Question

10. The physician orders furosemide 80 mg intravenously (IV) for Mr. Abdul. An important nursing intervention is monitoring the IV access site every shift to assess for complication. Describe the complications of intravenous therapy as well as the symptom and the nursing consideration.

Answer 1

Ans) Complications of gaining I.V. may include infiltration, hematoma, an air embolism, phlebitis, extravascular drug administration, and intraarterial injection.

1) Infiltration:

- Infiltration is the infusion of fluid and/or medication outside the intravascular space, into the surrounding soft tissue. Generally caused by poor placement of a needle or angiocath outside of the vessel lumen. Clinically, you will notice swelling of the soft tissue surrounding the IV, and the skin will feel cool, firm, and pale.

- Small amounts of IV fluid will have little consequence, but certain medications even in small amounts can be very toxic to the surrounding soft tissue.

2) Hematoma:

- A hematoma occurs when there is leakage of blood from the vessel into the surrounding soft tissue. This can occur when an IV angiocatheter passes through more than one wall of a vessel or if pressure is not applied to the IV site when the catheter is removed.

- A hematoma can be controlled with direct pressure and will resolve over the course of 2 weeks.

3 )Air Embolism:

- Air embolism occurs as a result of a large volume of air entering the patient's vein via the I.V. administration set.

- The I.V. tubing holds about 13 CCs of air, and a patient can generally tolerate up to 1 CC per kilogram of weight of air; small children are at greater risk.

- Air embolisms are easily prevented by making sure that all the air bubbles are out of the I.V. tubing; fortunately, it is an extremely rare complication.

4) Phlebitis and Thrombophlebitis:

- Phlebitis and thrombophlebitis occur more frequently. Phlebitis is inflammation of the vein which occurs due to the pH of the agent being administered during the administration of the I.V, while thrombophlebitis refers to inflammation associated with a thrombus.

- Both are more common on the dorsum of the hand than on the antecubital facia and may occur especially in hospitalized patients where an I.V. may be in for several days, where use of an angiocatheter, as opposed to a needle, can increase the risk of phlebitis, as the metal needle is less irritating to the endothelium. (Needles are generally used for short term IV access of less than three hours, while angiocaths are used for longer periods of time.)

- The infusate itself may cause phlebitis and may be irritating to the skin. Older patients are also more susceptible to phlebitis.

- Treatment is generally elevating the site, providing warm compresses and administering non-steroidal agents to the patient. Anticoagulants and antibiotics are usually not required.

5) Extravascular Injection

- Extravascular injection of a drug may result in pain, delayed absorption and/or tissue damage (if the pH of the agent being administering is too high or too low).

- If large volumes have been injected and the skin is raised and looks ischemic, then 1% procaine should be infiltrated. Procaine is a vasodilator, which will improve the blood supply both to the area and improve venous drainage away.