IV Therapy

complications
COMPLICATIONS OF INTRAVENOUS
THERAPY
Complications that occur from intravenous therapy are either systemic or local
or a combination of both.
Local
Venous spasm, Haematoma, Phlebitis, Thrombophlebitis, Infection, Infiltration,
Extravasation.

Systemic
Bacteraemia, Septicaemia, Cardiovascular Overload, Speed Shock, Emboli (air,
particle, thrombus), AllergicReaction/Anaphylaxis.
Venous Spasm
The sudden involuntary contraction of the vein into which a cannula or solution is being
placed.
Probable Causes
 infusion of cold or irritating solution
 too rapid infusion flow rate
 traumatic cannulation.
Prevention
 use recommended dilution and/or infusion
 duration
 ensure adequate haemodilution for type ofsolution
 bring solutions to room temperature prior to infusing (ifappropriate)
 use appropriate access device for the treatment. Signs and Symptoms
 sharp cramping pain above the insertion site, blanching of skin, sluggish flow rate despite
infusion being set to free flow. Intervention
 apply warm compress to site
 decrease flow rate until spasm
 relieved
 dilute medicationsfurther66
 if unrelieved, resite IV cannula
 document in patient’s notes.
Phlebitis/Thrombophlebitis
The inflammation of a vein/inflammation and the presence of thrombus within the vein.
Probable Causes
Mechanical – poor cannulation technique, internal friction of the cannula against the wall of
the vein, cannula gauge too large for the vein, poor site for cannula placement,
inadequate securing of cannula, trauma from patient activity, cannula insitu for too long.
Chemical – High/low pH of fluid/medicine, hypertonic solutions, drug not
reconstituted/diluted correctly, reaction to cannula material.
Infective – Poor asepsis of inserter, poor asepsis when accessing cannula, cannula insitu for
too long, self-seeding from distant infection site.
Prevention
 skilled cannula insertion
 maintain sterile intact dressing
 stable cannula fixation
 frequent flushing to prevent thrombus formation
 ensure adequate haemodilution for type ofsolution
 vigilant monitoring of intravenous therapy (see visual infusion phlebitisscale)
 maintain consistent flow rate
 educate patients on symptoms to report.
Signs and Symptoms
tenderness/pain at IV site, erythema, increased skin temperature, induration, oedema,
palpable venous cord, streak formation, slowing of infusion rate, pyrexia.
Intervention
 discontinue IV therapy (see scale)
 if infected, swab injection site and send for cultures
 remove cannula (see scale)
 document in patient’s notes
 inform the GP

Infection
Invasion of a pathogenic organism; may be local or systemic.
Probable Causes
 introduction of the organism into the local tissue/bloodstream by health care worker or
patient
 poor aseptic technique of the health careworker
 contaminated infusate, equipment, dressing
 self-seeding from distant infection site
 general poor health of the patient increasing susceptibility
Prevention
 effective hand hygiene
 maintaining aseptic technique whenever manipulating IV system
 rigorous skin decontamination prior to IV insertion
 changing equipment/solution as recommended
 maintaining sterile intact dressing68
 appropriate labeling of equipment alerting when changesdue
 vigilant monitoring of intravenous therapy
 educate patients about symptoms to report.
Signs and Symptoms
Local - Pain at IV site, erythema, increased skin temperature, induration, palpable venous
cord, slowing of infusion rate, pyrexia, cellulitis, discharge of purulent exudate at exit site, raised
WBC.
Systemic - Onset may be abrupt, patient may become hot and flushed, pyrexia, chills/rigors,
muscle and joint pains, tachycardia, tacypnoea, apathy, nausea, vomiting, headache,
fatigue, hypotension, raised WBC, positive blood cultures.
Intervention
Local - Stop infusion, remove cannula, swab injection site and send for cultures, clean and
dress site, monitor temperature and pulse, inform Medical Officer, treat, document in patient’s
notes. Systemic – Treat as an emergency, call Ambulance , monitor vital signs, change tubing,
KVO with infusion of 0.9% normal saline and document in patient’s notes
Infiltration
The escape of non-vesicant solutions from the intravascular space into extravascular tissue.
Probable Causes
 Partial or complete puncturing of vessel due to:
 insertion needle/stylet puncturing the vein wall on cannulation
 puncturing of the vein wall by the cannula secondary to poor stabilisation of cannula/limb
 poor location of cannula e.g. over a joint/area of flexion
 trauma from patient activity
 fragility of a patient’s veins.

Other (less common):

increased hydrostatic pressure secondary to a blood clot or vasoconstriction beyond the
cannula, forcing fluid out of the vessel
inflammation of the vein increasing vessel permeability allowing fluid to infiltrate into the
surrounding tissues.
Prevention
 skilled cannulation avoiding areas of flexion
 stable cannula fixation
 use recommended dilution and/or infusion duration
 ensure adequate haemodilution for type ofsolution
 vigilant monitoring of intravenous therapy (see infiltration scale)
 educate patients on symptomst o report and their role in prevention
 Vesicant solutions
Signs and Symptoms
Coolness of skin around site, skin taut, oedema, blanching, pain at site, slowing of infusion
rate, numbness, fluid leaking from injection site.
Intervention
 discontinue IV use
 remove cannula (see scale)
 elevate the extremity based on patient comfort
 document in patient’s notes
 inform GP

Extravasation
The escape of vesicant solutions from the intravascular space into extravascular tissue.
Examples of known vesicant solutions.

Probable Causes
 insertion needle/stylet puncturing the vein wall on cannulation
 puncturing of the vein wall by the cannula secondary to poor stabilisation ofcannula/limb
 poor location of cannula e.g. over a joint/area of flexion
 trauma from patient activity
 ragility of a patient’s veins.
Prevention
 anticipate extravasation when administering vesicantsolutions
 know medication antidotes and extravasation managementprocedure
 choose access device appropriate to purpose
 avoid using butterfly needles
 skilled cannulation avoiding areas of flexion
 secure cannula fixation
 aspirate for blood return prior to medication administration to establish that
catheter/cannula is situated in the venous system
 use recommended dilution and/or infusion duration
 ensure adequate haemodilution for type ofsolution
 vigilant monitoring of intravenoustherapy
 educate patients on symptoms to report and their role inprevention.

Signs and Symptoms

Pain or burning at/around the injection site, coolness of skin around site, skin taut, oedema,
blanching, slowing of infusion rate, fluid leaking from injection site, erythema, blistering, tissue
necrosis (late symptom).
Intervention
 discontinue Ivimmediately
 leave cannula in place and try to aspirate the vesicant solution with a 10mlsyringe
 mark the skin with a pen outlining the area extravasated into
 Advise GP
 consult pharmacy/manufacturer's guidelines for treatment recommendations for
extravasation e.g. instill the appropriate antidote then remove cannula (if unable to
aspirate the extravasated drug from the IV cannula/extension set, do NOT instill the
antidote through the cannula - inject subcutaneously), apply cold/warm compress
 elevate the extremity
 administer analgesia
 document in patient’s notes.

Cardiovascular Overload/Pulmonary Oedema

The administration of a greater fluid volume than the circulatory system can manage
leading to Pulmonary Oedema; a severe state of increased interstitial fluid within the lung
that leads to 71 flooding of the alveoli with fluid.
Probable Causes
 rapid infusion of fluids
 excessive volume of fluidsinfused
 renal/cardiac dysfunction
Prevention

 assess patient history,

 identify those at risk & monitor closely
 utilise electronic infusion devices to deliver consistent volumes
 eliminate accidental free flow by using volume control sets avoid increasing infusion
rate to ‘catch up’. maintain fluid balance record & 24-hour net balance
 monitor weight
 early consultation with GP if concerned.

Signs and Symptoms

 Rapid weight increase, positive fluid balance, restlessness, raised JVP,

tachyapnoea/dyspnoea, tachycardia, persistent moist cough, pink frothy sputum, drop
in SpO2, crackles on auscultation. Intervention
 slow or stop the infusion, keep the Iv open
 place patient in high Fowler’s position administer oxygen via Hudson mask if SOB
 monitor vital signs consult with GP
 administer medications as prescribed (usually includes diuretics, vasodilators, morphine
 document in patient’s notes.
Intervention
 slow or stop the infusion, keep the IVopen
 place patient in high Fowler’s position
 administer oxygen via Hudson mask if SOB
 monitor vitalsigns
 consult with GP administer medications as prescribed (usually includes diuretics, vasodilators,
morphine)
 document in patient’s notes.

Speed Shock
A systemic reaction that occurs when a substance foreign to the body is rapidly introduced to the
circulatory system.
Probable Causes
 rapid infusion of medications/fluids
 rapid bolus administration of medication.
Prevention
 follow recommended bolus injection times and dilutions
 maintain constant infusion rate.
Signs and Symptoms
Dizziness, facial flushing, headache, chest tightness, hypotension, irregular pulse, shock, loss of
consciousness, cardiac arrest
Intervention

 stop the infusion immediately, keep cannulaopen

 Call Ambulance
 inform GP
 remain with the patient
 treat symptoms of shock
 monitor vitalsigns
 document in patient’s notes.

Air Embolism

The inadvertent entry of air into the cardiovascular system via the intravenous line leading
to the occlusion of blood vessels.

Probable Causes
 loose connections on IV equipment
 failure to clamp line when accessing/changing solution
 damage to connections/IV line when using forceps
 solution container is empty
Prevention
 vigilant assembly and checking ofsystem
 use luer-lock connections
 careful adherence to clamping when accessing the line
 use protected cover on forceps when using on IVequipment
Signs and Symptoms
Dyspnea, hypotension/dizziness, tachycardia, cyanosis, anxiety, confusion, loss of
consciousness, cardiac arrest.

Intervention
 immediately stop the infusion
 prevent further air entry
 place patient on left side, head down (leftTrendelenburg)
 Call Ambulance seek immediate medical assistance
 remain with the patient
 administer oxygen via Hudsonmask
 monitor vitalsigns
 treatshock/arrest
 document in patient’s notes.
Pulmonary Embolism
Pulmonary embolism refers to the lodgment of a free-floating blood clot (or emboli) in the pulmonary
vasculature.
Probable Causes
 thrombosis development
 force flushing a vascular device
 prolonged venous stasis
 coagulopathy.

Prevention
 discontinue flushing if resistance encountered
 aspirate blood prior to flushing devices
 Signs and Symptoms
 Pleuritic pain, tachypnea, dyspnea, restlessness, apprehension, hypoxia, wheeze, transient ECG
changes, hypotension, tachycardia, diaphresis,fever.
Intervention
 stop the infusionimmediately
 maintain IV access
 seek immediate medial attention
 remain with the patient
 administer oxygen for SOB and place in high semi Fowler’s position
 administer anticoagulant and analgesia as prescribed by GP document in patient’s notes.
Allergic Reaction
An allergic reaction is an inappropriate, hypersensitive immune response to the solution being
administered and can range from a mild delayed reaction to anaphylaxis.
Probable Causes
 IV antibiotics Prevention
 always ask the patient about allergies prior to intravenous fluid/medication administration
 knowledge of substances likely to cause anaphylaxis.

Signs and Symptoms

Pruritis, uticarial rash, local oedema, watering eyes/running nose, dyspnoea, wheezing, stridor,
hypotension, tachycardia, respiratory/cardiac arrest.
Intervention
 stop the infusion immediately
 Seek urgent medical assistance. Call Ambulance as appropriate
 maintain IV access institute basic life support as indicated
 administer oxygen for respiratory distress
 administer fluid bolus for hypotension as prescribed
 administer antihistamine, anti-inflammatory medications as prescribed
 follow procedure for anaphylaxis as needed (refer organizational policy