Complications

of IVF
Therapy
By : Group 1
Abid ,Abucejo ,Abulag , Acuram , Artajo, Bautista
Bucad , Cabanag , Cahiles , Camello
Remember that :
● IV STANDS FOR INTRAVENOUS THERAPY OR “INSIDE THE VEIN” . IT MEANS THAT
PATIENT RECEIVES SUBSTANCES DIRECTLY TO THEIR VEINS THROUGH A TUBE OF
CANNULA.
● THIS COULD BE A MEDICATION OR NUTRITION.
● IV THERAPY IS A COMMON PRACTICE FOR ADMINISTERING FLUIDS TO DEHYDRATED
PATIENTS , MEDICATIONS , TREATMENTS AND BLOOD TRANSFUSIONS.

INDICATIONS:
● INTRAVENOUS ACCESS TO PATIENTS CIRCULATORY SYSTEM

CONTRAINDICATIONS:
● IV ACCESS SHOULD BE ATTEMPTED AS DISTAL AS POSSIBLE.
● AVOID VEINS THAT CROSS OVER JOINTS , LOCAL INFECTION INJURY
● EXTREMITIES WITHIN RENAL SHUNTS
 COMPLICATIONS OF IV THERAPY
LOCAL COMPLICATION: At the site, near the SYSTEMIC COMPLICATIONS : Occurs within
insertion site or as a result of MECHANICAL the vascular system, remote from the IV site.
FAILURE. Can be serious and life threatening.
● Occurs as adverse reactions or trauma to
the surrounding venipuncture site. ❏ Embolism
● Assessing and monitoring are the key ❏ Hematoma
components to early intervention ❏ Systemic infection
❏ Circulatory overload or Speedshock
❏ Infiltration ❏ Allergic Reaction
❏ Extravasation
❏ Thrombosis
❏ Thrombophlebitis
❏ Phlebitis
 Local
Complications
Infiltration
Extravasation
Thrombosis
Thrombophlebitis
Phlebitis
 Infiltration
● Results when the cannula becomes
dislodged from the vein and fluids are
infused into the surrounding tissues.
● Device dislodged from vein or
perforator vein.

Signs and symptoms

● Increasing edema at the site of the infusion
● Discomfort of tightness at site
● Feeling of tightness at site
● Decreased skins temperature around site
● Blanching at the site
● Absent backflow of blood
● Slower flow rate.
 Nursing
Prevention
Intervention

● Remove the device ● Check the IV site frequently

● Apply warm soaks to aid ● Don't obscure area above site
absorption with tape
● Elevate the limb ● Teach the patient to report
● Notify the doctor if severe discomfort , pain or swelling.
● Assess circulation
● Restart the infusion
● Document the patient
condition
Extravasation
It occur when fluids seep out from the lumen of a
vessel into the surrounding tissue.

CAUSES:
Damage to the posterior wall of the vein
Occlusion of the vein proximal to the injection site

Signs and symptoms

Swelling
Discomfort
Burning
Tightness
Coolness in the adjacent skin
Slow flow rate
 Nursing
Intervention
● Immediately stop the infusion
and remove the device
● Elevate the affected limb
● Apply cold compress to
decrease edema and pain
● Apply moist heat to facilitate
the absorption of fluid at
grossly infiltrated sites
Prevention
● Confirm patency of catheter
prior to administering
medications or solutions.
● Once infusion begins, observe
the access site for 1 to 2
minutes.
● Use a syringe barrel size of 10
ml or greater when flushing.
Thrombosis
● Catheter-related obstructions
can be mechanical or
non-thrombotic
● Trauma to the endothelial cells
of the venous wall causes red
blood cells to adhere to the vein
wall , forms a clot or thrombosis
● Drip rate slows , line does not
flush easily , resistance is felt
● NEVER forcible flush catheter.

Signs and symptoms

Fever
Slowed or stopped infusion rate
Inability to flush
 Nursing
Intervention
● Never flush a cannula to
remove an occlusion
● Discontinue the cannula
● Notify physician and assess the
site for circulatory impairment.
● Watch for IV therapy related to
infection
● Apply warm soaks
Prevention
● Use pumps and controllers to
manage flow rate
● Micro drip tubing for rate below
50mL/hr
● Avoid areas of flexion
● Use filters
● Avoid lower extremeties
Thrombophlebitis
● Occurs when thrombosis is accompanied
by inflammation
● Infusions allowed to continue after
thrombophlebitis develops will slow and
eventually stops , indicating progression to
an obstructive thrombophlebitis.
● Various terms can be used to distinguish the
type of phlebitis a patient experiences.
● All thrombotic complications have the
associated danger of embolism , especially
in cases where the thrombus is not well
attached to the wall of the vein.
Signs and Symptoms
● Local tenderness
● Swelling
● Induration
● A red line detectable above the IV site.
 Nursing
Intervention
● Apply warm soaks. Watch for I.V
therapy related infection.
Prevention
● Use veins in the upper
extremities
● Avoid placing catheters over
joint flexions
● Select veins with adequate
blood volume for solution
characteristics.
● Anchor cannulas securely
● Avoid multiple venipunctures
 Phlebitis
● Injury during venipunctures
● Prolonged use of the same IV site
● Irritating / incompatible IV additives
● Use of vein that is too small for the flow rate
● Use of needle size too large for the vein size
Signs and symptoms
● Pain
● Vein that is sore , hard , cord like and
warm to touch
● Red line above the site
● Signs of infection
PAIN SCALE
0 = no symptoms
1= erythema at site with or
without pain
2= pain at site , erythema or
edema no streak , no palpable
cord
3= pain at site , erythema and or
edema , streak present , palpable
cord
4= pain at site , erythema , or
edema streak , present , palpable
cord
Nursing Interventions
● Upon assessment of phlebitis , removal of the needle
● Avoid multiple insertion
● Application of warm compress
● Continuously monitor the patient - vital signs
 Systemic
Complications
Embolism
Hematoma
Systemic infection
Speedshock
Circulatory overload
Allergic Reaction
Systemic Infection
➢ Systemic infections are characterized
by the presence of >10-15 times the
colony forming units of bacteria per
ml of blood drawn from the vascular
access.
Signs and symptoms:
● Tenderness
● Erythema
● Induration
● Sudden onset of symptoms
● Onset or worsening of symptoms upon start or
increased rate of infusion
● Febrile episode
 Nursing
Prevention
Intervention

● Notify physician immediately; ● Follow proper hand antisepsis

Obtain blood cultures ● Change administration set and
● Culture infusion solution of rotate IV access site at
medication, if contamination is established intervals
suspected
● Administer anti-infective
therapy, as ordered
Hematoma
➢ Collection of blood in the
tissues and the most common
complication.
➢ Can be starting point for other
complications:
thrombophlebitis and infection

Causes related to: Signs and symptoms:

● Nicking the vein.
● Discoloration of the skin
● Discontinuing the IV without
● Site swelling and discomfort
apply adequate pressure.
● Inability to advance the cannula into the
● Applying the tourniquet to
vein during insertion
tightly above a previously
● Resistance to positive pressure during the
attempted venipuncture site.
lock flushing procedure
 Nursing
Intervention
● Properly position the needle
within the vein
● Release the tourniquet before
removing the needle
● Be sure that the right
equipment is being used
● Be gentle
Prevention
● Apply direct , light pressure for
2-3 minutes after needle
removed.
● Have patient elevate extremity
● Apply Ice

Embolism
➢ An embolism, also called
thromboembolism, is a
blockage in one of the arteries
of the body due to a blood clot
that has broken off from
another location in the body
(embolus) and traveled through
the bloodstream to lodge in a
small blood vessel. The
blockage may limit or stop
blood flow. An embolism may
be serious and life threatening.
Symptoms of embolism vary
greatly depending on the severity
and location of the embolism.
Some individuals with embolism
have no symptoms.
Examples of embolism as an IV Complication:
❖ Air embolism
Air embolism refers to the presence of air in the
vascular system and occurs when air is introduced
into the venous system and travels to the right
ventricle and/or pulmonary circulation. An air
embolism is reported to occur more frequently
during catheter removal than during insertion, and
the administration of up to 10 ml of air has been
proven to have serious and fatal effects. Small air
bubbles are tolerated by most patients.
➔ Signs and symptoms of an air embolism include:
sudden shortness of breath, continued coughing,
breathlessness, shoulder or neck pain, agitation,
feeling of impending doom, lightheadedness,
hypotension, wheezing, increased heart rate, altered
mental status, and jugular venous distension.
 Nursing
Intervention
● To avoid air embolisms, ensure
● Occlude source of air entry.
Place patient in a
Trendelenburg position on the
left side (if not
contraindicated), apply oxygen
at 100%, obtain vital signs, and
notify physician promptly.
Prevention
drip chamber is one-third to
one-half filled, ensure all IV
connections are tight, ensure
clamps are used when IV
system is not in use, and
remove all air from IV tubing by
priming prior to attaching to
patient.
Examples of embolism as an IV
Complication:

❖ Catheter Embolism
A catheter embolism occurs when a
small part of the cannula breaks off
and flows into the vascular system.
When removing a peripheral IV
cannula, inspect tip to ensure end is
intact.
➔ Signs and symptoms of an air
embolism include: Cyanosis
Hypotension
Tachycardia
Syncope/ loss of consciousness
 Nursing
Intervention
● Notify physician immediately.
● Place tourniquet above venipuncture
site. Do not occlude arterial flow.
● Place resident on bed rest.
● Monitor resident closely for signs of
distress.
● Administer interventions and
treatment, as ordered.
● Document observations, interventions,
resident’s response and outcome in
resident’s medical chart.
Prevention
● Inspect catheters for defects before
using.
● When using through-the-needle
catheters, never pull catheter back
through the needle.
● When using over-the-needle
catheters, never withdraw or
reinsert once threaded.
● Use appropriate size syringe and
technique when flushing catheter.
Circulation Overload or
Speed shock
➢ Complication caused by too rapid or
excessive infusion of fluids.
Signs and symptoms:
● Engorged neck veins
● Anxiety
● Restlessness
● Increased blood pressure and pulse
● Cyanosis
● Dyspnea
● Cough and crackles
● Bounding pulse
 Nursing
Prevention
Intervention

● Stop the infusion immediately or ● Monitor administration sets and

slow the infusion to keep the vein
open.
● Place patient in high fowler’s
position.
● Notify physician immediately.
● Administer interventions and
treatments as ordered.
electronic pumps to ensure
correct flow-rate.
● Use electronic pumps to
ensure accurate rate of flow
● Monitor the I and O
Allergic Reactions
➢ is a generalized hypersensitivity reaction
to a solution, medication, or additive.
Allergic reactions can be immediate or
delayed, mild or severe. Severe allergic
reactions (anaphylaxis) can be life
threatening.
Signs and symptoms:
● Chills and fever, Urticaria
● Erythema
● Pruritis
● Shortness of breath
● Respiratory distress
● Anaphylactic shock
● Cardiac arrest
 Nursing
Intervention
● Stop infusion immediately.
● Discontinue any suspected
medication or substance causing
the reaction.
● Maintain vascular access.
● Notify physician immediately.
● Administer treatment as ordered.
● Do not use the same administration
tubing used to administer the
suspected allergen.
● Monitor vital signs.
Prevention
● Obtain a thorough history of drug
allergies.
● Place ID bracelet on resident noting
allergies.
● Flag medical record and alert other
providers of resident’s allergies.
● Re-check resident identification and
blood type during blood transfusion
procedures.
RESOURCES
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