Complications of IV Therapy Flashcards
1
Q
Infiltration: Causes
A
- Catheter is through the vein
- Inflammation causes capillary leak
- Retrograde flow
2
Q
Infiltration: S&S
A
- Slow IV rate
- Edema around site
- Coolness
- Burning
- Tenderness
- No blood return
3
Q
Infiltration: Interventions
A
- INS scale
- New catheter in opposite arm
- Cool compress
- Warm compress
- Remove catheter immediately
4
Q
Infiltration: Prevention
A
- Use smallest catheter needed
- No restraints at IV site
- Central venous cath- obtain brisk blood return before running anything
5
Q
Extravasation: Causes
A
- Catheter is through the vein
- Inflammation causes capillary leak
- Retrograde flow
6
Q
Extravasation: S&S
A
- Slow IV rate
- Edema around site
- Coolness
- Burning
- Tenderness
- No blood return
Blistering & tissue sloughing may occur in days, resolves in 1-4 weeks with chemo drug infiltration
7
Q
Extravasation: Interventions
A
- Aspirate drug from needle
- Stop infusion
- Leave port access needle in case antidote needed
- Cold compress EXCEPT vinca alkaloids or epipodophyllotoxins
- Photograph site
8
Q
Extravasation: Prevention
A
- Use smallest catheter needed
- No restraints at IV site
- Central venous cath- obtain brisk blood return before running anything
9
Q
Phlebitis: Causes
A
- Insertion technique
- Catheter size
- Lack of securement
- pH extremes of med/fluid
- Extended dwell time
- Broken aseptic technique
10
Q
Phlebitis: S&S
A
- Pain
- Red
- Inflamed
- Hard & cordlike vein
11
Q
Phlebitis: Interventions
A
- Remove catheter immediately
- Warm compress
- Phlebitis scale
- Within first week of PICC line: Treat w/out removing catheter & use constant heat + elevate extremity
12
Q
Phlebitis: Prevention
A
- Avoid joint flexion areas- or use armboard
- Nothing through peripheral IVs with pH below 5 or above 9
- Nothing through peripheral IV with osmolarity over 500
13
Q
Thrombosis: Causes
A
- Traumatic venipuncture
- Multiple attempts
- Catheter too big for vein
- Virchows triad
14
Q
Thrombosis: S&S
A
- Slow or stopped rate of infusion
- Tender
- Red
- CVCs have engorged ipsilateral chest veins
15
Q
Thrombosis: Interventions
A
- Cold compress
- Stop infusion
- Remove catheter
- Low dose thrombolytics for CVCs
16
Q
Thrombosis: Prevention
A
- 2 attempts at venipuncture max
- Secure catheter
- Armboards in flexion areas
17
Q
Thrombophlebitis: Same as thrombosis but use what
A
Cold compress, then heat
18
Q
Ecchymosis & hematoma: Causes
A
- Fragile skin
- Elderly
- Multiple attempts
- Vein laceration
19
Q
Ecchymosis & hematoma: S&S
A
- Bruising
- Swelling
- Pain
20
Q
Ecchymosis & hematoma: Interventions
A
- Light pressure when removing
- Hematoma = direct pressure until bleeding stops
- Elevate extremity
- Ice packs
- Warm packs after 24 hr
Prevention: No hidden veins or coagulopathy patients
21
Q
IV infection interventions
A
- Send catheter tip for culture
- Express drainage
- Clean site with alcohol
- Dry, sterile dressing
22
Q
Venous spasm: S&S
A
- Cramping above/at insertion site
- Numbness
- Slowing of the rate
- Unable to withdraw midline catheter or PICC
23
Q
Venous spasm: Interventions
A
- Slow rate
- Warm compress
- Do not remove catheter
- Drink warm fluids
- Keep covered & dry
- 12-24 hr before removal can happen
Prevent via running room temp fluids, allow vein to return to normal size before advancing after tourniquet removed, gently remove PICC in short segments
24
Q
Nerve damage: S&S
IV therapy
A
- Pins & needles at/below site
- Numb
25
Nerve damage: Interventions
| IV therapy
* Stop insertion if reporting severe pain
* Remove if discomfort does not improve once secured
26
Nerve damage: prevention
| IV therapy
* Avoid cephalic vein in wrist
* No palm veins
* No side of the wrist
* Secure catheter
* Armboard
27
Circulatory overload: S&S
* SOB
* Cough
* HTN
* Edema
* +4 pulses
* JVD
* Crackles
* Low SpO2
| Diuretics, HOB high, call HCP, give O2
## Footnote
Monitor I&O
28
Speed shock: S&S
| When bolus of Rx causes toxic levels quickly
* Lightheaded
* Dizzy
* Chest tightness
* Flushed face
* Irregular pulse
* Unconscious
* Cardiac arrest
* Shock
29
Speed shock: Interventions
* Stop infusion
* Hang isotonic (NS)
* KVO rate
* Call HCP
30
Catheter embolism: S&S
* Avoid forcefully flushing!
* Cardiopulmonary arrest
31
Catheter embolism: Interventions
* Call HCP
* Remove catheter
* Tourniquet high on affected limb
* X-ray
32
Catheter migration: Causes
* Cough
* Sneeze
* Lifting heavy objects
* CHF
33
Catheter migration: S&S
* Neurologic complications if Rx are running
* Azygos vein migration: Back pain between shoulder blades
* Jugular migration: Gurgling or running stream sound on the side of catheter insertion
| Stop all infusions & flush catheter
## Footnote
CXR needed
34
34
Catheter dislodgment: Causes
* Excess activity with PICC
* Inadequately secured
35
Catheter dislodgment: S&S
* external length of catheter changes
* May be no sx
36
Catheter dislodgment: Interventions
* Stop infusions
* Flush
* Never readvance
* Compare documented catheter length with current length
37
Catheter rupture: Causes
* Forcefully flushing against resistance
* Scissors to remove dressing
* Pinch off syndrome
| Subclavian catheter pinched between clavicle & 1st rib (pinch-off synd)
38
Catheter rupture: S&S
* Fluid leaking from insertion site
* Pain & swelling during infusion
* Reflux of blood into catheter extension tubing
* Unable to aspirate blood
39
Lumen occlusion: Causes
* Precipitate from phenytoin, calcium, diazepam
* Long-term fat emulsion sludge
* Blood clots
* Fibrin sheath
* Allowing administration set to remain connected for long periods after Rx has infused
40
Lumen occlusion: S&S
* Infusion stops
* Unable to start fluids
* Cannot draw blood
* Flushing resistance
* Sudden: Incompatible meds
* Gradual: Clot
* Precipitate: Hydrochloric acid for acidic drug, bicarb for alkaline
* Clot: Use alteplase
| Flush catheters before, after, between meds
41
Catheter related bloodstream infection
| CRBSI
* Fever
* Chills
* HA
* Malaise
* Tachycardia
* HOTN
* Decreased urine output
| Change entire infusion system
42
Never ____ before inserting IV
Shave
