection, such as redness and discharge at the I.V. site or an elevated temperature. If the infection is systemic: I Stop the infusion. I Notify the health care provider. I Remove the device. I Culture the site and device as ordered. I Administer medications as prescribed. I Monitor the patients vital signs.

Classifying phlebitis
Use these classications when documenting phlebitis. Degree 0 1+ 2+ 3+ Description No signs and symptoms Erythema with or without pain Erythema with pain Edema may or may not be present. Erythema with pain Edema may or may not be present. Streak formation Palpable cord Erythema with pain Edema may or may not be present. Streak formation Palpable cord longer than 1 inch (2.5 cm) Purulent drainage

Lets not get too complicated


Complications of peripheral I.V. therapy can be serious, but with your careful attention and eye on prevention, you can help your patient avoid these pitfalls. I

Learn more about it


Infusion Nurses Society. Infusion Nursing Standards of Practice. Journal of Infusion Nursing. 29(1, Suppl.):S1-S92, January/February 2006. I.V. Therapy: An Incredibly Easy Pocket Guide. Philadelphia, Pa., Lippincott Williams & Wilkins, 2006:174-177. I.V. Therapy Made Incredibly Easy!, 3rd edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2006:187-189. Smeltzer SC, et al. Brunner and Suddarths Textbook of Medical-Surgical Nursing, 11th edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2007:350-351.

4+

Source: Infusion Nurses Society, Infusion Nursing Standards of Practice, Journal of Infusion Nursing, January/February 2006.

18 Nursing made Incredibly Easy! January/February 2008