Complications of Intravenous Catheter-related obstructions can be mechanical

or non-thrombotic
Therapy Trauma to the endothelial cells of the venous
wall causes red blood cells to adhere to the vein
 Classified according to their location
wall, forms a clot or Thrombosis
 Local complication: at or near the Drip rate slows, line does not flush easily,
insertions site or as a result of resistance is felt
mechanical failure Never forcible flush a catheter
TYPES:
 Occur as adverse reactions or trauma to the  Persistent withdrawal occlusion
surrounding venipuncture site  Partial occlusion
 Complete occlusion
 Assessing and monitoring are the key  Fibrin tail
components to early intervention  Fibrin sheath
 Good venipuncture technique is the main factor  Mural thrombosis
related to the prevention of most local  Thrombosis related to:
complications associated with IV Therapy.  Hypertensive pt; blood backing up
 Low flow rate
 Local complications include: hematoma,  Location of the IV cannula
thrombosis, phlebitis, postinfusion phlebitis,  Compression of the IV line for an
thrombophlebitis, infiltration, extravasation, extended period of time
local infection, and veno spasm.  Trauma to the wall of the vein
 Signs and Symptoms
 Systemic complications: occur within  Fever and Malaise
the vascular system, remote from the IV  Slowed or stopped infusion rate
site. Can be serious and life threatening  Inability to flush
 Prevention
1. HEMATOMA
 Use pumps and controllers to manage
Hematoma and ecchymosis demote formations
flow rate
resulting from the infiltration of blood into the
 Microdrip tubing for rate below50mL/hr
tissues at the venipuncture site
 Avoid areas of flexion
a. Related to venipuncture technique
 Use filters
b. Use of large bore cannula: Trauma to
 Avoid lower extremeties
the vein during insertion
 Treatment
c. Patients receiving anticoagulant therapy
 Never flush a cannula to remove an
and long term steroids
occlusion
PREVENTION  Discontunue the cannula
 Notify the physician and assess the site
 Use of an indirect method for circulatory impairment
 Document
 Apply tourniquet just before venipuncture
3. PHLEBITIS
 Use a small need in the elderly and patients on Inflammation of the vein in which the
steriods, or patients with thin skin. endothelial cells of the venous wall become
irritated and cells roughen, allowing platelets to
 Use blood pressure cuff to apply pressure adhere and predispose the vein to inflamation-
induced phlebitis
 Be gentle
a. Tender to touch and can be very painful

Mechanical:
TREATMENT
b. To large a catheter for the size of the
 Apply direct, light pressure for 2-3 minutes after vein
needle removed
c. Manipulation of the catheter: improper
 Have patient elevate extremity stabilization

 Apply Ice Chemical: vein becomes inflamed by irritating

or vessicant solutions or medication
 Document
d. Irritation medication or solution
2. THROMBOSIS
 e. Improperly mixed or diluted
f. Too-rapid infusion
g. Presence of particulate matter
h. The more acidic the IV solution the
greater the risk
i. Additives: Potassium
j. Type of material
k. Length of dwell:
l. 30% by day 2, 39-40% by day 3 (Macki
and Ringer)
m. The slower the rate of infusion the less
irritation
* BACTERIAL PHLEBITIS
Also called Septic phlebitis: least common
 Inflammation of the intima of the vein
 Contributing factors
 Poor aseptic technique
 Failure to detect breaks in the integrity
of the equipment
 Poor insertion technique
 Inadequate stabilization
 Failure to perform site assessment
 Aseptic preparation of solutions
 Hand washing and preparing the skin
*POST INFUSION PHLEBITIS
 Inflamation of the vein 48-96 hr after
discontinued
 Factors that contribute:
 Insertion technique
 Condition of the vein used
 Type, compatibility, pH of solution used
 Gauge, size, length, and material
 Dwell time
 Infrequent dressing change
 Host factors: age, gender, age and
presence of disease
 Immune system causes leukocytes to gather at
the inflamed site
 Pyrogens stimulate the hypothalamus to raise
body temperature
 Pyrogens stimulate bone marrow to release more
leukocytes
 Redness and tenderness increase
4. Thrombophlebitis
denotes a twofold injury: thrombosis and
inflammation
Related to:
Use of veins in the lower extremity
Use of hypertonic or highly acidic infusion
solutions
Causes similar to those leading to phlebitis
 Signs and Symptoms
 Sluggish flow rate
 Edema in the limbs
 Tender and cord like vein
 Site warm to the touch
 Visible red line above venipuncture site
 Diminished arterial pulses
 Mottling and cyanosis of the extremities
 Prevention
 Use veins in the forearm rather than the
hands
 Do not use veins in a joint
 Assess site q 4 hr in adults, q 2 hr in
children
 Catheter securment
 Infuse at rate prescribed
 Use the smallest size catheter to do the
job
 Proper dilution
 Septic thrombophlebits can be prevented:
 Appropriate skin preparation
 Aseptic technique in the maintance of
infusion
 Proper hand hygiene
 60% from patients skin
 35% from the line itself
 5% from hands
5. INFILTRATION
The inadvertent administration of a non-vesicant
solution into surrounding tissue
Dislodgment of the catheter from the vein
Second to phlebitis as a cuase of IV therapy
morbidity
 Related to:
 Puncture of the distal vein wall during
access
 Puncture of the vein wall by mechanical
friction
 Dislodgement of the catheter from the
intima of the vien
 Poor securment
 High delivery rate
 Overmanipulation
 Signs and Symptoms
  Coolness of the skin around site  Unable to communicate
 Taut skin  Treatment
 Dependent edema 7. OTHERS
 Absence of blood return Local infection:
 “Pinkish” blood return a. Microbial contamination of the cannula
 Infusion rate slows or the infusate
 Complications fall into 3 catagories b. Thrombus becomes infected
 Ulceration and possible tissue necrosis Venous Spasm: a sudden involuntary contraction
 Compartment syndrome of a vein or an artery resulting in temporary
 Reflex sympathetic dystrophy syndrome cessation of blood flow through a vessel
6. EXTRAVASATION
Inadvertent administration of a vesicant solution
into surrounding tissue
a. Vesicant is a fluid or medication that
causes the formation of blisters, with THANK YOU !!!
subsequent sloughing of tissues GOD BLESS YOUR HARDWORK.
occurring from the tissue necrosis VPGHI
Extravasations related to:
b. Puncture of the distal wall
c. Mechanical friction
d. Dislodgement of the catheter
Example of Vesicants
 Phenergan pH is 4 to 5.5
 Dilantin pH is 12 (Drano has a pH of 14)
 High concentration KCL pH is 5 to 7.8
 Calcium gluconate pH is 6.2
 Amphotericin B pH is 5.7 to 8
 Dopamine pH is 2.5 to 5
 Nipride pH is 3.5 to 6
 10%, 20% or 50% dextrose pH is 3.5 to 6.5
 Sodium bicarbonate pH is 7 to 8.5
 Signs and Symptoms
 Complaints of pain or burning
 Swelling proximal to or distal to the IV
site
 Puffiness of the dependent part of the
limb
 Skin tightness at the veinpuncture site
 Blanching and coolness of the skin
 Slow or stopped infusion
 Damp or wet dressing
 Prevention:
 Use of skilled practitioners
 Knowledge of vesicants
 Condition of the patients veins
 Drug administration technique
 If continuous give in CVAD
 Only with brisk blood return of
3-5 cc
 Use of a free flow IV
 Do not use a pump on vesicants
given peripherally
 Assess for blood return
frequently
 Prevention (cont)
 Site of venous access
 Condition of the patient
 Vomiting, coughing, retchin
 Sedated