Benefits and Complications of Ivt.ppt Thelma

BENEFITS, RISKS & BENEFITS, RISKS & COMPLICATIONS OF COMPLICATIONS OF IV IV THERAPYTHERAPY

BLOOD TRANSFUSIONBLOOD TRANSFUSION BENEFITS:BENEFITS: Restore & maintain adequate Restore & maintain adequate

circulatory volume.circulatory volume. Prevent cardiogenic shockPrevent cardiogenic shock Increase the blood’s oxygen- carrying Increase the blood’s oxygen- carrying

capacity.capacity. Maintain hemostasis.Maintain hemostasis.

ComplicationsComplications Signs and Signs and SymptomsSymptoms

LOCALLOCAL

1. PHLEBITIS1. PHLEBITIS

- tenderness at tip - tenderness at tip of device & aboveof device & above

- redness at tip of - redness at tip of catheter & along veincatheter & along vein

- puffy area over - puffy area over veinvein

- vein hard on - vein hard on palpationpalpation

- elevated temp.- elevated temp.

Possible CausesPossible Causes

-Poor blood flow -Poor blood flow around devicearound device

-Friction from -Friction from catheter movement catheter movement in veinin vein

- Device left in vein - Device left in vein too longtoo long

- Clotting at catheter - Clotting at catheter tip tip (thrombophlebitis)(thrombophlebitis)

- Solution with high - Solution with high or low pH or high or low pH or high

osmolalityosmolality

Signs and Signs and SymptomsSymptoms

2. INFILTRATION2. INFILTRATION

- Swelling at & - Swelling at & around IV site which around IV site which may extend along may extend along entire limbentire limb

- Discomfort, - Discomfort, burning, or pain at burning, or pain at site.site.

- Feeling of tightness - Feeling of tightness at site.at site.

- Decreased skin - Decreased skin temperature around temperature around sitesite

- Blanching at site- Blanching at site


- Device dislodged - Device dislodged from vein or from vein or perforated vein.perforated vein.

Signs and SymptomsSigns and Symptoms

- continuing fluid - continuing fluid infusion even when infusion even when vein is occluded, vein is occluded, although rate may although rate may decrease.decrease.

- absent backflow of - absent backflow of bloodblood

- slower flow rate- slower flow rate



3. CATHETER3. CATHETER

DISLODGMENTDISLODGMENT

- catheter partly - catheter partly backed out of veinbacked out of vein

- infusate infiltrating- infusate infiltrating

4. OCCLUSION4. OCCLUSION

- no increase in flow - no increase in flow rate when iv rate when iv container is raised.container is raised.


- Loosened tape or - Loosened tape or tubing snagged in tubing snagged in bedclothes, resulting bedclothes, resulting in partial retraction in partial retraction of catheter.of catheter.

- iv flow interrupted- iv flow interrupted

- intermittent device - intermittent device not flushednot flushed


- blood backup in - blood backup in lineline

- discomfort at - discomfort at insertion siteinsertion site

5. VEIN IRRITATION 5. VEIN IRRITATION OR PAIN AT IV SITEOR PAIN AT IV SITE

- pain during - pain during infusioninfusion


- blood back up in - blood back up in line when patient line when patient walkswalks

- hypercoagulable - hypercoagulable patientpatient

- line clamped too - line clamped too longlong

- solution with high - solution with high or low pH or high or low pH or high osmolarity, such as osmolarity, such as Kcl,Kcl,


- possible blanching - possible blanching if vasospasm occursif vasospasm occurs

- red skin over vein - red skin over vein during infusionduring infusion

- rapidly developing - rapidly developing signs of phlebitissigns of phlebitis

6. SEVERED 6. SEVERED CATHETERCATHETER

- leafage from - leafage from catheter shaftcatheter shaft


phenytoin, and phenytoin, and some antibiotics some antibiotics (vancomycin)(vancomycin)

- catheter - catheter inadvertently cut by inadvertently cut by scissorsscissors

- reinsertion of - reinsertion of needle into catheterneedle into catheter


7. HEMATOMA7. HEMATOMA

- tenderness at - tenderness at venipuncture sitevenipuncture site

- bruising around - bruising around sitesite

- inability to - inability to advance or flush iv advance or flush iv lineline

8. VENOUS SPASM8. VENOUS SPASM

- pain along vein- pain along vein


- vein punctured - vein punctured through ventral wall through ventral wall at time of at time of venipuncturevenipuncture

- leakage of blood - leakage of blood from needle from needle displacementdisplacement

- severe vein - severe vein irritationirritation

from irritating drugs from irritating drugs or fluidsor fluids


- sluggish flow rate - sluggish flow rate when clamp is when clamp is completely opencompletely open

- blanched skin over - blanched skin over veinvein

9. THROMBOSIS9. THROMBOSIS

- painful, reddened - painful, reddened and swollen veinand swollen vein

- sluggish or stopped - sluggish or stopped iv flowiv flow


- administration of - administration of cold fluids or bloodcold fluids or blood

- very rapid flow rate - very rapid flow rate (with fluids at (with fluids at rm.temp)rm.temp)

- injury to - injury to endothelial cells of endothelial cells of vein wall, allowing vein wall, allowing platelets to adhere platelets to adhere and thrombus to and thrombus to formform


10.THROMBOPHLEBI10.THROMBOPHLEBITISTIS

- severe discomfort- severe discomfort

- reddened, swollen - reddened, swollen and hardened veinand hardened vein

11. NERVE, TENDON 11. NERVE, TENDON OR LIGAMENT OR LIGAMENT DAMAGEDAMAGE

- extreme pain - extreme pain similar to electric similar to electric shock when nerve is shock when nerve is contractedcontracted


- thrombosis and - thrombosis and inflammationinflammation

-improper -improper venipuncture venipuncture technique, resulting technique, resulting in injury to in injury to surrounding surrounding nerves,tendons & nerves,tendons & ligamentsligaments


- numbness and - numbness and muscle contractionmuscle contraction

- delayed effects, - delayed effects, including paralysis, including paralysis, numbness and numbness and deformitydeformity


- tight taping or - tight taping or improper splinting improper splinting with arm boardwith arm board

SYSTEMIC COMPLICATIONSSYSTEMIC COMPLICATIONS Signs and Signs and

SymptomsSymptoms

1.1. CIRCULATORYCIRCULATORY

OVERLOADOVERLOAD

- discomfort- discomfort

- neck vein - neck vein engorgementengorgement

- respiratory distress- respiratory distress

- increased BP- increased BP

- crackles- crackles

- large + fluid - large + fluid balancebalance


- roller clamp - roller clamp loosened to allow loosened to allow run- on infusionrun- on infusion

- flow rate too rapid- flow rate too rapid

- miscalculation of - miscalculation of fluid requirementsfluid requirements


2.SYSTEMIC 2.SYSTEMIC INFECTIONINFECTION

(septicemia or(septicemia or

bacteremia)bacteremia)

- fever, chills and - fever, chills and malaise for no malaise for no apparent reasonapparent reason

- contaminated iv - contaminated iv site, usually with no site, usually with no visible signs of visible signs of infection at siteinfection at site


- failure to maintain - failure to maintain aseptic technique aseptic technique during insertion or during insertion or site caresite care

- severe phlebitis, - severe phlebitis, which can set up which can set up ideal conditions for ideal conditions for organism growthorganism growth

- poor taping that - poor taping that permits venous permits venous access device to access device to move which can move which can introduce org.introduce org.


3. AIR EMBOLISM3. AIR EMBOLISM


- unequal breath - unequal breath soundssounds

- weak pulse- weak pulse


into the bloodstreaminto the bloodstream

- prolonged - prolonged indwelling time of indwelling time of devicedevice

- - immunocompromiseimmunocompromised patientd patient

- empty solution - empty solution containercontainer

- solution container - solution container empties; next empties; next containercontainer


- increases cvp- increases cvp

- decreased BP- decreased BP

- confusion - confusion disorientation, loss of disorientation, loss of consciousnessconsciousness

4. ALLERGIC 4. ALLERGIC REACTIONREACTION

- itching- itching

- tearing eyes and - tearing eyes and runny noserunny nose


pushes air down linepushes air down line

- tubing - tubing disconnected from disconnected from venous access venous access device or IV bagdevice or IV bag

- allergens such as - allergens such as medicationsmedications


- bronchospasm- bronchospasm

- wheezing- wheezing

- urticarial rash- urticarial rash

- edema at iv site- edema at iv site

- anaphylactic - anaphylactic reaction (within reaction (within minutes or up to 1 minutes or up to 1 hour after exposure), hour after exposure), including flushing, including flushing, chills, anxiety, chills, anxiety, agitation, agitation, generalized itching, generalized itching, palpitations, palpitations, parestheisa,parestheisa,


- allergens such as - allergens such as medicationsmedications


throbbing ears, throbbing ears, wheezing, coughing, wheezing, coughing, seizures and cardiac seizures and cardiac arrestarrest


IV DRUG ADMINISTRATIONIV DRUG ADMINISTRATION BENEFITS:BENEFITS:

- Rapid response- Rapid response

- Effective absorption- Effective absorption

- Accurate titration- Accurate titration

- Less discomfort- Less discomfort

COMPLICATIONSCOMPLICATIONS

1.1. CIRCULATORY CIRCULATORY

OVERLOADOVERLOAD


- neck vein - neck vein distention or distention or engorgementengorgement


- increases BP- increases BP

- crackles- crackles

- positive fluid - positive fluid balancebalance

2. HYPERSENSITIVITY2. HYPERSENSITIVITY


- itching, urticarial - itching, urticarial rashrash

- tearing eyes, - tearing eyes, runny noserunny nose

- bronchospasm- bronchospasm

- wheezing- wheezing

- anaphylactic - anaphylactic reactionreaction

3. INFILTRATION 3. INFILTRATION

(Peripheral IV)(Peripheral IV)


- swelling- swelling

- discomfort- discomfort

- burning- burning

- tightness- tightness

- cool skin- cool skin

- blanching- blanching

4. PHLEBITIS 4. PHLEBITIS

5. SYSTEMIC 5. SYSTEMIC

INFECTIONINFECTION


- redness or - redness or tenderness at the tip tenderness at the tip of the deviceof the device

- puffy area over the - puffy area over the veinvein

- elevated - elevated temperaturetemperature

- elevated - elevated temperaturetemperature

- malaise- malaise

6. VENOUS SPASM6. VENOUS SPASM


- pain along the vein- pain along the vein

- sluggish flow rate - sluggish flow rate when clamp is when clamp is completely opencompletely open

- blanched skin over - blanched skin over the veinthe vein

7. SPEED SHOCK7. SPEED SHOCK


- headacheheadache

- syncope- syncope

- flushed face- flushed face

- tightness in chest- tightness in chest

- irregular pulse- irregular pulse

- shock- shock

- cardiac arrest- cardiac arrest

PARENTERAL NUTRITIONPARENTERAL NUTRITION

BenefitsBenefits

-substitute for oral and nasogastric -substitute for oral and nasogastric intubationintubation

-supplement for patients demonstrating -supplement for patients demonstrating large nitrogen losseslarge nitrogen losses

-means of putting GIT at rest -means of putting GIT at rest


CATHETER RELATED CATHETER RELATED

- Clotted catheter- Clotted catheter

- Dislodged catheter- Dislodged catheter

- Cracked or broken tubing- Cracked or broken tubing

- Pneumothorax- Pneumothorax

- Sepsis- Sepsis


METABOLIC METABOLIC HyperglycemiaHyperglycemia HypoglycemiaHypoglycemia Hyperosmolar hyperglycemic Hyperosmolar hyperglycemic

nonketoticnonketotic

SyndromeSyndrome HypokalemiaHypokalemia HypomagnesemiaHypomagnesemia HypophosphatemiaHypophosphatemia

COMPLICATIONSCOMPLICATIONS HypocalcemiaHypocalcemia Metabolic acidosisMetabolic acidosis Liver dysfunctionLiver dysfunction HyperkalemiaHyperkalemia


Mechanical ComplicationsMechanical Complications

Air embolismAir embolism

Venous thrombosisVenous thrombosis

Too rapid infusionToo rapid infusion

ExtravasationExtravasation

PhlebitisPhlebitis

4.FLUIDS AND ELECTROLYTES4.FLUIDS AND ELECTROLYTES

Benefits:Benefits:

Helps regulates body temperatureHelps regulates body temperature

Transport nutrients and gases throughout Transport nutrients and gases throughout the bodythe body

Carry cellular waste products to excretion Carry cellular waste products to excretion sitessites

COMPLICATIONSCOMPLICATIONSSodium (Na+) (n.v. 135-145mEq/L)Sodium (Na+) (n.v. 135-145mEq/L)S/sx: HyponatremiaS/sx: Hyponatremia1.1. Muscle weaknessMuscle weakness2.2. Muscle twitchingMuscle twitching3.3. Decreased skin turgor Decreased skin turgor 4.4. HeadacheHeadache5.5. TremorsTremors6.6. SeizuresSeizures7.7. ComaComa

HypernatremiaHypernatremia

1.1. ThirstThirst

2.2. FeverFever

3.3. Flushed skinFlushed skin

4.4. OliguriaOliguria

5.5. DisorientationDisorientation

6.6. Dry, sticky membranesDry, sticky membranes

POTASSIUM (k+) (NV 3.5 – 5.0mEq/L)POTASSIUM (k+) (NV 3.5 – 5.0mEq/L)

HypokalemiaHypokalemia

1. Decreased GI,skeletal & cardiac 1. Decreased GI,skeletal & cardiac muscle fxmuscle fx

2. Decreased reflexes2. Decreased reflexes

3. Rapid, weak, irregular pulse3. Rapid, weak, irregular pulse

4. Muscle weakness or irritability4. Muscle weakness or irritability

5. Fatigue5. Fatigue

6. Decreased BP6. Decreased BP

7. Decreased bowel motility7. Decreased bowel motility

8. Paralytic ileus8. Paralytic ileus

HYPERKALEMIAHYPERKALEMIA

1.1. Muscle weakness Muscle weakness

2.2. nauseanausea

3. Diarrhea3. Diarrhea4. Oliguria4. Oliguria5. Paresthesia of face, tongue, hands & feet5. Paresthesia of face, tongue, hands & feet

CALCIUM (Ca++) (n.v. 8.9-10.1mg/dl)CALCIUM (Ca++) (n.v. 8.9-10.1mg/dl)S/Sx: HypocalcemiaS/Sx: Hypocalcemia1.1. Muscle tremor, crampsMuscle tremor, cramps2.2. TetanyTetany3.3. Tonic- clonic seizuresTonic- clonic seizures4.4. ParesthesiaParesthesia5.5. BleedingBleeding6.6. ArrhythmiasArrhythmias7.7. HypotensionHypotension

8. Hypotension8. Hypotension

9. Numbness or tingling in fingers, toes and 9. Numbness or tingling in fingers, toes and area surrounding the moutharea surrounding the mouth

Hypercalcemia:Hypercalcemia:

1.1. Lethargy 7. hypertensionLethargy 7. hypertension

2.2. H/A 8. oliguriaH/A 8. oliguria

3.3. Muscle flaccidityMuscle flaccidity

4.4. N/VN/V

5.5. AnorexiaAnorexia

6.6. constipationconstipation

Chloride (Cl-) (n.v. 96-106 mEq/L)Chloride (Cl-) (n.v. 96-106 mEq/L)

Hypochloremia:Hypochloremia:

1.1. Increased muscle excitabilityIncreased muscle excitability

2.2. TetanyTetany

3.3. Decreased respirationsDecreased respirations

HyperchloemiaHyperchloemia

1.1. StuporStupor

2.2. Rapid, deep breathingRapid, deep breathing

3.3. Muscle weaknessMuscle weakness

Phosphorus (P) (n.v. 2.5-4.5mg/dl)Phosphorus (P) (n.v. 2.5-4.5mg/dl)Hypophosphatemia:Hypophosphatemia:1.1. Paresthesia (circum oral & perpheral)Paresthesia (circum oral & perpheral)2.2. LethargyLethargy3.3. Speech defectsSpeech defects4.4. Muscle pain and tendernessMuscle pain and tenderness

Hyperphosphatemia:Hyperphosphatemia:1.1. Renal failureRenal failure2.2. Vague neuroexcitability to tetany & Vague neuroexcitability to tetany &

seizuresseizures3.3. AryrhthmiasAryrhthmias4.4. Muscle twitching with sudden rise in Muscle twitching with sudden rise in

Phosphate levelPhosphate level

Magnesium (Mg++) (n.v. 1.5- 2.5 Magnesium (Mg++) (n.v. 1.5- 2.5 mg/dl)mg/dl)

Hypomagnesemia:Hypomagnesemia:

1.1. Dizziness 6.arrhythmiasDizziness 6.arrhythmias

2.2. Confusion 7. vasomotor Confusion 7. vasomotor changeschanges

3.3. Seizures tremor 8. anorexiaSeizures tremor 8. anorexia

4.4. Leg & foot cramps 9. nauseaLeg & foot cramps 9. nausea

5.5. hyperirritabilityhyperirritability

Hypermagnesemia:Hypermagnesemia:1.1. DrowsinessDrowsiness2.2. LethargyLethargy3.3. ComaComa4.4. ArrhythmiasArrhythmias5.5. HypotensionHypotension6.6. Vague neuromuscular changesVague neuromuscular changes7.7. Vague GI symptomsVague GI symptoms8.8. Peripheral vasodilationPeripheral vasodilation9.9. Facial flushingFacial flushing10.10. Sense of warmthSense of warmth11.11. Slow, weak pulseSlow, weak pulse

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Benefits and Complications of Ivt.ppt Thelma