Infiltration | Infiltration is caused by dislodgement of the catheter from the vein with unintentional infusion into the surrounding tissue |
Prevention | Signs and symptoms | Intervention |
Select the best catheter and insertion site Secure catheter and tubing Splint site Assess catheter for patency prior to use | Discomfort or pain Swelling Blanching Coolness of surrounding tissue Slows or quits flowing Absence of blood backflow | Stop infusion Disconnect tubing Remove catheter If severe, apply warm compress and elevate site |
Vesicant Extravasation | Extravasation is the infiltration of vesicant solutions into the surrounding tissue. Vesicants include chemotherapy, hyperosmolar solutions, parenteral nutrition, and KCL |
Prevention | Signs and symptoms | Intervention |
Same as infiltration | Same as infiltration Infusing a vesicant solution | Stop infusion Disconnect tubing Do not remove catheter Apply dry cold compress Contact provider |
Phlebitis | Caused by - Injury to the vein during venipuncture or prolonged catheter use
- Catheter too large for the vein
- Poor aseptic technique
- Irritation to the vein because of rapid infusion or irritating solutions (smaller veins are more susceptible)
- Clot formation at the end of the catheter due to slow infusion rates or inadequate hemodilution of infused medication or solutions
- More commonly seen with synthetic polyurethane catheters then silicone catheters
|
Prevention | Signs and symptoms | Intervention |
Secure catheter and tubing Splint site Assess catheter for patency prior to use Use large vein for irritating infusion Adequately dilute irritating medications | Discomfort and pain that will progress along the path of the catheter and vein Redness, swelling, warmth, induration Purulence Red streak above site Palpable venous cord | Apply warm compress Elevate site Consider removing the catheter Consider pharmacological interventions (analgesic, anti-inflammatory, corticosteroids) |
Catheter-associated bloodstream infection | Caused by - Underlying thrombophlebitis
- Contaminated equipment or solutions
- Prolonged placement of the IV catheter, tubing or solution container
- Lack of aseptic technique in insertion or dressing changes
- Cross-contamination from other infected areas of the body
- Critically ill or immunosuppressed
|
Prevention | Signs and symptoms | Intervention |
Adhere to hand hygiene Use aseptic technique, maximum sterile barrier precautions during insertion, mask, cap, sterile gown and sterile gloves Clean site appropriately Chlorhexidine use instead of povidone-iodine Change tubing as recommended Maintain integrity of the administration system Use dressing that allows visualization of the site Avoid insertion into the femoral vein Use best practices checklists for insertion and maintenance Remove unnecessary CVC Antibiotic-impregnated catheters Vigilant catheter care | Signs of local infection Fever, chills Nausea, vomiting Elevated WBC Malaise, tachycardia Backache, headache May progress to septic shock with profound hypotension | Stop infusion Consider removing the catheter Get a sample of any exudate for possible culture When removing catheter, cut off the tip of with sterile scissors and place in sterile dry container for possible culture Start appropriate antibiotic therapy |
Circulatory overload | Fluid overload is caused by the infusion of excessive IV fluids. The elderly, infants and patients with cardiac or renal failure are at greater risk. |
Prevention | Signs and symptoms | Intervention |
Assess for cardiac or kidney conditions Be vigilant in high-risk patients Monitor infusion rate Use electronic infusion device in high-risk patients Keep accurate intake and output Splint the site if the flow rate fluctuates too widely with movement | Increased BP and pulse Increased CVP, venous distention, engorged jugular veins Headache Anxiety Shortness of breath, tachypnea, coughing Pulmonary crackles Chest pain | Notify the provider Sit the patient up to ease breathing Reduce IV infusion rate Monitor for worsening condition |
Air Embolism | - Caused when air enters catheter during tubing change or catheter removal of central venous line (negative intrathoracic pressure sucks in air during inspiration)
- Air in tubing deliver by IV push or infusion
|
Prevention | Signs and symptoms | Intervention |
Clear all air from tubing before infusion Change solution containers before they run empty Ensure all connections are secure Use Luer-lock connections or administration sets with air-eliminating filters unless contraindicated Use correct technique when removing central venous access devices When removing central venous device, place the patient in supine or Trendelenburg, unless contraindicated, so the insertion site is at or below the level of the heart Instruct the patient to bear down (Valsalva maneuver) during catheter removal | Sudden onset of dyspnea, breathlessness, and tachypnea Chest pain, hypotension tachycardia Altered mental status, altered speech Change in facial appearance, paralysis | Immediately prevent additional air from entering the bloodstream by closing, kinking, clamping, or covering the existing device or insertion site with an air occlusive dressing Immediately turn the patient on the left side and lower the head of the bed. This will trap air in the right side of the heart Notify the provider immediately Administer oxygen as needed |
Occlusion or sluggish flow | Caused by: - Malposition of the catheter against the side of a vein or valve
- Clot at the end of the catheter
- External mechanical causes (kinking of tubing, clogged filter, needless connector)
- Compression of the catheter between the clavicle and first rib, leading to occlusion, damage, or breakage
|
Prevention | Signs and symptoms | Intervention |
Assess the functionality of the vascular access device routinely Use appropriate flushing procedures Secure the IV with tape and armboard if needed | Unable to withdraw blood or sluggish blood return Sluggish flow or frequent occlusion alarms Signs of infiltration or extravasation | Assess for mechanical causes of occlusion Reposition the catheter by pulling back slightly on the cannula in case the cannula is against a wall or valve Lower the solution container below the patient heart and observe for blood backflow Assess the functionality of the electronic infusion device Consider removing the device |
Venous thrombosis | Caused by: - Infusion of irritating solutions
- Infection along catheter
- Fibrin sheath formation around the catheter with eventual clot formation
- Patient factors
- Hypercoagulable state (cancer diabetes, end state renal failure)
- History of deep vein thrombosis
- Surgical or trauma patients
- Critical care patients
- Extreme age
|
Prevention | Signs and symptoms | Intervention |
Select appropriate vascular access device and site location Ensure proper dilution of irritating substances Ensure proper placement of vascular access device Institute nonpharmacological strategies for thrombosis prevention if possible (early mobility, adequate hydration) Anticoagulant prophylaxis if ordered | Swelling and pain around the IV or in the extremity proximal to the insertion site Slowing of IV infusion or inability to draw blood from the central line Palpable lump in the cannulated vessel | Notify provider Anticipate therapeutic anticoagulant dose |
Insertion or migration injury | - Brachial plexus injury
- Cardiac arrhythmia
- Cardiac tamponade
- Catheter tip malposition or retraction
- Catheter or cuff erosion through the skin
- Insertion site necrosis
- Hemothorax
- Hydrothorax
- Pneumothorax
- Thoracic duct injury
- Laceration or perforation of vessels or viscus
- Myocardial erosion
- Vessel erosion
- Venous stenosis
|
Prevention | Signs and symptoms | Intervention |
Experienced operator Ultrasound-guided insertion | Specific to the injury | Specific to injury and symptoms Notify the practitioner |