If you are administering I.V. fluids or medications to a patient through a peripheral I.V. site, be alert for signs and symptoms of complications, institute preventive measures, and know how to intervene when complications do occur. 
 
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I.V. Fluids

Infiltration of I.V. Fluids

Infiltration occurs when I.V. fluid or medications leak into the surrounding tissue. Infiltration can be caused by improper placement or dislodgment of the catheter. Patient movement can cause the catheter to slip out or through the blood vessel lumen. 

 

Infiltration Signs and symptoms

• Swelling, discomfort, burning, and/or tightness 
• Cool skin and blanching
• Decreased or stopped flow rate

I.V. Infiltration Prevention

• Select an appropriate I.V. site, avoiding areas of flexion. 
• Use proper venipuncture technique.
• Follow your facility policy for securing the I.V. catheter.
• Observe the I.V. site frequently.
• Advise the patient to report any swelling or tenderness at the I.V. site.

Management of I.V. Infiltration

• Stop the infusion and remove the device.
• Elevate the limb to increase patient comfort; a warm compress may be applied.
• Check the patient's pulse and capillary refill time.
• Perform venipuncture in a different location and restart the infusion, as ordered.
• Check the site frequently.
• Document your findings and interventions performed.

Extravasation

Extravasation is the leaking of vesicant drugs into surrounding tissue. Extravasation can cause severe local tissue damage, possibly leading to delayed healing, infection, tissue necrosis, disfigurement, loss of function, and even amputation.

Signs and Symptoms

• Blanching, burning, or discomfort at the I.V. site
• Cool skin around the I.V. site
• Swelling at or above the I.V. site
• Blistering and/or skin sloughing

Extravasation Prevention 

• Avoid veins that are small and/or fragile, veins in areas of flexion, veins in extremities with preexisting edema, or veins in areas with known neurologic impairment.
• Be aware of vesicant medications, such as certain antineoplastic drugs (doxorubicin, vinblastine, and vincristine), and hydroxyzine, promethazine, digoxin, and dopamine.
• Follow your facility policy regarding vesicant administration via a peripheral I.V.; some institutions require that vesicants are administered via a central venous access device only. 
• Give vesicants last when multiple drugs are ordered.
• Strictly adhere to proper administration techniques.

Management of Extravasation

• Stop the I.V. flow and remove the I.V. line, unless the catheter should remain in place to administer the antidote.
• Estimate the amount of extravasated solution and notify the prescriber.
• Administer the appropriate antidote according to your facility's protocol.
• Elevate the extremity.
• Perform frequent assessments of sensation, motor function, and circulation of the affected extremity. 
• Record the extravasation site, your patient's symptoms, the estimated amount of extravasated solution, and the treatment.
• Follow the manufacturer's recommendations to apply either cold or warm compresses to the affected area.

Phlebitis from I.V. Therapy

Phlebitis is inflammation of a vein. This complication of peripheral I.V. therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. catheter size for the vein, or prolonged use of the same I.V. site.

 

Phlebitis Signs and Symptoms

• 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

Phlebitis Prevention

• Use proper venipuncture technique.
• Use a trusted drug reference or consult with the pharmacist for instructions on drug dilution, when necessary.
• Monitor administration rates and inspect the I.V. site frequently.
• Change the infusion site according to your facility's policy.

Management of Phlebitis

• Stop the infusion at the first sign of redness or pain.
• Apply warm, moist compresses to the area.
• Document your patient's condition and interventions.
• If indicated, insert a new catheter at a different site, preferably on the opposite arm, using a larger vein or a smaller device and restart the infusion.

Hypersensitivity Reaction

An immediate, severe hypersensitivity reaction can be life-threatening, so prompt recognition and treatment are imperative.

Signs and Symptoms

• Sudden fever
• Joint swelling
• Rash and urticaria
• Bronchospasm
• Wheezing 

Hypersenstivity Prevention

• Ask the patent about personal and family history of allergies.
• For infants younger than 3 months, ask the mother about her allergy history because maternal antibodies may still be present.
• Stay with the patient for five to 10 minutes to detect early signs and symptoms of hypersensitivity.
• If the patient is receiving the drug for the first or second time, check him every five to 10 minutes or according to your facility's policy. 

Management of Hypersensitivity

• Discontinue the infusion and notify the prescriber immediately.
• Administer medications as ordered.
• Monitor the patient's vital signs and provide emotional support.

I.V.-Associated Infection

Local or systemicinfection  is another potential complication of I.V. therapy. 

Signs and Symptoms

• Redness and discharge at the I.V. site
• Elevated temperature

Infection Prevention

• Perform hand hygiene, don gloves, and use aseptic technique during I.V. insertion. 
• Clean the site with approved skin antiseptic before inserting I.V. catheter.
• Ensure careful hand hygiene before any contact with the infusion system or the patient. 
• Clean injection ports before each use.
• Follow your institution’s policy for dressing changes and changing of the solution and administration set. 

Management of Infection

• Stop the infusion and notify the prescriber.
• Remove the device, and culture the site and catheter as ordered. 
• Administer medications as prescribed.
• Monitor the patient's vital signs.

With careful attention and skill, you’ll be able to recognize, prevent, and manage these complications of peripheral I.V. therapy.

I.V. Therapy Complications References

(2008). I.V. Essentials: Complications of Peripheral I.V. Therapy. Nursing Made Incredibly Easy!, 6 (1).

Smeltzer, S. (2010). Brunner and Suddarth's Textbook of Medical Surgical Nursing, 12e. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Spencer, S. & Gilliam, P. (2015). Teaching patients about their short peripheral I.V. catheters.  Nursing2015, 45 (2).

Vacca, V. (2013). TIME CRITICAL: Vesicant extravasation. Nursing2013, 43(9).

 

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