Blood, Electrolytes, and Intravenous Infusions

3-11. COMPLICATIONS

The complications of intravenous therapy may be mild or life threatening, but they are always uncomfortable for the patient. Many can be prevented with proper care.

a. Infiltration. Infiltration (the most frequent complication) is caused by dislodgement of the needle or catheter or by puncture of the vein. This allows the fluid to collect in the surrounding tissue. Signs or symptoms include, slowing or stopping of the intravenous flow and reduced skin temperature in the venipuncture area. This is not usually serious but can be very uncomfortable for the patient. You can restart the intravenous at another site. The danger of this happening can be reduced by securely taping the intravenous line and providing arm boards for stability.

b. Speed Shock or Circulatory Overload. The "average" person has a blood volume of about five to six quarts. Blood is approximately ninety-one percent fluid. The body has intricate mechanisms for making up for changes in blood volume. For example, when you donate blood, some fluid from the inside of the cells and fluid surrounding the cells enters the circulating blood volume. There is a reverse flow when the blood volume is normal and intravenous fluids are administered. Unfortunately, when too much fluid and/or too much medication is administered too rapidly, circulatory overload can result. Signs and symptoms include patient complaints of pounding headache and chills, a flushed look, irregular pulse, and dyspnea.

c. Sepsis and Pyrogenic Reactions. Sepsis and pyrogenic reactions are usually caused by the introduction of pyrogenic organisms or their toxins into the bloodstream. In addition to these organisms, febrile reactions can be caused by various chemicals and certain types of particles. If an infection results, the reaction can be localized or systemic. A systemic reaction can occur about thirty minutes after starting the intravenous infusion. Long-term therapy patients can develop sepsis from the growth of microorganisms on the skin after a two to three day period. Signs and symptoms include an unexpected rise in temperature preceded by chills, nausea, vomiting, backache, and malaise. To reduce the possibility of developing sepsis, use aseptic techniques when starting the infusion and change the infusion site, bottle, and tubing at least every two to three days on long term intravenous therapy patients.

d. Phlebitis. Phlebitis is an irritation or injury to the vein. It can be caused by mechanical, chemical, or bacterial irritation. Signs and symptoms include redness, pain, and swelling at the infusion site and patient complaints of fatigue together with fever and a rapid pulse. If signs appear, change the needle to another site and apply warm moist compresses to relieve discomfort and aid healing. Do not rub or massage the affected area. You could cause thrombus or emboli and add to the vein damage. A thrombus is a clot that is formed in the blood vessels. A thrombus is usually a further complication of phlebitis. A clot formed in the vessels can produce damage to tissue below the stoppage.

e. Air Embolism. An air embolism is a very serious intravenous therapy complication. It can occur when a sizeable amount of air gets into the circulatory system through the intravenous administration set. It can block a vessel so that tissues are unable to get oxygen. Nutrients and waste products cannot be removed. The air bubble can cut off cardiac, cerebral, or pulmonary circulation. Symptoms include a fall in blood

pressure, tachycardia (rapid pulse), and loss of consciousness. If a patient has these symptoms, take his vital signs, place patient on his left lateral side, administer oxygen, and get immediate medical help. Air embolism can be prevented by removing all air (bleeding) from intravenous lines, using venipuncture sites below heart level, and never allowing an intravenous line to run dry before disconnecting or adding another bottle. The larger the embolus, the greater the danger. Death could result.