Complications of IVT:

Question 1

IVT complications can include:

Answer 1

o Phlebitis
o Thrombophlebitis
o Infiltration
o Extravasation
o Septicaemia
o Embolus
o Fluid overload

Question 2

Fluid Balance:

Answer 2

• in maintaining homoeostasis and a healthy environment of the body; fluids, electrolytes, acids and bases play a vital role

Question 3

Common conditions affecting fluid & electrolyte balance:

Answer 3

• Skin losses:
• excessive sweating, burns, fever
• GIT losses:
• diarrhoea, vomiting, nasogastric suctioning
• Renal losses:
• diuretics
• Others:
• IV fluid administration, chronic heart failure, chronic renal failure, crush injuries

Question 4

Dehydration:

Answer 4

• dehydration is a sudden loss of 3% or more of the individuals body weight
• inadequate intake of fluid and an excessive output or combination of the two are the main issues associated with dehydration

Question 5

Dehydration signs and symptoms:

Answer 5

• thirst, dry mucous membrane, cold and clammy skin
• confusion, weakness
• decreased skin turgor and capillary refill
• increased pulse, decreased BP and increase RR
• dizziness, weight loss, seizures, coma

Question 6

Hypovolaemia (FVE):

Answer 6

• is the abnormal loss of body fluid and electrolyte from ECF
• causes for fluid volume deficit include:
• decreased fluid intake
• increased fluid output due to other conditions e.g. diarrhoea, vomiting, prolonged fever, excessive perspiration, drained fluids etc.
• uncontrolled diabetes mellitus

Question 7

Hypovolaemia signs and symptoms:

Answer 7

• dry lips and oral mucosa
• poor cognition and confusion
• reduced activity levels
• headache and fatigue
• reduced skin turgor
• sunken and dry eyes

Question 8

Signs and symptoms of sodium imbalance:

Answer 8

Hyponatraemia:
- cramps, muscle weakness, headache
- anorexia, nausea, confusion, seizure, coma

Hypernatraemia:
- tachycardia, thready pulse, hypotension
- thirst, dry mucous membranes
- cool extremities, muscle weakness
- lethargy, confusion, seizures, coma

Question 9

Potassium imbalance:

Answer 9

• both hypokalaemia and hyperkalaemia have the potential to cause major disruptions to muscle and cardiac function and have similar signs and symptoms
• symptoms may not be present until potassium imbalance is significant
• potassium levels are monitored with blood tests (U&E)
• ECG can alert to imbalance

Question 10

IV fluid classifications:

Answer 10

• Crystalloids:
• fluids that contain solutes e.g. 5% dextrose, normal saline.
• used for fluid and electrolyte replacement and maintenance
  *Colloids:
• fluids in which components are suspended, such as blood plasma
• used for plasma expansion in acute hypovolaemia
• Tonicity:
• a measure of the concentration of electrolytes in the fluid

Question 11

Ongoing IVT nursing management:

Answer 11

• monitoring the IV site for complications
• maintenance of equipment
• prevention of complications occurring during and after completion of the intravenous (IV) infusion
• patient education
• assisting with mobility and ADLS
• continuous assessment

Question 12

Phlebitis: Signs and symptoms:

Answer 12

• inflammation of the vein
• redness or tenderness at the site of the tip of the catheter or along the path of the vein
• puffy area over the vein
• warmth around the insertion site

Question 12

Phlebitis: Prevention:

Answer 12

• monitor administration rates and inspect the IV site frequently
• check when the cannula is due to be re-sited (as per policies and procedures of facility)

Question 12

Phlebitis: Managment:

Answer 12

• stop the infusion at the first signs of redness or pain. Report to RN
• remove cannula
• apply warm moist compress to the area
• document conditions and interventions

Question 13

Thrombophlebitis:

Answer 13

• Thrombophlebitis will have similar signs and symptoms to phlebitis:
• tender, warm, redness, palpable (cord) cause by a clot in the vein
• Prevention and management:
• same as phlebitis
• do not force the flush as this can dislodge the clot into the systemic circulation

Question 14

Complications associated with dislodgement of cannula:

Answer 14

• Infiltration:
• IV cannula becomes dislodges from the vein or passes through the wall of the vein. infusion fluid enters the surrounding tissue
• cause by poor secured cannulas
• fragile veins; vein wall being punctured on insertion of the cannula
• Extravasation:
• dislodged cannula
• increase pressure or irritation of the vesicant fluid on the vein wall
• vein wall being punctured on insertion of the cannula

Question 15

Infiltration:

Answer 15

• Signs and symptoms:
• oedema surrounding the cannula site and adjacent tissue
• cool to touch, pale skin, infusion slows
  -pinkish coloured blood on draw or no draw back
• Prevention:
• check site frequently
• educate patient to report signs and symptoms
• Managment:
• report to RN
• remove cannula
• elevate limb
• check there are no constrictions due to swelling
• apply warm compresses

Question 16

Extravasation:

Answer 16

• Signs and symptoms:
• site pain and tenderness
• oedema, paleness around insertion site
• burning sensation, slow or stopped infusion
• Prevention:
• ensure cannula is secured
• vesicant medications should be infused into larger veins
• closely observe site
• Managment:
• stop infusion immediately
• notify RN
• leave cannula in place until further orders

Question 17

Septicaemia:

Answer 17

• Cause:
• poor aseptic technique during insertion and in accessing the cannula allow microorganisms to enter the systemic circulation
• Signs and symptoms:
• pyrexia, diarrhoea, nausea, vomiting, abdominal pain, tachycardia and hypotension
• Prevention:
• ANTT (aseptic non touch technique)

Question 18

Fluid Overload:

Answer 18

Patients with cardiac, renal or neurologic problems and older people are at risk of overload.
* Signs and symptoms
- shortness of breath and moist crackers on auscultation
- jugular venous distention
- bounding, full pulse, increase blood pressure

Question 19

Air Embolus:

Answer 19

• Cause:
• air in the line from un/poorly primed IV line that enters circulatory system
• Signs and symptoms:
• dizziness, dyspnoea, cough and expiratory wheeze, hypotension, chest pain, confusion, coma
• Prevention:
• prime line and check patency
• do not re-pierce IV bags

Question 20

Peripheral Oedema:

Answer 20

• excess fluid causes pressure in the intravascular space causing it to leak into dependent limbs (legs)
• Cause:
• excess IV fluid or given too rapidly
• insufficient monitoring of fluid balance status in a person with reduced CV or renal function
• Signs and symptoms:
• pitting oedema and pallor in lower limbs
• skin tightness, weight gain