Problem |
Intervention |
Catheter-related infection: Infection that occurs at the insertion site. Risk factors are associated with dwell time, presence of distant infection, care, and maintenance practices. |
Monitor for symptoms associated with febrile episodes. Monitor site for inflammation or purulence at insertion site, sudden onset of symptoms.
Symptoms will increase at the start of infusion.
Monitor for tenderness, redness, induration, purulence.
Notify healthcare prescriber if suspected.
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Extravasation: Extravasation is the inadvertent administration of a vesicant solution into surrounding tissues as a result of catheter dislodgement. Vesicant solutions can cause blisters, with subsequent sloughing of tissues as a result of necrosis. |
IV site checks are to include assessment along the path of the catheter.
Measure the circumference of the extremity above the IV site and compare serial measurements.
If extravasation occurs, discontinue infusion. Rate extravasation; according to the infiltration scale (Table 53-2 ), an extravasation is always rated a 4.
Notify healthcare prescriber of extravasation, solution, or medications infusing at time of infiltration, and site appearance. Obtain healthcare prescriber order for agent to treat extravasation as needed.
Immediately elevate extremity to promote venous return; maintain elevation for 24-48 hours.
For children in early childhood and older, use cold (for DNA-binding vesicants except mechlorethamine, contrast media, and hyperosmolar fluids) or dry heat (for non-DNA-binding vesicants) compresses for about 15 minutes, every 4 hours, for 24-48 hours.
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Infiltration: Infiltration is the unintended administration of nonvesicant medication or solution into the interstitium and tissue surrounding the vein. An increase in circumference of the extremity may indicate an infiltration is present. Treatment of an infiltration is dependent on the properties of the infiltrated medication or solution, the manufacturer’s guidelines for that agent, and the severity of the infiltration. |
IV site checks are to include assessment along the path of the catheter.
Measure the circumference of the extremity above the IV site and compare serial measurements.
If infiltration occurs, discontinue infusion. Measure degree of infiltration using a standard scale (see Table 53-2 ); measurements in proportion to patient size should be considered.
Notify healthcare prescriber of infiltration, solution, or medications infusing at the time of infiltration, and site appearance. Obtain healthcare prescriber order for agent to treat infiltration as needed.
Immediately elevate extremity to promote venous return; maintain elevation for 24-48 hours.
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Hematoma: Indicating undue trauma to the vessel wall or extravasation of blood into the extravascular space. |
Apply warm compress to extremity for discomfort.
If symptoms increase, discontinue IV use at the site.
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Nerve damage: Numbness or tingling sensations in arm, hand, or extremity. Indicates trauma to adjacent nerve during insertion of IV. |
Many veins are located near nerves. Discontinue insertion if excessive pain at insertion site, and attempt another site.
Discontinue IV if painful.
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Phlebitis: An inflammation of the vein usually caused by mechanical irritation from catheter trauma or early signs of infection. Some catheter materials are associated with increased risk for phlebitis. May be caused by excessive movement. Studies have shown phlebitis occurs due to poor securement of IV sites. Phlebitis may continue for 48 hours after IV is removed. |
Apply warm compress to extremity to ease discomfort.
Assess IV site and path every 1 hour for signs of phlebitis: pain, tenderness, erythema, inflammation, warmth, edema, induration.
Measure degree of phlebitis using a phlebitis scale (see Table 53-2 ); measurements in proportion to patient size should be considered.
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Septicemia: Indicates systemic infection related to presence of blood-borne infection. |
Assess the patient for signs and symptoms: chills, backache, fever, hypothermia, nausea, malaise, vomiting, headache, hypotension, flushing.
Do not apply compresses because this may potentiate infection.
Notify healthcare prescriber and obtain orders for antibiotics.
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KidKare Stress the importance of holding still during the catheter placement because this facilitates insertion. Children identify needles as the most painful and scary part of hospitalization. Include a child-life specialist, if available, to assist with distraction techniques.
