a. Infiltration. Infiltration is an accumulation of fluids in the tissue surrounding the venipuncture site.

(1) Cause of the infiltration. Infiltration is the leaking of IV fluid into the surrounding tissue. Infiltration is usually caused by the catheter becoming dislodged or by the needle penetrating through the vein.

(2) Signs and symptoms of infiltration.

(a) Solution is flowing at a sluggish rate or not at all.

(b) Infusion site is cool and pale.

(c) Infusion site or extremity is swollen.

(d) Patient complains of pain, tenderness, burning, or irritation at the infusion site.

(e) Fluid leaking around infusion site.

(f) Absence of blood backflow when IV bag/bottle is lowered below IV site.

(3) Intervention measures for infiltration.

(a) If flow is sluggish, pull back on the catheter a bit and rotate it or elevate and depress the catheter a bit. If elevating the catheter helps, a small piece of gauze may be placed under the needle to hold it in position. The bevel of the catheter may be resting against the side of the vein and this will help to free it.

(b) If this does not correct the flow or if infiltration has occurred, stop the infusion and notify your supervisor. You may be directed to remove the IV and restart it in an alternate location.

(c) Apply a cold pack to site if infiltration has occurred within the last 30 minutes. A cold pack will help reduce the pain and swelling.

(d) Apply warm, wet compresses to promote absorption if infiltration has occurred more than 30 minutes earlier. A warm, wet compress stimulates circulation, promoting the absorption of the infiltrated solutions into surrounding tissues.

(e) Document your observations and actions for future reference.

(4) Preventive measures against infiltration.

(a) Apply a splint for stability and to prevent dislodging the IV catheter.

(b) Tape the catheter securely.

b. Phlebitis. Phlebitis is an inflammation of the wall of the vein.

(1) Associated problems. Problems associated with phlebitis include thrombophlebitis and thrombosis.

(a) Thrombophlebitis is an inflammation of the vein accompanied by the formation of a clot.

(b) Thrombosis is a formation of a clot in a blood vessel without accompanying inflammation.

(2) Causes. Phlebitis can be caused by the following:

(a) Injury to the vein during venipuncture or from later movement.

(b) Irritation to vein caused by:

1 Long-term therapy.

2 Infusion of irritating or incompatible additive.

3 Using a vein that is too small to handle the amount or type of IV solution being used.

4 Sluggish flow rate that allows a clot to form at end of the catheter.

5 Infection.

(3) Signs and symptoms. Signs and symptoms of phlebitis include the following.

(a) Swelling and redness around the venipuncture site.

(b) Tenderness of tissue around the venipuncture site.

(c) A yellowish, foul-smelling discharge from venipuncture site.

(d) A sluggish flow rate.

(4) Intervention measures against phlebitis.

(a) When phlebitis is noted, report your observations to the supervisor. Trained personnel will then remove the IV and restart it in an alternate location and initiate proper care for the inflammation.

(b) Document your observations and actions.

(5) Prevention measures against phlebitis.

(a) Keep the infusion flowing at the prescribed rate.

(b) Stabilize the catheter with correct taping and a splint.

(c) Select a large vein when irritating drugs and fluids are given.

(d) Maintain strict aseptic techniques.

(e) Change catheters and tubing every 48 to 72 hours or in accordance with (IAW) local policy.

(f) Change bags, bottles, and dressings every 24 hours or IAW local policy.

c. Circulatory Overload. Circulatory overload is a state of increased blood volume.

(1) Causes of circulatory overload.

(a) Fluid is infused too fast.

(b) Too much fluid is infused.

CAUTION: Circulatory overload can occur in any patient who receives an excess of fluid. It is not confined to elderly, pediatric, or debilitated patients.

(2) Signs and symptoms of circulatory overload.

(a) Rise in blood pressure.

(b) Dilation of veins with neck veins sometimes visibly engorged.

(c) Rapid pulse, rapid breathing, shortness of breath, and rales.

NOTE: Rales is an abnormal crackling or rattling sound heard upon listening to sound within the chest.

(d) Wide variance between fluid input and urine output.

(3) Intervention measures for circulatory overload.

(a) Slow the infusion to keep open (TKO) rate.

(b) Raise the head of the patient's bed to assist with respiratory effort.

(c) Immediately notify your supervisor.

(4) Preventive measures against circulatory overload.

(a) Monitor the urine output. An Intake and Output (I&O) Worksheet (DD Form 3630) is required for all IV patients. A record of liquid input and output (including IV therapy) is maintained on this worksheet.

(b) Check the flow rate at frequent intervals to ensure the desired rate is being maintained.

d. Air Embolism. Air embolism is an obstruction of a blood vessel by air carried via the bloodstream.

(1) Causes of air embolism.

(a) Allowing the solution to run dry.

(b) Air bubbles in the IV tubing.

(c) Disconnected tubing.

(2) Signs and symptoms of air embolism.

(a) Abrupt drop in blood pressure.

(b) Chest pain.

(c) Weak, rapid pulse.

(d) Cyanosis (a blue-gray discoloration of the skin due to inadequate perfusion of oxygen).

(e) Loss of consciousness.

(3) Intervention measures for air embolism.

(a) Notify supervisor immediately.

(b) Administer oxygen, if allowed.

(c) Turn the patient on his left side and lower the head of the bed so the air bubbles can float to and remain in the right atrium. The risk of serious effects of an air embolism increases if the embolism passes to the left side of the heart.

(4) Preventive measures against air embolism.

(a) Clear all air from the tubing before attaching it to the patient.

(b) Monitor solutions closely and change the before they are empty.

(c) Check to see that all connections are secure.

e. Infection. Infection is the state or condition in which the body or a part of it is invaded by a pathogenic agent (microorganism or virus) which, under favorable conditions, multiplies and produces effects that are injurious. Localized infection is usually accompanied by inflammation, but inflammation may occur without infection.

(1) Causes of infections.

(a) Poor aseptic techniques.

1 Unsterile venipuncture techniques.

2 Contamination of equipment during manufacture.

3 Failure to keep the site clean or to change IV equipment regularly.

(b) Transmission from another infected part of the body to the infusion site.

(c) Introduction of contaminants while irrigating or manipulating an occluded, leaking, or infiltrated catheter.

(2) Signs and symptoms of infection.

(a) Swelling, redness, and soreness around the infusion site.

(b) A yellowish, foul-smelling discharge from the venipuncture site.

(c) Rise in the patient's temperature and pulse rate.

(3) Intervention measures for suspected infection.

(a) Report observations to the supervisor.

(b) Save the IV equipment for possible laboratory analysis IAW local policy.

(c) Document all of your observations and actions.

(4) Preventive measures against infection.

(a) Use rigid aseptic techniques when initiating and maintaining an IV.

(b) Anchor the catheter firmly with tape.

(c) Check the vein at least once each shift for evidence of tenderness and other signs of inflammation.

f. Disturbance of infusion. This is any disturbance or failure of the infusion apparatus to deliver proper prescribed solution infusion rate.

(1) Signs of disturbance in the infusion.

(a) Flow rate slowing down or speeding up.

(b) Solution flow stopping.

(2) Intervention measures for a disturbance of infusion.

(a) Frequent observations of flow rate and equipment.

(b) If flow rate disturbance is noted, attempt to locate the cause and perform follow-up action. Some causes and follow-up actions are given below.

1 Solution container is empty. Stop flow and notify supervisor.

2 Drip chamber is less than half full. Squeeze the drip chamber until it is half full.

3 Control clamp is closed. Readjust clamp to restore prescribed drip rate and notify the supervisor.

4 Defect in equipment. Report the defect immediately to the supervisor.

5 Tubing is kinked or caught under patient. Untangle the line or reposition patient so that the solution flows through the tube at the prescribed rate. Monitor for correct flow and rate.

6 Catheter is bent or compressed in the vein. Reposition the extremity and splint area if necessary.