Category: Nursing Skills

More than 90% of hospitalised patients receive some form of IV therapy. Unfortunately, about 1/5 of these patients experience IV complications due to lack of administration care and adequate monitoring.

Phlebitis

Phlebitis is the inflammation of the vein which is caused whenever the used cannula is too large for the chosen vein, or when the cannula is not secured in place. Using the smallest cannula possible depending on the patient and the fluid being administered will reduce the chance of phlebitis to occur during IV therapy administration.

Signs & Symptoms:

• warm to the touch around the insertion site
• redness and/or tenderness at insertion site or along the vein
• bulge over the vein

Management:

• at first sign or symptom of phlebitis stop IV infusion immediately
• apply warm compresses onto the area
• if further IV infusion is required, insert a new catheter into a different vein and into a different site, preferably choosing a bigger vein and opposite arm
• document patient condition and management

Air Embolism

Air Embolism a.k.a. gas embolism occur when one or multiple air bubbles enter the blood stream through a vein or artery and blocks it. Air embolism is one of the most dangerous IV complications as it can cause death.

Signs & Symptoms:

• blue skin hue
• anxiety
• dizziness
• nausea
• headache
• muscle pain
• joint pain
• hypotension
• dyspnoea
• gasp reflex
• persistent cough
• tachypnoea
• respiratory failure
• shock
• confusion
• syncope / loss of consciousness
• seizures
• stroke
• syncope

Management:

• if air embolism is noted, flush or infusion administration should be stopped immediately and the rotating haemostatic valve (RHV) should be fully opened
• if patient is unresponsive administer first aid, prioritising airway (A), breathing (B) and circulation (C) and if necessary resuscitate. Once resuscitated and stabilised, patient should be administered 100% oxygen treatment through a non-rebreather mask to ensure full body oxygen perfusion.
• document patient condition and management

IV Site Infection

A localised infection around the IV cannula site can be prevented by use of veins that are not small or fragile, not in extremities, not in areas that may need to be flexed and not in veins situated in sites with oedema or neurological impairment. Adherence to IV therapy safety procedures, maintaining a clear, dry dressing and frequent monitoring can help lessen the chance of infection.

Signs & Symptoms:

• redness
• swelling
• burning sensation
• discomfort
• discharge
• increase in temperature

Management:

• when noted, infusion should be stopped immediately
• remove cannula
• clean site of infection
• administer antibiotics as prescribed
• monitor patient’s vital signs
• document patient condition and management

Flare Reaction

Venous flare reaction is usually a localised allergic response to the administration of an irritant via IV. To minimise risk for a flare reaction, patient’s allergy history should be taken prior to therapy administration, and administration should ideally happen slowly through an infusion pump. Additionally, monitor patient during infusion administration for any pain or discomfort.

Signs & Symptoms:

• redness along the vein or at cannula site
• tenderness
• itchiness
• warm to the touch
• swelling
• hypotension
• anaphylaxis

Management:

• stop irritant administration immediately
• administer antidote if available
• monitor for worsening of patient condition
• document condition and management

Extravasation

Extravasation is the unintentional leakage of vesicant fluids or medications into the vein’s surrounding tissue. It can be prevented by ensuring proper drug dilution as per recommended guidelines prior to IV administration.

Signs & Symptoms:

• discomfort, blanching and/or burning sensation at IV site
• cool sensation at IV site
• swelling at or right above IV site
• blistering
• skin sloughing

Management:

• stop IV therapy administration immediately by disconnecting IV tube from cannula
• aspirate any residual drug
• administer antidote if available
• document patient condition and management

Infiltration

Infiltration is the accumulation of fluid in the IV surrounding tissue caused by the needle puncturing the vein wall or by eventual needle misplacement. Stabilising chosen vein extremity and taping cannula firmly to the skin can help prevent infiltration.

Signs & Symptoms:

• little or no flow of IV infusion or bolus
• cool to the touch
• hard to the touch
• swollen and pale infusion site
• fluid leakage from infusion site
• pain, tenderness, irritation and/or burning sensation at infusion site

Management:

• stop infusion immediately and remove cannula
• elevate effected extremity
• apply warm compresses to encourage absorption (apply ice to the swelling if noticed within 30 minutes of infiltration onset)

Thrombophlebitis

Thrombophlebitis is an inflammation that causes the formation of a blood clot, which blocks one or more veins, usually in the legs. Superficial Thrombophlebitis occurs when the affected vein is closer to the surface of the skin, whilst Deep Vein Thrombosis (DVT) occurs when the affected vein is at a deeper level.

To prevent thrombophlebitis, one needs to avoid prolonged periods of standing and elevate legs when sitting down. Improving blood circulation helps. This can be done by regular exercise.

Signs & Symptoms:

• sudden or gradual swelling in the affected area
• tenderness and/or pain in the affected area
• redness or discolouration in the affected area
• warm to the touch

Management:

• apply heat to affected area
• elevate
• use of NSAIDs
• wear compression stockings

Haematoma

A haematoma is leakage of blood from the blood vessel into the surrounding soft tissue. As one of the possible IV complications, a haematoma occurs when an IV catheter passes through multiple walls of a vessel, or when not enough pressure is applied to an IV site after catheter removal.

Signs & Symptoms:

• redness
• swelling
• pain
• disfiguring bruises

Management:

• during the first 24hrs from the formation of a haematoma apply ice packs wrapped in cloth for 20 minutes (you can repeat this multiple times)
• after the first 24hrs from the formation of a haematoma apply warm, moist compresses to the affected site for 20 minutes (you can repeat this multiple times in the second 24hrs post haematoma formation)
• do not massage affected area
• compress and elevate if affected area is a limb

Electrolyte Imbalance

Electrolytes are minerals that carry an electrical charge in the blood, tissues, organs and everywhere within the body. An electrolyte imbalance is the result of too much or too little water.

Signs & Symptoms:

• fatigue
• lethargy
• nausea and vomiting
• diarrhoea or constipation
• dysrhythmias
• tachycardia
• convulsions or seizures

Management:

• monitor for dehydration
• monitor ECG for prolonged QT interval
• IV fluids
• diet changes (eating more foods containing lacking electrolyte)
• check current drug prescriptions for any possible replacement need (eg. loop diuretics may be changed to potassium-sparing diuretics in the case of loss of potassium)

Acute Hypervolaemia

Hypervolaemia is a condition in which there is excess fluid in the blood. Whilst an adequate amount of water is necessary for the body to function well, excessive fluid leads to an imbalance, resulting in complications.

Signs & Symptoms:

• oedema in the ankles, feet, face and wrists
• body discomfort
• cramping
• headaches
• bloating
• hypertension
• dyspnoea
• tachycardia
• cardiomegaly
• cardiovascular problems

Management:

• watch fluid intake
• minimise sodium intake
• monitor weight and report any changes and swelling immediately
• diuretics
• if present manage other existing comorbidities such as heart failure and chronic kidney disease to minimise hypervolaemia

Anaphylaxis

Anaphylaxis is a severe immediate hypersensitive reaction which is usually triggered by an allergen. Identifying the signs and symptoms of an anaphylactic shock is crucial as this is a life-threatening situation requiring immediate treatment.

Signs & Symptoms:

• hives / itching
• flushed or pale skin
• dizziness or fainting
• hypotension
• bronchoconstriction / swollen tongue and/or throat leading to wheezing and dyspnoea
• weak rapid pulse

Management:

• epinephrine shot administered immediately
• maintain a patent airway
• if required, antihistamines and / or steroids may also be administered
• oxygen administration
• bronchodilators
• monitor blood pressure, heart rate and oxygen saturation

Speed Shock

Speed Shock is a systemic reaction to a drug being administered rapidly, leading to toxicity onset. An infusion device ensures that a drug is administered at the recommended rate.

Signs & Symptoms:

• headache
• flushed face
• chest tightness
• irregular pulse
• syncope
• loss of consciousness
• shock
• cardiac arrest

Management:

• Stop IV immediately
• Monitor ABC’s (Airway, Breathing, Circulation)
• Report reaction
• Do not leave patient unattended

CRBSI – Catheter Related Blood Stream Infection

Catheter Related Bloodstream Infection (CRBSI) is a complication resulting from the use of IV catheters. Septicaemia can also result from a CRBSI, causing a prolonged hospital stay. CRBSI can be prevented using an aseptic non-touch technique (ANTT) during insertion, use of PPEs, disinfecting external surfaces of the catheter hub and connecting ports, and removing and/or replacing at the appropriate time.

Signs & Symptoms:

• fever
• chills
• hypotension
• signs of infection proximal to the insertion site of the PVC (peripheral venous cannula)

Management:

• removing catheter immediately when a CRBSI is noted
• administrating antibiotics
• maintaining infection control

Adverse Drug Reactions

An adverse drug reaction (ADR) is a harmful or unpleasant reaction resulting from an IV infusion which can be caused by a single or a combination of drugs. An ADR can be prevented by avoiding consumption with alcohol, reading instructions and consuming medication only as prescribed, and taking note of any previous reactions to the same ingredients. Avoid taking over-the-counter medications with vitamins.

Signs & Symptoms:

• phlebitis
• infiltration
• extravasation
• speed shock
• shock
• cardiac arrest
• venous spasms (presenting as cramping and pain above IV site)

Management:

• stop drug administration immediately
• do not discard syringe…keep for further investigation
• monitor vital signs
• provide reassurance
• perform CPR or administer Oxygen if required

Below you can find a collection of videos that can help provide a more visual approach to IV Complications.

IV Complications

IV Complications: Phlebitis Animation

IV Complications: Air Embolism

IV Flare Reaction

Extravasation

Infiltration Animation

Infiltration

Thrombophlebitis

Anaphylaxis

Special thanks to the creators of the featured videos on this post, specifically Youtube Channels ivWatch, Lineus Medical Channel, What Happens If ?, Chronically Jaquie, Kathryn the Educator, DrER.tv and Alila Medical Media.

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