UMM AL- QURA UNIVERSITY

FACULTY OF APPLIED MEDICAL SCIENCES

NURSING DEPARTMENT

Complications of
Intravenous
Therapy

Prepared By
Dr. Nahed Said El-nagger
Assistant Professor of Nursing
1430-1431 H

Unit . 2
Lecture No. 3.B

Learning Outcomes:
Differentiate between local and systemic

complications.
Describe the signs and symptoms of local
complications.
Identify prompt treatment for local and
systemic complications.
Identify International Standards of practice
rating infiltration.
List three risk factors for phlebitis.
Identify organisms responsible for
septicemia related to infusion therapy.
Identify prevention techniques for the
systemic complications.

I. Local complications
1. Hematoma:
Formations resulting from the infiltration of blood
into the tissues at the Venipuncture site.
Causes:
Rupture the vein during an unsuccessful
Venipuncture attempt.
Discontinuing the I.V. cannula or needle without
pressure.
Applying a tourniquet too tightly above a
previously attempted Venipuncture site.

1. Hematoma (cont.)
Signs/symptoms:
Discoloration of the skin.
Site swelling and discomfort.
Inability to advance the cannula all
the
way into the vein during insertion.
Resistance to positive pressure during
the lick flushing procedure.
Document:
The observable ecchymotic areas.

2. Thrombosis
Catheter-related obstructions can be
categorized as mechanical or nonthrombotic ( 42% of all obstructions)
or thrombotic (58% of all obstructions),
Signs/symptoms:
Fever and malaise.
Slowed or stopped infusion rate.
Inability to flush licking device.

2. Thrombosis (cont.)
Documentation:
Document the change of infusion
rate.
The steps taken to solve the problem,
and the end result.
Chart new IV sites.
It s patency, and the size of the
catheter used.

3.phlebitis
An inflammation of the vein.
Signs/symptoms:
Redness at site.
Site warm to touch and local swelling.
Palpable cord along the vein.
Sluggish infusion rate.
Increase in basal temperature of 1 C or
more.

3. Phlebitis (cont.)
Nursing Interventions:

Remove IV device.

Apply warm soaks.

Notify primary care provider.
Restart IV infusion in a different
extremity.

Document your actions.

4.Thrombophlebitis
Thrombosis and inflammation.
Signs/symptoms:
Sluggish flow rate, edema in the limbs.
Tender and cordlike vein, site warm to
touch.
Visible red line above Venipuncture site.
Diminished arterial pulses.
Mottling and Cyanosis of the
extremities.

5. Infiltration
Accidental administration of a non vesicant
solution into surrounding tissue.
Signs/symptoms:
Coolness of skin around site, and
tight skin.
Dependent edema and absence of
blood backflow.
A pinkish blood return.
Infusion rate slows but the fluid
continues to infuse.

Treatment of Infiltration
Discontinue the infusion.
Apply warm, moist heat to

edema.
Elevate the extremity.
Restart the infusion at another
site, preferable the other arm.

Prevention of Infiltration

Select site over long bone to act as a

splint.
Avoid sites over joints.
Use arm board to stabilize (as a last
resort!).

5. Infiltration (cont.)
Documentation:
assessment findings.
any written and verbal
communications.
nursing and medical interventions.
client response patterns.

6. Extravasations
The accidental administration of a vesicant
solution into surrounding tissue.
Signs/symptoms:
Complaints of pain or burning; swelling
proximal or distal to the IV site.
puffiness of the dependent part of the limb;
skin tightness at the Venipuncture site; and
coolness of the skin.
Slow or stopped infusion; damp or wet
dressing.

Extravasations Interventions

Stop the infusion, and elevate

extremity.
Remove the cannula.
Call physician.
Administer antidote (if appropriate)
intradermaly into infiltrated tissue.
Apply warm moist compresses for 20
minutes every 4 hours (see hospital
policy).

6. Extravasations (cont.)
Documentation:
Document assessment and
interventions. Include the vascular
access device type, insertion site,
name of medication or solution, and
how it was infused.

7. Local infection
Microbial contamination of the cannula or
infusate
Signs/symptoms:
Redness and swelling at the site;
possible
exudates of purulent material.
Increased quantity of white blood cells;
and elevated temperature.

7. Local infection (cont.)

Documentation:
Assessment of site.
culture technique & sources of
culture.
physician notification and any
treatment initiated.

8. Venous spasm
A sudden involuntary contraction of a vein
or an artery resulting in temporary
cessation of blood flow through a vessel.
Signs/symptoms:
sharp pain at the IV site that travels up
the arm, which is caused by acute flow
of fluid that irritates the vein wall;
slowing of the infusion

8. Venous spasms (cont.)

Documentation:
client complaints, duration of
complaints, treatment, and length of
time to resolve the problem.

II. Systemic Complication

1. Septicemia:
A febrile disease process that results
from the presence of microorganisms or
their toxic products in the circulatory
system.

Signs and Symptoms:

Fluctuating fever, tremors, little cold sweat,

nausea and vomiting, diarrhea, abdominal pain.

Tachycardia, increased respirations or
hyperventilation, altered mental status, and
hypotension

Septicemia Interventions
Notify physician immediately.
Symptomatic care.
Identify other sources of

infection.
Remove IV device.
Culture the IV cannula, tubing, or
solution if it is suspect.
Return fluid to pharmacy.
Establish a new IV site for
medication or fluid administration.

1. Septicemia (cont.)
Documentation:
Document S/S assessed; physician
notification, all treatments instituted.

2. Fluid overload & Pulmonary

edema

Caused by infusing excessive

amounts of isotonic or hypertonic

crystalloid solutions to rapidly,
failure to monitor the IV infusion
or too-rapid infusion of any fluid in
a patient compromised by
cardiopulmonary or renal disease.

2. Fluid overload & Pulmonary

edema (cont;)
S/S:

Restlessness, headache,

tachycardia, weight gain over a short

period of time, cough, and presence
of edema.
Hypertension, wide variance
between intake and output,
distended neck veins.

2. Fluid overload & Pulmonary

edema (cont.)
Documentation:
client assessment, notification of
physician, and treatments instituted
by physician order.

3. Air embolism
Air entering the central vein,
which is quickly trapped in the
blood as it flows forward.
Prevention is the key.

3. Air embolism(cont.)
S/S:

complaints of palpitations, and

weakness.
Pulmonary findings: dyspnea, cyanosis,
tachypnea, expiratory, wheezes, cough,
and pulmonary edema.
Cardiovascular: murmur; weak,
thready pulse; tachycardia; substernal
chest pain; hypotension; and jugular
venous distention.
Neurologic findings: change in mental
status, confusion, coma, anxiousness,
and seizures.

3. Air embolism (cont.)

Nursing Interventions:

Immediately clamp the tubing.

Turn client to left, head down (to allow air to enter
right atrium and be dispersed via pulmonary artery)
Monitor vital signs.
Administer O2.
Notify physician.
Document actions.
Documentation:
Client assessment, nursing interventions, physician
notification, and treatment.

4. Speed shock
Occurs when a foreign substance
usually a medication is rapidly
introduced into the circulation
S/S: dizziness, facial flushing,
headache, tightness in the chest,
hypotension, irregular pulse,
progression of shock.

4. Speed shock (cont.)

Documentation: medication or fluid
administered and the signs and
symptoms the pt reported, physician
notification, treatment initiated and
the client response.

5. Catheter embolism
A piece of the catheter breaks off and
travels through the vascular system.

S/S: sharp sudden pain at the IV site,

minimal blood return, rough and
uneven catheter noted on removal,
cyanosis, chest pain, tachycardia,
hypotension.