Iv Therapy- Complications, Signs/symptoms, Causes, & Treatments (Nac1)

Front 1

(def)

the inadvertent administration of a nonvesicant solution into surrounding tissues; occurs from the dislodgement of the catheter from the lumen of the vein

Back 1

infiltration

Front 2

What are 7 causes of infiltration?

Back 2

1. faulty catheter insertion
2. infusion device not secured properly
3. high delivery rate
4. high pressure from an electric pump
5. overmanipulation of an IV device
6. obstruction of blood flow through the catheter
7. phlebitis

Front 3

What are 6 signs and symptoms of infiltration?

Back 3

1. infusion slows or stops
2. coolness of skin around IV site
3. taut skin
4. edema
5. absence of back flow or diluted blood return
6. pain (depending on degree of infiltration)

Front 4

What are 3 advanced complications from infiltration?

Back 4

1. ulceration and possible tissue necrosis
2. compartment syndrome (change in pressure leads to arterial compression, which leads to vascular spasm, pain, and muscle necrosis)
3. Reflex sympathetic dystrophy syndrome- chronic and exaggerated inflammatory process which leads to limited function of the area

Front 5

How quickly can muscular changes occur with compartment syndrome? nerve damage?

Back 5

muscular changes= 4-12 hours
nerve damage= 24 hours

Front 6

How can you prevent infiltration?

Back 6

check iv site every 2 hours (or more); check that iv isn't caught underneath patient when turning

Front 7

How can you check for infiltration?

Back 7

place pressure 3 inches above catheter site in front of tip and apply pressure either digitally or with a tourniquet; if IV slows or stops, placement is proper. If IV continues to run, suspect infiltration.

Front 8

How do you treat infiltration?

Back 8

- stop infusion; use warm or cold compress (depending on hospital policy)
- possible to aspirate infused medication; stop infusion but do not remove catheter and attempt to aspirate surrounding fluid

Front 9

(def)

inflammation of a vein

Back 9

phlebitis

Front 10

Phlebitis may lead to ________ if the patient isn't treated early.

Back 10

sepsis

Front 11

True/False:

Phlebitis may lead to thrombophlebitis

Back 11

true

Front 12

Mechanical phlebitis can be caused by what?

Back 12

the use of a large catheter in a small vein and improper taping

Front 13

Chemical phlebitis could occur with what 4 situations?

Back 13

1. irritating or vesicant solutions are infused
2. improperly diluted medication
3. rapid infusion
4. presence of particulate matter in a solution

Front 14

Bacterial phlebitis may occur in what 7 situations?

Back 14

1. poor aseptic technique
2. breaks in the integrity of the equipment
3. poor insertion technique
4. inadequately taped catheter
5. condition of the patient
6. vein condition
7. failure to do a site assessment

Front 15

What two skills are essential to preventing bacterial phlebitis?

Back 15

1. handwashing
2. careful and proper site preparation

Front 16

What are 5 measures to prevent phlebitis?

Back 16

1. use large veins and central lines for hypertonic solutions
2. rotate IV site ever 72-96 hours (or per hospital policy)
3. stabilize the catheter
4. use a 0.22 micron filter
5. choose the smallest catheter possible

Front 17

True/False:

You should d/c infusion within 24 hours of the first sign of phlebitis.

Back 17

False- you should d/c immediately

Front 18

What are 4 steps/treatments for phlebitis?

Back 18

1. d/c infusion
2. apply warm/cold compress
3. notify MD
4. notify infection control (depends on hospital policy)

Front 19

(def)

a blood clot that results from trauma to a vein

Back 19

thrombosis

Front 20

True/False:

An IV site may appear healthy when a thrombosis is present.

Back 20

True

Front 21

Should you ever force fluid into an IV site that is resistant? Why or why not?

Back 21

No, b/c a thrombosis could be present and become dislodged with pressure

Front 22

Can a thrombosis ever become infected?

Back 22

yes, bacteria and other particles may become trapped in the clot leading to thrombophlebitis

Front 23

Thrombosis along with thrombophlebitis can lead to what?

Back 23

embolus

Front 24

What are 3 methods to prevent thrombosis?

Back 24

1. use an IV pump
2. when infusing by gravity @ rates lower than 50 ml/hr, select microdrip tubing
3. avoid IV placement in areas of flexion and the lower extremities

Front 25

What is the treatment method for a thrombosis?

Back 25

1. d/c and restart a new catheter
2. assess the site for circulatory impairment

(never flush a catheter to remove an occlusion)

Front 26

What are the signs/symptoms of thrombophlebitis?(6)

Back 26

1. sluggish flow rate
2. edema
3. tender/cordlike vein
4. site warm to touch
5. red line above site
6. mottling/cyanosis of the involved extremity

Front 27

What is the treatment for thrombophlebitis?

Back 27

- Remove entire IV set up and restart in opposite upper extremity using ALL new equipment
- follow treatment measures for thrombosis and phlebitis

Front 28

Clotting at the tip of the cannula that results in sluggish or absent flow is caused by what 4 things?

Back 28

1. IV rate too slow
2. saline/heparin lock not flushed regularly
3. IV bag allowed to run dry
4. precipitates from incompatible medications

Front 29

How can you prevent clotting at the tip of the cannula?

Back 29

1. monitor flow rate regularly
2. use microdrip if flow rate is less than 50ml/hr
3. flush saline/heparin lock every shift and before/after medications

Front 30

What steps do you take if you suspect a clot at the tip of a cannula?

Back 30

- aspirate blood with a 5cc syringe and discard blood (do not irrigate)
- restart IV infusion and observe if flow resumes and observe site
- if flow does not infuse, remove IV and restart in another suitable site

Front 31

What is the result when the patient's own blood infiltrates the tissues at the venipuncture site?

Back 31

ecchymosis/hematoma

Front 32

What causes an ecchymosis/hematoma at the IV site? (3)

Back 32

1. nicking the vein during an unsuccessful venipuncture attempt
2. d/c of an IV cannula without sufficient pressure held over the site
3. applying a tourniquet too tightly, too long, or too soon above a previously attempted venipuncture site

Front 33

What are 5 recommendations to reducing the likelihood of hematoma development at the IV site?

Back 33

1. apply tourniquet just before venipuncture (no longer than 2 minutes)
2. use a 20-22 gauge for patients with paper-thin skin
3. be gentle
4. use a dry, sterile gauze when removing cannula
5. be alert to coagulation problems

Front 34

What are 3 treatment measures for hematomas?

Back 34

1. after removal apply direct, firm pressure for 2-3 minutes using dry, sterile gauze (5-10 if patient is on anticoagulants)
2. elevate on a pillow
3. use ice to prevent the hematoma from enlarging

Front 35

(def)

the inadvertent administration of a vesicant solution into the surrounding tissues which results in the formation of blisters and subsequent sloughing of tissues due to necrosis

Back 35

extravasation

Front 36

What are examples of vesicant solutions?

Back 36

- antineoplastic drugs
- electrolyte solutions
- certain antibiotics
- vasopressors
- radiocontrast media
- hypertonic dextrose solutions
- misc. IV drugs (phenergan, ativan, dilantin)

Front 37

What are 6 causes of extravasation?

Back 37

1. puncture of the vein wall during venipuncture or by mechanical friction from the catheter
2. dislodgement of the catheter
3. poorly secured infusion device
4. high delivery rate/high pressure
5. overmanipulation of the infusion device
6. thrombus at catheter tip

Front 38

What are the signs/symptoms of extravasation? (7)

Back 38

- slow or stopped infusion
- complaint of pain or burning
- swelling proximal or distal to IV site
- puffiness in the dependent part of the extremity
- skin tightness at the IV site
- blanching or coolness of the skin
- damp or wet dressing

Front 39

What determines the severity of damage due to extravasation?

Back 39

- type, concentration and volume of fluid

Front 40

What are 4 ways to prevent extravasation?

Back 40

1. use a skilled practitioner for infusion
2. verify good blood return
3. use free-flowing IV solution for push medications
4. remove gauze dressing fully to visualize site during administration

Front 41

If extravasation is suspected, what should you do? (list steps in order) (9)

Back 41

1. stop infusion
2. leave catheter in place
3. aspirate medication and blood
4. instill antidote immediately through catheter
5. remove catheter
6. apply cold compress for 24-72 hours for all extravasation except those of the vinka alkaloids (antineoplastics)
7. notify MD
8. photograph area
9. document an incident report

Front 42

(def)

a spasm of a vein resulting in temporary cessation of blood flow

Back 42

vasospasm

Front 43

Vasospasms can be caused by what? (4)

Back 43

1. administering cold solution
2. administering an irritating solution
3. too rapid infusion
4. administering a viscous solution

Front 44

What are 2 signs/symptoms of vasospasm?

Back 44

1. sharp pain at the IV site that travels up the arm
2. slowing of the flow

Front 45

What techniques are used to prevent vasospasm?

Back 45

1. dilute meds as recommended in IV book
2. keep solution at room temperature
3. consider using a fluid warmer for rapid infusions of cold agglutins
4. wrap extremity with warm compress during infusion

Front 46

What is the treatment method for vasospasms?

Back 46

- decrease the flow rate until the spasm subsides and restart
- apply warm compress to the affected extremity

Front 47

Local infections of the vein (such as intravascular thrombus) are one of the most serious catheter related infections. What are 4 causes attributed to this type of infection?

Back 47

1. catheters left in place longer than 5 days
2. field sticks not changed within 24 hours
3. poor technique in placing catheter
4. poor technique in maintaining and monitoring the peripheral site

Front 48

What are 4 signs/symptoms of a local infection (such as thrombophlebitis)?

Back 48

1. redness and swelling at the site
2. exudates of purulent material
3. elevated WBC
4. fever

Front 49

How do we prevent local infections (such as thrombophlebitis)? (5)

Back 49

- inspect all solution containers
- change solution every 24 hours
- adequate skin prep
- thorough hand washing
- maintaining asepsis at all times

Front 50

What are the steps (in order) for treating a local infection? (6)

Back 50

- notify MD
- remove catheter and send for culture without contaminating it
- obtain a swab from the insertion site for culture
- prepare for 2 blood cultures before antibiotic therapy is started
- apply sterile dressing
- monitor IV site

Front 51

What are 6 systemic complications related to IV therapy?

Back 51

1. septicemia
2. circulatory overload
3. pulmonary edema
4. air embolus
5. speed shock
6. catheter embolus

Front 52

(def)

the presence of microorganisms or their toxic products in the bloodstream

Back 52

septicemia

Front 53

What are the 2 most common microorganisms involved in catheter-related HAIs?

Back 53

1. coagulase-negative staphylococcus
2. enterococci

Front 54

What are examples of practitioner-related factors for the development of septicemia (in regards to IVs)? (6)

Back 54

- lack of handwashing
- break in sterile technique
- lack of experience inserting IVs
- inadequately prepared skin over insertion site
- inadequately stabilized and maintained IV access
- repeated manipulation of IV system

Front 55

What are 4 infusion related factors linked to the development of septicemia?

Back 55

1. problems with the solution container
2. problems with the catheter material
3. error at the insertion site
4. duration of the infusion

Front 56

Often times, the development of septicemia if related to patient risk factors. What are examples of this? (4)

Back 56

- age
- underlying disease
- immune status
- presence of other infectious processes

Front 57

What are 10 signs/symptoms of septicemia?

Back 57

- fever
- cold sweat
- tachycardia
- hyperventilation
- hypotension
- altered mental status
- nausea
- vomiting
- diarrhea
- abdominal pain

Front 58

True/False:

To prevent septicemia, you should follow the same techniques of prevention as used to prevent local infections, phlebitis, and infiltration.

Back 58

True

Front 59

True/False:

Solutions of albumin should be used within 1 hour of opening.

Back 59

False- albumin should be used as soon as the seal is broken.

Front 60

When treating septicemia, the regimen is similar to that of local infections, phlebitis, and infiltration. Supportive treatment may also be indicated for what 2 additional systemic problems?

Back 60

1. cardiovascular collapse
2. respiratory compromise

Front 61

What are 3 causes of fluid overload?

Back 61

1. excessive amounts of isotonic or hypertonic solutions rapidly
2. failure to monitor IV infusion
3. too rapid infusion in a compromised patient (renal/cardiopulmonary/elderly)

Front 62

Fluid overload can lead to what?

Back 62

pulmonary edema

Front 63

What are the signs/symptoms associated with fluid volume overload? (12)

Back 63

- irritated cough, SOB, or crackles, wheezing
- drop in O2 sat.
- pulmonary edema
- distended neck vein
- tachycardia
- increased BP/ bounding pulse
- polyuria
- urine SG less than 1.01
- moist, taut skin
- headache, confusion, lethargy
- weight gain in a short time
- decreased sodium, BUN, hct.

Front 64

If fluid volume overload is not corrected, what can result? (4)

Back 64

- pulmonary edema
- shock
- congestive heart failure
- cardiac arrest

Front 65

How can fluid volume excess be prevented? (4)

Back 65

1. monitor the infusion and know the solution's physiologic effect on the circulatory system
2. maintain prescribed rate (never try to "catch" up)
3. monitor intake/output
4. know the patients renal/cardio history

Front 66

What are the treatment measure you should implement for fluid volume overload? (7)

Back 66

1. decrease flow rate
2. position patient in high fowlers
3. monitor vital signs
4. place on continuous O2 saturation
5. administer O2 if less than 95%
6. Call MD
7. Keep patient warm

Front 67

(def)

an air pocket that causes obstruction to the forward flow of blood

Back 67

air embolism

Front 68

What are the chain of events following the obstruction of blood flow due to an air pocket?

Back 68

air pocket causes pulmonary hypoxia ----> results in vasoconstriction of lung tissue ----> reduces blood flow out of the heart ----> leads to decreased cardiac output, shock, and finally death

Front 69

What are 5 causes of an air embolism?

Back 69

1. improper priming of tubing with air still in the tubing
2. superimposing a new IV bag to a line that has run dry without clearing the line
3. loose connections that allow air to enter the system
4. poor technique in tube changing for central lines
5. allowing the solution container to run dry

Front 70

What are the "initial" signs/symptoms of an air embolism? (12)

Back 70

- palpitations
- lightheadedness
- weakness
- cough
- dyspnea
- cyanosis
- pulmonary edema
- tachycardia
- chest pain
- hypotension
- jugular vein distention
- anxiety, confusion, seizure

Front 71

If an air embolism is left untreated, the condition leads to what 4 signs/symptoms?

Back 71

1. hemiplegia
2. aphasia
3. coma
4. cardiac arrest

Front 72

As a nurse, you should implement what 6 measures to prevent an air embolism?

Back 72

1. instruct patient to do the valsalva maneuver when changing the tubing
2. remove air from the administration set
3. follow protocol for tubing changes of central lines
4. superimpose IV solution before the previous bag runs dry
5. attach piggyback to the injection port closest to the drip chamber
6. do not bypass the IV pump

Front 73

If an air embolism is suspected, you should immediately begin treatment. What 4 things should you do (in order)?

Back 73

1. have someone call MD
2. position patient on left lateral decubitus with the head down
3. monitor vitals and O2 sat.
4. administer 100% O2

Front 74

When treating an air embolism, what is the rationale for placing the patient on his left lateral side with the head down?

Back 74

this will cause the air to rise in the right atrium away from the pulmonic valve, preventing it from entering the pulmonary artery

Front 75

When treating an air embolism, what is the rationale for administering 100% O2?

Back 75

this causes nitrogen in the air embolus to dissolve in the blood and the bubble to decrease in size

Front 76

What type of therapy is indicated for a large air emboli?

Back 76

hyperbaric therapy

Front 77

Describe the surgical procedure that may be indicated for an air embolus.

Back 77

percutaneous aspiration of the air through the right ventricle

Front 78

(def)

medication is rapidly introduced into circulation which allows it to reach toxic proportions

Back 78

speed shock

Front 79

What are the signs/symptoms of speed shock? (7)

Back 79

- dizziness
- facial flushing
- headache
- tightness in the chest
- hypotension
- irregular pulse
- shock

Front 80

What are 2 preventative measures of speed shock?

Back 80

1. follow manufacturer's recommendation re: rate of administration
2. use an IV pump

Front 81

What is the treatment for speed shock?

Back 81

Call MD and give the antidote or resuscitation medication as needed

Front 82

(def)

a piece of catheter breaks off and travels through the vascular system

Back 82

catheter embolism

Front 83

What are the causes of catheter embolism? (4)

Back 83

- reinsertion of the same catheter that was used in an unsuccessful venipuncture attempt
- pressure directly over the catheter during d/c of therapy
- placement of catheter in joint flexion
- removing a stylet and reinserting it thus shearing off the catheter tip

Front 84

What are the signs/symptoms of a catheter emboli? (4)

Back 84

- sharp, sudden pain at the IV site
- minimal blood return
- rough/uneven catheter noted on removal
- additional s&s same as an air emboli

Front 85

How can a catheter embolism be prevented?

Back 85

- never reinsert a needle in a catheter
- do NOT apply pressure over the site when removing catheter
- avoid inserting over a joint flexion
- splint arm if flexion must be used

Front 86

What is the treatment for a catheter embolism?

Back 86

1. have patient apply digital pressure on vein above catheter site
2. apply a tourniquet above the elbow
3. call MD
4. start a new IV line
5. prep patient for xray
6. keep catheter in a clear specimen container to facilitate measuring the remaining tip

Front 87

(def)

systemic and immediate hypersensitivity reaction caused by an immunoglobulin Ig-E mediate release fro mast cells and basofils

Back 87

anaphylaxis

Front 88

True/False:

Anaphylaxis is often unpredictable.

Back 88

True

Front 89

What causes anaphylaxis? (5)

Back 89

- meds such as antibiotics, muscle relaxants, radio-contrast media, anesthetics, non-steroidal anti-inflammatory drugs
- latex
- food
- stings
- idiopathic causes

Front 90

What are the signs/symptoms of anaphylaxis? (3)

Back 90

- mild skin reactions
- respiratory problems
- cardiovascular collapse

Front 91

What measures should be taken to prevent anaphylaxis? (5)

Back 91

- identify known allergies
- take patient history
- perform physical exam
- inquire about and adverse drug reactions among family
- have thorough knowledge of the medications

Front 92

What is the treatment for anaphylaxis? (7)

Back 92

- d/c suspect med.
- monitor vitals and O2 saturation
- EKG
- administer O2, IV fluids and adrenaline as ordered or per hospital policy
- activate ERT
- maintaing ABCs
- start CPR if pulse is absent