| Complication | Signs & Symptoms/Etiology | Prevention | Management |
| Septicemia (pyrogenic reaction) | Pyrogens introduced into the bloodstream, producing a febrile reaction. S/Sx: chills, fever, malaise, headache, backache, nausea & vomiting, vascular collapse, shock, glucose intolerance, death CDC definition: >15 colony forming units (CFUs) on at least 2 semiquantitative cultures from blood culture from catheter, site, separate site < 15 CFUs = localized infection | Use aseptic technique for cannula insertion, use approved skin preparation prior to insertion; maintain clean, dry, adherent dressing to site; rotate sites q 48 ñ 72 h; inspect all equipment for integrity, expiration dates; use all luer lock equipment; monitor VS q 8 hrs. including Temp. (have self-care patients monitor T. q day minimally); patient teaching for self-monitoring; follow agency policy for changing tubing, solutions, etc. | Stop infusion, save for culture, along with all tubings, add ons, etc., Do not dc catheter until new access established; reestablish new IV site, notify MD with Temp >101°F, administer therapeutic interventions as ordered |
| Broken Catheter | Leakage of fluid, blood from catheter or dressing | Keep sharps away from catheter, always check position of clamps before attempting to flush, do not use pressure injectors, do not use syringes smaller than 10cc to flush | Clamp catheter with toothless clamp below break towards chest wall. Send for catheter repair or replacement |
| Embolism (Air/Pulmonary/Catheter) | A clot, catheter segment, or air bubbles become free-floating in the circulation and are propelled by the venous circulation through the right heart and into the pulmonary artery. Tenacious air bubbles then block the pulmonary capillaries in the case of air embolism. S/Sx: (PE/Catheter): sudden onset of chest pain, tachycardia, dyspnea, productive cough with reddish-pink sputum. May mimic symptoms of MI. (Air): pallor, cyanosis, cough, dyspnea, weak/rapid pulse, hypotension, syncope, mill-wheel murmur, shock, loss of consciousness, death | Use air and particle eliminating filters on all infusions, avoid use of lower extremities for cannulation, do not forcibly flush against resistance to clear catheter occlusion, use only luer lock equipment, remove all air from tubing prior to starting infusion, do not use scissors to remove tape from catheters. Prevent IV from running dry, reinforce connections with tape, assist patient with ADLs to prevent disconnection of IV when changing clothing. | PE/Catheter: >remain with patient, administer O2, maintain patient on complete bedrest, notify MD stat, administer therapeutic interventions as ordered. Air: close off source of air, if possible (ie, empty glass bottle), place patient on Left side in Trendelenburg position, administer O2,, notify MD stat, administer treatment as ordered. |
| Circulatory Overload | Occurs when patient cannot effectively circulate the volume of fluid received. Presents as CHF. S/Sx: jugular vein distention, peripheral edema, dyspnea, agitation, ‚BP, ‚ CVP, tachypnea, cough, disparity between I & O | Maintain strict I&O, use pumps for all continuous infusions given into central lines, if patient has a history of CHF, renal failure, use rate controller, tamper-proof clamps to prevent ìtwiddlerís syndromeî, use microdrip tubing on elderly, pediatric patients, do not play ìcatch upî if IV fluids running behind schedule, notify MD of seeming impending disparity in I & O | Position patient in high fowlerís position, monitor VS continuously, administer O2,, notify MD stat, administer treatment as ordered, cap off IV into saline lock as access will likely be needed to administer diuretics. |
| Speed Shock | Systemic toxic reaction occurring when a substance foreign to the body is rapidly introduced into the circulation, such as an IV push medication or runaway infusion. S/Sx: flushing, headache, syncope, shock, cardiac arrest | Administer all drugs & fluids at the rate prescribed in accordance with manufacturerís recommendations, keep all flow control devices out of reach of patient if disoriented/confused/peds, monitor flow rate at least hourly, use infusion pump for delivery of all continuous infusions of medications | Slow IV to KVO or cap off as saline lock, notify MD stat, perform emergency care as necessary to maintain airway, breathing & circulation, administer treatment ordered by MD |
| Anaphylaxis | Immediate hypersensitivity reaction between antigens and antibodies acting on target tissues and organs. S/Sx: dyspnea, wheezing, choking, cyanosis, coughing, shortness of breath, difficulty swallowing, tightness or pain in chest, hoarseness, urticaria, generalized erythema with feeling of warmth, edema of hands/feet/face/neck eyelids, pruritis, nausea, vomiting, abdominal cramps, diarrhea, incontinence, rapidly falling BP, chills, diaphoresis, weakness, thready pulse, dizziness, flushing followed by pallor, drowsiness, agitation, anxiety, shaking, throbbing in the ears, paresthesias, Coma, death may ensue if prompt intervention not made | Obtain baseline nursing assessment including all allergies to drugs, environment, foods, what happened during previous allergic reactions, obtain baseline VS and at the beginning of every medication infusion, instruct patient what symptoms to report to RN immediately, whether in hospital or other care setting, monitor patient closely during first 15 minutes of any infusion for s/sx of allergic response, instruct patient to self-administer drugs only when someone else present who can call for assistance, be aware of cross sensitivities (ex. PCN/cephalosporins) between medications, know agency anaphylaxis policy and frequently review protocols for administering emergency medications, have standing orders on all patients receiving infusions of IV medications to initiate anaphylaxis protocol prn | Anaphylaxis Interventions:Stop medication administration, maintain airway, call code/911, evaluate signs/symptoms, maintain patent infusion cannula & begin additional infusion prn, administer emergency medications per agency anaphylaxis policy, monitor vital signs, elevate legs with hypotension, stay with patient, notify administrative personnel, RPh and MD Stat, document sequence of events and care provided, note new allergy in patient record |
| Vasovagal reaction | SympSympathetic nervous system response to to pain, anticipated pain, site of needle, more frequent in younger men, pregnant womewomen S/Sx: tachycardia, pallor diaphoresis, dyspnea, syncope, nausea, vomiting, Ø BP | Thoroughly explain all procedures to patient, obtain IV history prior to attempting venipuncture, no more than 2 attempts per nurse, place patient in supine position prior to venipuncture, obtain baseline VS, be aware of patient diagnosis, age, hydration status, previous history of ìneedle phobiaî, have emergency equipment accessible | Maintain patient safety, airway. Severe hypotension may require administration of atropine per policy/order, notify MD, elevate legs, administer O2, stimulants prn, document reaction. Reaction usually self-limiting |
| Deep Vein Thrombosis | Can occur as a result of fibrin sheath breaking away from indwelling device, mural thrombosis from intimal damage during insertion, dwell, infusion. Thrombus blocks flow through a vessel, causing pressure to rise distal to the blockage in the vessel S/Sx: redness, pain, swelling on the same side as the IV device, edema distal to IV, difference in color, temperature of extremities between affected and unaffected sides, vein engorgement on affected side as other vessels attempt to pick up extra flow from clotted vessel | Use of smallest gauge catheter to safely administer infusion, be aware of patients with hypercoaguable states, eg., cancer, pregnancy, appropriate use of cannulated arm, securely anchor cannula to prevent movement in situ, be aware of tonicity and pH issues with infusions and choose appropriate infusion device for hypertonic/low pH infusions, q hour site inspections, thorough comparison of both arms during head to toe assessments at least daily, patient teaching about activities permitted with IV in place. | Notify MD of s/sx, administer therapies as ordered |
| Pinch Off Syndrome | Presents as change in flow with patient position changes.Catheter can fracture from scissoring action between clavicle and 1st rib | Avoid subclavian approach for insertion | Obtain Chest xray and dye study to see if catheter gets pinched when patient moves arms.Ý Catheter generally needs to be removed to prevent fracture & embolus |
| Port-Catheter Separation | Catheter comes off of port due to excessive pressure, fracture, or has developed hole in catheter.Ý Can result in extravasation/infiltration/catheter embolus.Ý S/Sx:Ý patient c/o ìcoolnessî or burning sensation during infusion/flushing, edema along port catheter, loss of blood return | Do not flush against resistance, listen to all patient c/o sensation during flushingÝ & infusion,Do not use pressure injectors unless manufacturer approved to do so, do not use syringes smaller than 10cc size to flush | Dx: dye study. Removal/surgical repair probably necessary. |
| Occluded Catheter/Port | Unable to flush, unable to aspirate blood return, slow/sluggish blood return or infusions | Flush promptly after all intermittent infusions, lab draws, maintain positive pressure in line when not in use, assure that all flush solutions & drugs are compatible | Assess reason for occlusion:Ý clot ñ refer patient for thrombolytic/catheter stripping.Ý Other occlusions cleared per physician/facility protocol (ie lipids, drug precipitates) |