Hi. I'm Cathy with Level Up RN. In this video, we are going to talk about
IV complications. I'm going to go through many of the complications that you can find here
in our Pharmacology Basics flashcard deck but not every single one. At the end of the video,
I'm going to test your knowledge about some of the information I'll be covering here by giving you a
little quiz, so definitely stay tuned for that. Let's talk about phlebitis first. So any time
you see that "itis" at the end of a word, it means inflammation, an inflammation of whatever's at the
first part of the word. So in this case, "phleb" is Greek for "vein", so inflammation of the veins.
So what can cause phlebitis? It may be due to mechanical irritation. So that catheter
could be rubbing against the vein, causing that irritation and inflammation. It could also be due
to the pH or osmolality of the medication that's being infused. In terms of the signs and symptoms
of phlebitis, those will include erythema, which is a fancy word for redness, as well as warmth,
pain. You also may find that the vein there is indurated, which is also a fancy term for
being hard. So you'll have a hardened vein. And you may see a red streak as well. So those are
all symptoms of phlebitis. If your patient is exhibiting these symptoms, you're going
to want to discontinue the IV, elevate the extremity, and apply warm, moist compresses.
All right. Next complication is infiltration. This is where IV fluids or medications leak into
the surrounding tissue. So they are outside the vein. Symptoms of infiltration include swelling,
coolness, dampness, a slowed rate of IV infusion, and fluid may be leaking from the IV site itself.
So when I was hospitalized during my pregnancy, which was a lot, and I was receiving IV fluids,
my nurse during one shift was very busy. And my IV infiltrated such that my arm was twice as big
as my other arm. It was huge, and it was cool to the touch, and it kind of felt damp. And I didn't
know at the time that that's what that meant, that my IV had infiltrated, or else I would've
discontinued my own IV myself. But I sat there and waited until finally someone came and took that
IV out. So in terms of nursing care, you want to discontinue the IV, elevate the extremity,
and apply warm or cold compresses, depending on what was infusing. So we would use warm
compresses for normal- or high-pH solutions, and we would use cold compresses for low-pH solutions.
Next, we have extravasation. So with extravasation, this means infiltration,
like we just talked about, but with a vesicant agent, meaning a medication that can really cause
tissue damage. So signs and symptoms of extravasation can include erythema, pain,
edema, the formation of blisters. You may also see necrotic tissue, such as slough,
and ulceration may also be present. In terms of nursing care for extravasation,
you're going to want to stop the infusion, you're going to want to aspirate any residual medication
in the IV line, and then you're going to administer an antidote per facility policy.
Then after the administration of that antidote, you can discontinue the IV,
elevate the extremity, and apply a warm or cold compress, depending on the solution.
Next, we have a catheter embolus. This is where a IV catheter fragment breaks off into the patient's
venous system. So anytime we discontinue an IV, we always want to look at the catheter tip to make
sure it is fully intact. If we look at the tip and we see that a piece of it is missing, that
is obviously a sign that there may be a catheter embolus present in the patient's venous system.
Other symptoms of a catheter embolus include pain along the vein. It may be severe pain. Also,
a weak, thready pulse and hypotension are other symptoms of a catheter embolus. If you suspect
that this may be the case for your patient, you're going to want to place a tourniquet
high on that extremity and prepare that patient for surgery to remove the catheter fragment.
Next, we have an air embolus. This is where air enters the venous system from the IV catheter.
And symptoms can include hypotension, tachycardia, tachypnea, and cyanosis. If your patient has an
air embolism, you're going to want to clamp the catheter, place the patient in a Trendelenburg
position. So this is where their head is lower than their feet. You're going to want
to administer oxygen and notify the provider. All right. Next, we have a thrombosis,
which is a blood clot. So we do all the flushing of peripheral IVs and central venous catheters
to help prevent the formation of a thrombosis or blood clot, but sometimes they occur. So
when a patient gets a PICC line inserted, for example, when they come back to the floor,
there are often standing orders in place for a thrombolytic agent, such as alteplase,
that the nurse can use in the event that a blood clot occurs. So when your patient has a PICC line,
and you go in the room to try to do a blood draw or to give medications, and you try to aspirate,
you're not getting a blood return, then that is definitely a sign that you may have a thrombosis.
So you'll need to pull that alteplase or whatever thrombolytic medication is ordered, let it instill
in the area for about 30 minutes, and then come back and check the patency of that line.
Last complication I'm going to go over is fluid overload.
This is where too much volume is introduced into the circulatory system such that your patient
will exhibit signs such as shortness of breath, crackles, hypertension, jugular vein distention,
edema, and tachycardia. If your patient has fluid overload, you're going to want to raise the head
of the bed so it's easier for them to breathe. You're going to want to slow the infusion rate
so we're not overwhelming the circulatory system. And then we're going to monitor the patient's
oxygen and vital signs, and we may also need to administer diuretics as ordered by the provider.
Okay, you guys ready for your quiz? I have three questions for you.
First question. Coolness, dampness, and swelling are signs of what IV complication?
If you said infiltration, you are correct.
Second question. If you suspect an air embolism, what position should you place your patient in?
The answer is Trendelenburg. Third question. If your patient
is exhibiting signs of fluid volume overload, you should discontinue the IV. True or false?
False. Most times, this is not necessary. We just need to slow the infusion rate of the IV fluids.
Hopefully, this video's been helpful. If so, be sure to like it and leave
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