Risks 1. Needlestick injury 2. Infectious organism exposure Needlestick Injury An AIDS patient became agitated and tried to remove the intravenous catheters. Hospital staff struggled to restrain the patient. During the struggle, an IV infusion line was pulled, exposing the connector needle. A nurse recovered the connector needle at the end of the IV line and attempted to reinsert it. The patient kicked her arm, pushing the needle into the hand of the second nurse. Three months later, the nurse who sustained the needlestick injury tested positive for HIV1. . Prevention: Avoid the use of needles where safe and effective alternatives are available. Create/maintain a safe. Report all needlestick and other sharps related injuries to ensure that you receive appropriate follow-up care. Avoid recapping needles. comprehensive disposal system. . Cleanse insertion sites with the recommended solutions.Infectious Organism Exposure Prevention: Do proper hand hygiene. Do not reuse tourniquets. . Wear gloves. 89 percent of HCW exposure to HIV were caused by percutaneous injuries.000 HCW became infected with HBV . more than 1. How Safe Are You? • In a CDC study. • As many as 40 percent of HCW who sustain needlesticks become infected with HBV • In 2004.IV Therapist. Occupational Risks Associated With IV Therapy Physical hazards. abrasions. contusions and chemical exposure Exposure to Infectious Agents . Accidents . • The following list is a summary of some of the rules to be observed in the workplace: – HEPATITIS B vaccine – STANDARD PRECAUTIONS – SHARPS AND WASTE DISPOSAL – PROTECTIVE DEVICE/EQUIPMENT – GLOVES – LAUNDRY – COMMUNICATING HAZARDS . COMPLICATIONS ASSOCIATED WITH IVT . Mechanical Risks 1. Phlebitis Possible Causes *Clotting at the catheter tip (thrombophlebitis) *Device left in the vein too long *Friction from catheter movement in the vein *Poor blood flow around the device *Solution with high or low pH or high osmolarity Signs/ Symptoms *Redness at Nursing Interventions *Remove the the tip of the device catheter and *Apply a warm along the vein pack *Tenderness *Notify the at the tip of physician device and *Document the above patient’s *Vein hard on condition and palpation your interventions Prevention Measures *Restart the infusion using a larger vein for initiating infusate. or restart with a smaller-gauge device to ensure adequate blood flow *Tape the device securely to prevent movement . Mechanical Risks 2. although rate may decrease *Cool skin around site *Discomfort. pain or swelling . burning. or pain at site *Feeling of tightness at site *Slower flow rate *Swelling at and above IV site (may extend along entire limb) Nursing Interventions *Remove the venipuncture device *Periodically assess circulation by checking for pulse and capillary refill *Restart the infusion in another limb *Notify the physician Prevention Measures *Check the IV site frequently (especially when using an IV pump) *Don’t obscure the area above the site with tape *Teach the patient to observe the IV site and report discomfort. Infiltration Possible Causes *Device dislodged from vein or perforated vein Signs/ Symptoms *Blanching at site *Continuing fluid infusion even when vein is occluded. Catheter dislodgement Possible Causes *Loosened tape or tubing snagged in bedclothes.Mechanical Risks 3. resulting in partial retraction of the catheter *Dislodged by a confused patient attempting to remove it Signs/ Symptoms Nursing Interventions *Catheter *Remove the backed out of catheter the vein *Infusate infiltrating into tissue Prevention Measures *Tape device securely on insertion *Use armboard . Severed catheter Possible Causes *Catheter inadvertently cut by scissors *Reinsertion of the needle into the catheter Signs/ Symptoms Nursing Interventions Prevention Measures *Leakage from the catheter shaft *If the broken portion of the catheter is visible. attempt to retrieve it.Mechanical Risks 4. notify the physician *If the broken portion of the catheter enters the bloodstream. If unsuccessful. place a tourniquet above the IV site to prevent its progression *Notify the physician and radiology department *Avoid using scissors around the IV site *Never reinsert the needle into the catheter *Remove the unsuccessfully inserted catheter and needle together . Hematoma Possible Causes Signs/ Symptoms Nursing Interventions Prevention Measures *Leakage of blood into tissue *Vein punctured through ventral wall at time of venipuncture *Bruising around venipuncture site *Tenderness at venipuncture site *Remove the venipuncture device *Apply pressure and cold compresses to the affected area *Recheck for bleeding *Document the patient’s condition and your interventions *Choose a vein that can accommodate the size of the intended venous access device *Release the tourniquet as soon as successful insertion is achieved .Mechanical Risks 5. Venous spasm Possible Causes *Administration of cold fluids or blood *Severe vein irritation from irritating drugs or fluids *Very rapid flow rate (with fluids at room temperature) Signs/ Symptoms Nursing Interventions Prevention Measures *Blanched skin over the vein *Pain along the vein *Sluggish flow rate when the clamp is completely open *Apply warm soaks over the vein and surrounding area *Slow the flow rate *Use a blood warmer for blood or packed red blood cells when appropriate .Mechanical Risks 6. pad the tape securing the arm board . numbness. tendons. including paralysis. or ligament damage Possible Causes Signs/ Symptoms *Improper venipuncture technique.Nerve. or ligaments *Tight taping or improper splinting with arm board *Delayed effects. and deformity *Extreme pain (similar to electric shock when nerve is punctured) *Numbness and muscle contraction Nursing Interventions *Stop procedure *Notify the physician Prevention Measures *Don’t repeatedly penetrate tissues with the venipuncture device *Don’t apply excessive pressure when taping or encircling the limb with tape *Pad the arm board and.Mechanical Risks 7. if possible. tendon. resulting in injury to surrounding nerves. or rate minder for elderly or compromise d patients *Recheck calculations of fluid requirements *Monitor the infusion frequently .Circulatory overload *Flow rate too rapid *Miscalculation of fluid requirements *Roller clamp loosened to allow run-on infusion *Crackles *Discomfort *Increased blood pressure *Large positive fluid balance (intake is greater than output) *Neck vein engorgement *Respiratory distress *Raise head of the bed *Administer oxygen as needed *Notify the physician *Administer medications (probably furosemide) as ordered *Use a pump. controller.Mechanical Risks Possible Causes Signs/ Symptoms Nursing Interventions Prevention Measures 8. Systemic infection Possible Causes Signs/ Symptoms Nursing Interventions Prevention Measures *Failure to maintain aseptic technique during insertion or site care *Immunocompro mised patient *Poor taping that permits the access device to move. . and the access device at recommended times.Mechanical Risks 9. which can set up ideal conditions for organism *Contaminated IV site usually with no visible signs of infection *Fever. inserting the venipuncture device. and discontinuing the infusion *Secure all connections *Change IV solutions. tubing. which can introduce organisms into the bloodstream *Prolonged indwelling time of device *Severe phlebitis. and malaise for no apparent reason *Notify the physician *Administer prescribed medications *Culture the site and the device *Monitor vital signs *Use scrupulous aseptic technique when handling solutions and tubings. chills. Air embolism Possible Causes Signs/ Symptoms Nursing Interventions Prevention Measures *Empty solution container *Secondary solution container empties. next container (primary) pushes air down line *Disconnected tubing *Decreased blood pressure *Increased central venous pressure *Loss of consciousness *Respiratory distress *Unequal breath sounds *Weak pulse *Discontinue the infusion *Place the patient in Trendelenburg’s position to allow air to enter the right atrium and disperse through the pulmonary artery *Administer oxygen *Notify the physician *Document the patient’s condition and your interventions *Purge the tubing of air completely before infusion *Use the airdetection device on the pump or the aireliminating filter proximal to the IV site *Secure connections .Mechanical Risks 10. chills. epinephrine agitation. Be aware of crossallergies *Assist with test dosing *Monitor the patient carefully during the first 15 minutes of administratio n of a new drug *Bronchospas m *Itching *Tearing eyes and runny nose *Urticarial rash *Wheezing . *Give 0.Mechanical Risks 11. stop the infusion immediately *Maintain a patent airway *Notify the physician *Administer an RED FLAG: antihistaminic An steroid. subcutaneously *Obtain the patient’s allergy history.5 including ml of 1:1. reaction can and antipyretics occur within drugs.2 to 0.000 flushing. aqueous anxiety.Allergic reaction Possible Causes *Allergens such as medications Signs/ Symptoms Nursing Interventions Prevention Measures *If reaction occurs. as minutes after ordered exposure. an antianaphylactic inflammatory. Mechanical Risks Possible Causes Signs/ Symptoms Nursing Interventions generalized itching. seizures. palpitations. coughing. as ordered *Administer cortisone if ordered Prevention Measures . paresthesia. throbbing in ears. and cardiac arrest *Repeat the epinephrine dose at 3minute intervals and as needed. wheezing. Occlusion Possible Causes Signs/ Symptoms *Blood backup in *IV flow the line when the interrupted patient walks *Hypercoagulabl e patient *Intermittent device not flushed *Line clamped too long Nursing Interventions Prevention Measures *Use mild flush pressure during injection *Don’t force the flush *If unsuccessful.Mechanical Risks 12. *Have the patient walk with his arm folded to his chest to reduce the risk of blood backup . reinsert the IV device *Maintain IV flow rate *Flush promptly after intermittent piggyback administratio n. and hardened vein *Severe discomfort Nursing Interventions Prevention Measures *Remove the device. Thrombophl ebitis Possible Causes Signs/ Symptoms *Thrombosis and *IV Reddened.Mechanical Risks 13. restart the infusion in the opposite limb if possible *Apply warm soaks *Watch for IV therapy-related infection (thrombi provide an excellent environment for bacterial growth *Notify the physician *Check the site frequently *Remove the device at the first sign of redness and tenderness . inflammation swollen. Thrombosis *Injury to the endothelial cells of the vein wall. and swollen vein *Sluggish or stopped IV flow *Remove the device. allowing platelets to adhere and thrombus to form *Painful. restart the infusion in the opposite limb if possible *Apply warm soaks *Watch for IV therapy-related infection (thrombi provide an excellent environment for bacterial growth *Notify the physician *Use proper venipuncture techniques to reduce injury to the vein .Mechanical Risks Possible Causes Signs/ Symptoms Nursing Interventions Prevention Measures 14. reddened. For example.Mechanical Risks 15. phenytoin. give antibiotics in a 250-ml solution rather than 100 ml *If the drug has a low pH. such as 40 mEq/L of potassium chloride. and some antibiotics (such as vancomycin and nafcillin) *Pain during the infusion *Possible blanching if vasospasm occurs Rapidly developing signs of phlebitis *Red skin over the vein during infusion Nursing Interventions *Slow the flow rate *Try using an electronic flow device to achieve a steady regulated flow Prevention Measures *Dilute solutions before administratio n. ask a pharmacist if it can be buffered with sodium bicarbonate (refer to facility policy) . Vein irritation at the IV site Possible Causes Signs/ Symptoms *Solution with a high or low pH or high osmolarity. ask the physician to use a central IV line .Mechanical Risks Possible Causes Signs/ Symptoms Nursing Interventions Prevention Measures *If long-term therapy of an irritating drug is planned. PROCEDURAL PROBLEMS ASSOCIATED WITH IV THERAPY . Fluctuating flow rate Runaway IV Sluggish IV Tubing / loose connection/ disconnection Blood back up in tubing . IV line obstruction/kinking of IV tubing Clogged filter Break in aseptic technique Leaks. due to inappropriate device . TROUBLESHOOTING PROMPTLY AND EFFECTIVELY . therapy I.V. More nursing time is allotted to I. I. Nurses are assuming more nursing responsibilities in I. therapy is the preferred mode of treatment because of its rapid onset. .V.V. therapy. Therapy is a risk specialty area.V. or phlebitis. Obstruction of flow is caused or affected by the following factors: . 2.V. system to locate the problem.Check for patency. extravasation.Assess the I.WHAT TO DO WHEN INFUSION SLOWS DOWN OR STOPS 1. Check for infiltration. Start at the insertion side. release every apply tapes.1 Patients limb is flexed. .2 Tip of needle or cannula is against the vein wall.3 Adhesive taping maybe too tight. 2. 2. 2. Lift or pullback the needle or cannula a little. Reposition limb to release venous pressure. patient lying on the side. V. .6. Replace the entire venipuncture device and solution. • 2.5. gently adjust. • 2. It may expose the patient to embolism.• 2. Transfer I. line to an unaffected site. Small cannulas or tubing may kink or fold. Local edema or poor tissue perfusion from disease can block venous flow. Presence of precipitates in solution either from incompatibility of fluids and medications or from infusion.4. Check if both are open or if these are properly adjusted. 3. Check the clamps. Check the patency of the air vent. . Some sets have two: the roller clamp and the side clamp. 4. reposition it if needed. push it more inside the fluid bag or adjust it. it may cause venous spasm and decrease the flow. If solution is too cold. keep room temperature regulated. Check fluid level: if empty replace as prescribed. Check the spike of the set. . 5. 6. If it has. Check filters: ordinary sets usually do not have in-line filters. Blood transfusion filters retain blood product debris. If flow rate decreases or stops after more than one unit has been transfused you may have to change the set. follow the manufacturer’s guide instructions. . Is gauge of the needle too small? Is fluid container too low above the venipuncture site? Adjust it around 36-48 inches above the site. release and round-up the tubing to its original shape • 8.• 7. Check tubings: if patient is lying on it or if it is kinked or it may be crimped with too tight roller clamps. . Therapy made Incredibly Easy.V. Therapeutics. F. Lynn. Inc. (ANSAP). . Philadelphia.REFERENCES • • • Association of Nursing Service Administrators of the Philippines. 2000. Springhouse Corporation. Manual of I. Davis Co. Nursing Standards on Intravenous Practice 7th EDITION. Pennsylvania. Cahil. I. Dionne. Matthew. Philips..V.A. Lippincott Williams and Wilkins./February 1998 vol. MAO 218. Jan.21. Supplement to Journal of Intravenous Nursing. Nursing Journal May and July 2000. .V. Therapy. Intravenous Nursing Society. Fresh Pond Square. Cambridge. 10 Faucett street. JUST THE FACTS I. 2005.