This document discusses complications of intravenous therapy, including both local and systemic complications. Local complications include hematoma, thrombosis, phlebitis, thrombophlebitis, infiltration, extravasations, local infection, and venous spasm. Signs, symptoms, treatment, and documentation requirements are provided for each local complication. Systemic complications discussed include septicemia, fluid overload/pulmonary edema, air embolism, speed shock, and catheter embolism. Prevention techniques and appropriate nursing interventions are also outlined for complications.

1. UMM AL- QURA UNIVERSITY
FACULTY OF APPLIED MEDICAL SCIENCES
NURSING DEPARTMENT
Complications of Intravenous
Therapy
Prepared By
Dr. Nahed Said El-nagger
Assistant Professor of Nursing
1430-1431 H

2. Unit . 2
Lecture No. 3.B

3. Learning Outcomes:
• Differentiate between local and systemic
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complications.
Describe the signs and symptoms of local
complications.
Identify prompt treatment for local and systemic
complications.
Identify International Standards of practice rating
infiltration.
List three risk factors for phlebitis.
Identify organisms responsible for septicemia
related to infusion therapy.
Identify prevention techniques for the systemic
complications.

4. I. Local complications
1. Hematoma:
Formations resulting from the infiltration of blood
into the tissues at the Venipuncture site.
Causes:
• Rupture the vein during an unsuccessful
Venipuncture attempt.
• Discontinuing the I.V. cannula or needle without
pressure.
• Applying a tourniquet too tightly above a
previously attempted Venipuncture site.

5. 1. Hematoma (cont.)
Signs/symptoms:
• Discoloration of the skin.
• Site swelling and discomfort.
• Inability to advance the cannula all the
way into the vein during insertion.
• Resistance to positive pressure during
the lick flushing procedure.
Document:
• The observable ecchymotic areas.

6. 2. Thrombosis
• Catheter-related obstructions can be
categorized as mechanical or non-thrombotic
( 42% of all obstructions)
or thrombotic (58% of all obstructions),
Signs/symptoms:
• Fever and malaise.
• Slowed or stopped infusion rate.
• Inability to flush licking device.

7. 2. Thrombosis (cont.)
Documentation:
• Document the change of infusion rate.
• The steps taken to solve the problem,
and the end result.
• Chart new IV sites.
• It’ s patency, and the size of the catheter
used.

8. 3.phlebitis
An inflammation of the vein.
Signs/symptoms:
• Redness at site.
• Site warm to touch and local swelling.
• Palpable cord along the vein.
• Sluggish infusion rate.
• Increase in basal temperature of 1 °C or
more.

9. 3. Phlebitis (cont.)
Nursing Interventions:
• Remove IV device.
• Apply warm soaks.
• Notify primary care provider.
• Restart IV infusion in a different
extremity.
• Document your actions.

10. 4.Thrombophlebitis
Thrombosis and inflammation.
Signs/symptoms:
• Sluggish flow rate, edema in the limbs.
• Tender and cordlike vein, site warm to
touch.
• Visible red line above Venipuncture
site.
• Diminished arterial pulses.
• Mottling and Cyanosis of the
extremities.

11. 5. Infiltration
Accidental administration of a non vesicant
solution into surrounding tissue.
Signs/symptoms:
• Coolness of skin around site, and tight
skin.
• Dependent edema and absence of blood
backflow.
• A pinkish blood return.
• Infusion rate slows but the fluid
continues to infuse.

12. Treatment of Infiltration
• Discontinue the infusion.
• Apply warm, moist heat to
↓ edema.
• Elevate the extremity.
• Restart the infusion at another
site, preferable the other arm.

13. Prevention of Infiltration
• Select site over long bone to act as a
splint.
• Avoid sites over joints.
• Use arm board to stabilize (as a last
resort!).

14. 5. Infiltration (cont.)
Documentation:
• assessment findings.
• any written and verbal communications.
• nursing and medical interventions.
• client response patterns.

15. 6. Extravasations
The accidental administration of a vesicant
solution into surrounding tissue.
Signs/symptoms:
• Complaints of pain or burning; swelling
proximal or distal to the IV site.
• puffiness of the dependent part of the
limb; skin tightness at the Venipuncture
site; and coolness of the skin.
• Slow or stopped infusion; damp or wet
dressing.

16. Extravasations Interventions
• Stop the infusion, and elevate
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extremity.
Remove the cannula.
Call physician.
Administer antidote (if appropriate)
intradermaly into infiltrated tissue.
Apply warm moist compresses for 20
minutes every 4 hours (see hospital
policy).

17. 6. Extravasations (cont.)
Documentation:
• Document assessment and interventions.
Include the vascular access device type,
insertion site, name of medication or
solution, and how it was infused.

18. 7. Local infection
Microbial contamination of the cannula or
infusate
Signs/symptoms:
• Redness and swelling at the site; possible
exudates of purulent material.
• Increased quantity of white blood cells;
and elevated temperature.

19. 7. Local infection (cont.)
Documentation:
• Assessment of site.
• culture technique & sources of culture.
• physician notification and any treatment
initiated.

20. 8. Venous spasm
A sudden involuntary contraction of a vein or
an artery resulting in temporary cessation
of blood flow through a vessel.
Signs/symptoms:
• sharp pain at the IV site that travels up
the arm, which is caused by acute flow of
fluid that irritates the vein wall; slowing of
the infusion

21. 8. Venous spasms (cont.)
Documentation:
• client complaints, duration of complaints,
treatment, and length of time to resolve
the problem.

22. II. Systemic Complication
1. Septicemia:
A febrile disease process that results from
the presence of microorganisms or their
toxic products in the circulatory system.
Signs and Symptoms:
• Fluctuating fever, tremors, little cold sweat,
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nausea and vomiting, diarrhea, abdominal pain.
Tachycardia, increased respirations or
hyperventilation, altered mental status, and
hypotension

23. Septicemia Interventions
• Notify physician immediately.
• Symptomatic care.
• Identify other sources of
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infection.
Remove IV device.
Culture the IV cannula, tubing,
or solution if it is suspect.
Return fluid to pharmacy.
Establish a new IV site for
medication or fluid
administration.

24. 1. Septicemia (cont.)
Documentation:
• Document S/S assessed; physician
notification, all treatments instituted.

25. 2. Fluid overload & Pulmonary
edema
• Caused by infusing excessive amounts
of isotonic or hypertonic crystalloid
solutions to rapidly, failure to monitor
the IV infusion or too-rapid infusion of
any fluid in a patient compromised by
cardiopulmonary or renal disease.

26. 2. Fluid overload & Pulmonary
edema (cont;)
S/S:
• Restlessness, headache,
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tachycardia, weight gain over a short
period of time, cough, and presence
of edema.
Hypertension, wide variance
between intake and output, distended
neck veins.

27. 2. Fluid overload & Pulmonary
edema (cont.)
Documentation:
• client assessment, notification of
physician, and treatments instituted by
physician order.

28. 3. Air embolism
Air entering the central vein, which is
quickly trapped in the blood as it flows
forward. Prevention is the key.

29. 3. Air embolism(cont.)
S/S:
• complaints of palpitations, and weakness.
• Pulmonary findings: dyspnea, cyanosis,
tachypnea, expiratory, wheezes, cough,
and pulmonary edema.
• Cardiovascular: murmur; weak, thready
pulse; tachycardia; substernal chest pain;
hypotension; and jugular venous
distention.
• Neurologic findings: change in mental
status, confusion, coma, anxiousness, and
seizures.

30. 3. Air embolism (cont.)
• Nursing Interventions:
– Immediately clamp the tubing.
– Turn client to left, head down (to allow
air to enter right atrium and be
dispersed via pulmonary artery)
– Monitor vital signs.
– Administer O2.
– Notify physician.
– Document actions.
Documentation:
– Client assessment, nursing interventions,
physician notification, and treatment.

31. 4. Speed shock
Occurs when a foreign substance usually a
medication is rapidly introduced into the
circulation
• S/S: dizziness, facial flushing, headache,
tightness in the chest, hypotension,
irregular pulse, progression of shock.

32. 4. Speed shock (cont.)
• Documentation: medication or fluid
administered and the signs and symptoms
the pt reported, physician notification,
treatment initiated and the client response.

33. 5. Catheter embolism
A piece of the catheter breaks off and
travels through the vascular system.
• S/S: sharp sudden pain at the IV site,
minimal blood return, rough and uneven
catheter noted on removal, cyanosis,
chest pain, tachycardia, hypotension.