Tuesday, July 6, 2010

Intravenous Injection and Complications of IVT

These is the Administering of IV injection and some complications that the patient can possibly have during IV therapy.

* Assemble equipment and check physician’s order.

* Explain the procedure to the patient.

* Perform hand hygiene.

* Ask the patient if he is allergic to latex. (Product use in preparing for IVT).

* Select the most appropriate insertion site and type of cannula for particular patient.

* Most distal site of arm or hand is generally used first so that subsequent IV access can be move progressively upward.

* Excessive hair at the selected site may be removed by clipping to increase the visibility of the veins and prevent infection and to adherence of dressing of IV insertion.

* Because infection can be a major complication of IV Therapy, the device, the fluid, the container and the tubing must be sterile.

* After applying tourniquet, the nurse palpates and inspects the vein. The vein should feel firm, elastic, engorged and round.

* Palpate for arterial pulsation, because arteries lie close to veins in the entecubital fossa.

* The insertion site is scrub with sterile pad soaked with alcohol, working from center of the area to the periphery allowing the area to dry.

* Cannula tips should not rest in a flexion area, as this could inhibit the IV flow.

* IV container should be marked with tape to indicate at a glance whether the correct amount has infused.

* Calculate for the flow rate and monitor at least hourly.


COMPLICATIONS OF INTRAVENOUS THERAPY


1. FLUID OVERLOAD

Overloading the circulatory system with excessive IV fluids causes increase blood pressure and central venous pressure.

Manifestation:

* Moist crackles on auscultation of lungs.

* Edema

* Increase weight

* Dispend

* Shallow respiration

* Increase respiration

Causes:

* Rapid infusion of an IV solution.

Management:

* Decrease IV infusion

* Monitor vital signs and rate every hour

* Assess breath sounds

* High Fowler position

* Can use infusion pump, if possible.

Complication:

* Heart Failure

* Pulmonary edema

2. Air Embolism

It is a rare but ever-present and most often associated with cannula of central veins.

Manifestation:

* Dyspnea and cyanosis

* Hypotension

* Weakness

* Increase pulse

* Loss of consciousness

* Chest, back and shoulder pain

Management:

* Clamping the cannula

* Placing patient on left side, in trendelenburg

* Assessing vital signs and breath sounds

* Administration of oxygen

Complication:

* Shock

* Death

3. Septicemia / Other infection

Cause:

* Contamination

Manifestation:

* Abrupt elevation of temperature

* shortly after infusion started

* Backache, headache

* Increase pulse rate and respiratory rate

* Nausea and vomiting

* Chills

* General body malaise

Management:

* Culturing the cannula, tubing/solution

* Establish new site

Complication:

* Septic Shock-severe causes

4. Infiltration

-unintentional administration of a non-vesicant solution or medication into surroundings of the tissue.

-can be occurring when the IV cannula dislodges or perforates the wall of the vein.

Manifestation:

* Edema around the insertion

* Leakage of IV fluid from insertion site

* Discomfort and coolness in the area on filtration

* A significant decrease of the flow rate

Management:

* Stop the infusion

* Start IV infusion, should be started in the

* New site or proximal to the filtration of the same estremities.

* Warm compress

* Elevates the affected site to promote the absorption of the fluid

* If the case is resent cold compress

5. Phlebitis

Inflammation of vein related to chemical or mechanical irritation or both.

Cause:

* Incidence increase length of time IOV in place

* Composition of fluid/medicine infused.

* Size at site of cannula inserted.

* Ineffective filtration.

* Improper anchoring of the line.

* Introduction of microorganism at the time inserted.

Manifestation:

* Redness

* Warm

* Pain or tenderness

* Swelling

Management:

* Discontinuing

* Restart the IV infusion

* Warm, moist compress

6. Thrombophlebitis

Presence of clot and inflammation of the vein.

Manifestation:

* Pain

* Redness

* Warmth

* Swelling

* Immobility of the extremities because

of discomfort and swelling

* Sluggush flow rate

* Fever

* Malaise and leukocytosis

Management:

* Discontinuing

* Cold compress-to decrease flow rate of blood, then,

* Warm compress to increase platelet aggregation

* Evaluating extremities

* Restarting of IV infusion

7. Hematoma

Result when blood leaks into tissue surrounding IV insertion site

Manifestation:

Ø Ecchymosis

Ø Immediate swelling at the site

Ø Leakage of blood at the site

Management:

Ø Removing needle or cannula

Ø Apply pressure

Ø Apply ice for 24 hours-to avoid extension

of the hematoma and then warm

compress to increase absorption of blood.

Ø Restart

8. Clotting and Obstruction

Blood clots may form in the IV line as a result of kinked IV tubing, a very slow infusion rate, failure to flush the IV line after intermittent medication or solution administration.

Management:

Ø Restart

Ø Tubing should not be irrigated/milked

Ø Container should be raised and the clot

should be aspirated from the tubing

Ø Prevent IV bag run dry

Ø Taping the tubing to prevent kinking

and maintain potency

Ø Flushing after intermittent medication

or other solution

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