IV Therapy: COMPLICATIONS – Flashcards
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What is a hematoma?
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A localized mass of blood outside the cell
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What causes a hematoma?
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Nicking the vein during insertion, D/C iv cannula, or applying tourniquet too tightly above a previous insertion site.
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Prevention of Hematoma?
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Using direct method for insertion, apply tourniquet just prior to insertion, and using the smallest gauge possible.
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Treatment of Hematoma?
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Direct pressure with 2x2 gauze over site after catheter is removed & Elevating extremity over head or on a pillow to minimize venous return
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What is a thrombosis?
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Formation or presence of a blood clot; Trauma to endothelial cells of venous wall may cause platelets to adhere to the vein wall forming a clot.
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Cause of thrombosis?
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Blood backing up in the system of a hypertensive patient. Low flow rate. Location of IV cannula. Obstruction of flow rate. IV line dry for an extended amt of time. Trauma to vein wall by cannula.
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What are some signs/symptoms of Thrombosis?
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IV site may appear healthy; IV flow rate is decreased.
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How can thrombosis be prevented?
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Avoid injury to vein wall; Limit venipuncture attempts; Use IV pumps; Use microdrip tubing for low rate infusions; Use filters when indicated; Avoid cannulation of lower extremities; Avoid flexion areas of movement.
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What is the treatment for thrombosis?
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D/C IV; Apply cold compress to site; Notify DR; Assess site for circ impairment.
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What is phlebitis?
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Inflammation of intima of a vein. Most common reported complication.
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What are the 4 types of phlebitis?
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Mechanical, Chemical, Bacterial, & Post-Infusion
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What is the cause of mechanical phlebitis?
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Cannula too large for vein; Improper taping.
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What is the cause of chemical phlebitis?
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High acidity of IV solutions; KCl in IV solution;IV's w/high particulate matter.
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What is the cause of bacterial phlebitis?
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Poor aseptic technique; Inadequate taping; Poor site assessment; Poor handwashing.
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What is the cause of post-infusion phlebitis?
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Insertion technique; Vein condition; Compatibility of IV solutions; pH of IV solution.
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What are some signs of phlebitis?
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Redness; Site warm to touch. Local swelling.Palpable cord along the vein. Sluggish infusion rate. Increase in basal temperature.
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What is the Rating Scale of Phlebitis?
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1+, 2+, & 3+.
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What is 1+?
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Pain @ site. Redness/Edema. Palpable cord, no streak.
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What is 2+?
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Pain @ site. Redness/Edema. Streak. No Palpable cord.
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What is 3+?
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Pain @ site. Redness/Edema. Streak. Palpable cord. Takes 10 days to 3wks to heal.
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How can phlebitis be prevented?
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Use of vein higher on forearm. Use larger veins for hypertonic solutions. Central/PICC lines=LT; Choose smallest catheter appropriate. Rotate IV sites. Change solutions q24h. Stabilize catheters.
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What are some risk factors for Phlebitis?
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IV therapy for more than 24hrs. Non-diluted IV solutions. TPN. Immunosuppressed pts, Multiple IV's.
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What is the treatment for Phlebitis?
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Prevention/attn to risk factors. D/C IV line. Warm compress. Notify DR of 2-3+ phlebitis.
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What is a thrombophlebitis?
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Two-fold injury. Thrombosis & inflammation. A painful, inflamed vein develops @ point of thrombosis. Can be made from mechanical/chemical phlebitis..
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What are some signs/symptoms of Thrombophlebitis?
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Sluggish flow rates. Edema (extremity). Vein tenderness. Palpable cord. Site warm to touch. Red line visible above puncture site.
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What is the prevention of Thrombophlebitis?
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Use veins in forearm. Avoid areas of flexion. Check IV site q1h for redness/pain/swelling. Anchor IV securely. Infuse solutions @ prescribed rates. Use smallest catheter for solution. Dilute irritating solutions. Perform good skin preparation.
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What is the treatment of Thrombophlebitis?
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Remove IV & restart in opposite extremity. Notify DR. Warm compress.
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What is infiltration?
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Seepage/diffusion of solution into tissues. Occurs due to dislodgement of cannula. Can result from phlebitis. Fluid outside tegaderm.
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What are some signs/symptoms of Infiltration?
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Coolness of skin around IV site. Taut skin. Dependent edema. Backflow of blood absent (pinkish blood return). Solution rate slowing but continuing to infuse.
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What is the prevention for Infiltration?
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Monitor site for edema. Choose veins that avoid dorsal area of hand, wrist, and digits. Avoid use of high pressure infusion pumps. Dilute all meds. Avoid areas of multiple venipunctures. Secure cannula so site is visible. Educate pt to report any burning or pain.
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What is the treament for Infiltration?
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Best treatment is prevention. D/C IV. Elevate extremity. Apply warm compress.
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What is extravasation?
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Escape of a vesicant med from a vessel into surrounding tissue. Causes formation of blisters.
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What are some signs/symptoms for Extravasation?
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Pain/Burning @ site. Skin tightness. Blanching/Coolness of skin. Slow/Stopped infusion. Dependent edema of extremity.
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How can Extravasation be prevented?
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Avoid areas of multiple venipunctures. Apply arm board/restraint prn. Dilute all meds. Secure cannula. Avoid use of high-press pumps. Check patency before instilling meds. Monitor site q1h. Educate pt on signs of complications.
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Treatment of Infiltration?
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Stop infusion. Notify DR. Prescribed antidote.Elevate extremity. Ice for 20mins q4h.
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What is local infection?
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Infection related to microbial contamination of cannula or solution.
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Causes of local infection?
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Venipuncture. Removal of stylet. Colonization from skin flora. Contaminated IV Solutions. Microorganisms entering @ insertion site/tubings.
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Signs/Symptoms of local infection?
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Redness/Swelling @ site. Possible exudate of purulent drainage. WBC's increased. Temp increased.
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What is a venous spasm?
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Contraction of muscular coats of blood vessel. Occurs suddenly & for a variety of reasons. Cold solution/Irritating solution/Too rapid rate of admin.
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What are some signs/symptoms of Venous Spasms?
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Sharp pain @ IV site traveling up arm. Slowing of infusion rate.
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How can venous spasms be prevented?
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Dilute meds. Wrap extremity w/warm compress during infusion. Admin solutions @ prescribed rates.
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What is the treatment for Venous Spasms?
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Warm compresses. Decrease IV flow rate. Restart IV if venous spasms continue.
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What are systemic complications of IV Therapy?
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Septicemia. Circulatory overload. Pulmonary edema. Air embolism. Speed shock. Catheter embolism. Pulmonary embolism.
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What is the cause of systemic complications?
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Invasion of bloodstream by microorganisms. Poor aseptic technique. Contaminated equip. Irrigation of clogged catheters.
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What are some risk factors for septicemia?
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Age. Alterations in immune system. Underlying illness, infectious processes. Contamination of solutions/catheters. Duration of cannulation. Manipulation of infusion devices.
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What are some signs/symptoms of Septicemia?
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Fluctuating fever-tremors, teeth chattering. Profuse cold sweat. Nausea/vomiting. Diarrhea. Malaise. Hypotension. Vascular collapse. Shock & death.
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Prevention of Septicemia?
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Use only freshly opened fluids. Cover Infusion sites w/sterile dressing. Use leur-locks correctly. Frequent inspection of IV sites.
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What is the treatment for septicemia?
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Notify DR. Restart IV in opposite extremity. Obtain cultures.
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Causes of circulatory overload?
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Infusing excessive amts of sodium chloride solutions too rapidly. Failure to monitor the IV infusion rate. Too rapid of infusion of any solution. Compromised pt- Cardiopulmonary or renal disease.
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Signs/Symptoms of Circulatory overload?
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Wt gain. Edema. Puffy Eyelids. Hypertension. Wide variations b/w I&O. Shortness of breath, rales, crackles. Distended neck veins.
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Prevention of circulatory overload?
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Don't play catch up w/fluids. Know pts cardiac/renal history.
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What is the cause of pulmonary edema?
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Results from circulatory overload. Abnormal accumulation of fluid in lungs. Risk factors-Cardiovascular disease. Renal disease. Elderly.
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Early signs of Pulmonary Edema?
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Restlessness. Slow increase in pulse. Headache. Shortness of breath. Cough. Flushing. Distended neck veins.
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Late signs of Pulmonary Edema?
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Hypertension. Severe Dyspnea. Gurgling Respirations. Frothy fluid. Moist crackles.
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Prevention of Pulmonary Edema?
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Baseline assessment before starting IV Therapy. Review pt history. Maintain consistent infusion rates. Monitor lung sounds for crackles.
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Treatment of Pulmonary Edema?
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Same as circ overload. Notify DR. Decrease IV solution to KVO. Elevate HOB. Keep pt warm. Monitor vitals. Oxygen.
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What is an air embolism?
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A rare but lethal complication. Esp. involving subclavian central lines.
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Causes of an Air Embolism?
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Allowing solution containers to run dry. Air in tubing that gets infused into pt. Loose connections. Poor technique in dressing/tubing changes for central lines.
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Signs/ Symptoms of Air Embolism?
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Hypoxia. Cyanosis. Hypotension. Respiratory distress. Changes in cardiac/neurological status. Weak,rapid pulse. Seizures. Coma. Cardiac Arrest.
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Prevention of air embolism?
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Use a filter. Use leur-locks correctly. Do not allow Iv bags to run dry. Follow protocol for dressing/tubing changes.
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Treatment of air embolism?
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Get help. Place in Trendelenburg position. Place on left side. Give O2.
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What is a catheter embolism?
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An infrequent systemic complication of over-the-needle catheters. A piece of catheter breaks off and travels through the vascular system.
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Signs/Symptoms of catheter embolism?
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Sharp, sudden pain @ IV site. Minimal blood return. Short, rough, & uneven catheter noted on removal. Cyanosis. Chest Pain. Tachycardia. Hypotension. Death.
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Prevention of catheter embolism?
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Avoid inserting catheter over joint flexion. Splint arm. Do not apply pressure over site when removing the catheter. Always use radiopaque catheters that can be seen on an x-ray.
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Treatment of a catheter embolism?
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Digital pressure on vein above insertion site to prevent migration. Apply tourniquet above elbow. Contact DR. Start new IV. Start xray. Measure remainder of catheter tip to determine length of embolized tip.
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Signs/ Symptoms of a pulmonary embolism?
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Breathlessness. Anxiety. Restlessness. Chest pain.
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What is a pulmonary embolism?
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When a substance(blood clot) becomes free floating & is propelled by venous circulation to right side of heart & into the pulmonary artery.
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Prevention of pulmonary embolism?
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Blood/plasma must be infused through an adequate filter to remove any particulate matter that could result in small embolism. Avoid using veins in lower extremities. Examine solutions for particulate matter.
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Treatment of pulmonary embolism?
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Initial treatment is supportive. Oxygen. Call DR.