Complications Associated With Intravenous Infusions
Complication/Cause
Signs and Symptoms
Nursing Considerations
Infiltration: the escape of fluid into the subcutaneous tissue Dislodged needle Penetrated vessel wall
Swelling, pallor, coldness, or pain around the infusion site; significant decrease in the flow rate
Check the infusion site every hour for signs/symptoms. Discontinue the infusion if symptoms occur. Restart the infusion at a different site. Use site-stabilization device.
Venous access device-related infection: Improper hand decontamination/hand hygiene Frequent disconnection of tubing, access ports, and/or access caps Poor insertion technique, multiple insertion attempts Multilumen catheters Long-term catheter insertion Frequent dressing changes Inadequate/improper decontamination of hub prior to use An IV solution that becomes contaminated when solutions are changed, a medication is added, or the solution is allowed to infuse for too long a period Inappropriate administration set changes
Erythema, edema, induration, drainage at the insertion site Fever, malaise, chills, other vital sign changes
Perform hand hygiene before and after palpating catheter insertion sites; before and after inserting, replacing, accessing, and dressing a VAD. Assess catheter site routinely. Notify health care team immediately if any signs of infection. Use scrupulous aseptic technique when starting an infusion. Follow best-practice guidelines for site care, changing of administration tubing sets, connectors, caps, and other administration equipment. Follow facility protocol for culture of drainage. Consider use of 2% chlorhexidine wash for daily skin cleansing.
Phlebitis: an inflammation of a vein Mechanical trauma from needle or catheter Chemical trauma from solution
Local, acute tenderness; redness, warmth, and slight edema of the vein above the insertion site
Use a phlebitis scale to assess and document phlebitis. Discontinue the infusion immediately. Apply warm compresses to the affected site. Avoid further use of the vein. Restart the infusion in another vein.
Thrombus: a blood clot Tissue trauma from needle or catheter
Symptoms similar to phlebitis IV fluid flow may cease if clot obstructs needle.
Stop the infusion immediately. Apply warm compresses as prescribed or according to facility policy. Restart the IV at another site. Do not rub or massage the affected area.
Speed shock: the body's reaction to a substance that is injected into the circulatory system too rapidly Too rapid a rate of fluid infusion into circulation
Pounding headache, fainting, rapid pulse rate, apprehension, chills, back pains, and dyspnea
Use the proper IV tubing. Carefully monitor the rate of fluid flow. Check the rate frequently for accuracy. A time tape is useful for this purpose.
Fluid overload: the condition caused when too large a volume of fluid infuses into the circulatory system Too large a volume of fluid infused into circulation
Engorged neck veins, increased blood pressure, and difficulty in breathing (dyspnea)
If symptoms develop, slow the rate of infusion. Notify the health care team immediately. Monitor vital signs. Carefully monitor the rate of fluid flow. Check the rate frequently for accuracy.
Air embolus: air in the circulatory system Break in the IV system above the heart level, allowing air in the circulatory system as a bolus
Respiratory distress Increased heart rate Cyanosis Decreased blood pressure Change in level of consciousness
Pinch off catheter or secure system to prevent entry of air. Place patient on left side in Trendelenburg position. Call for immediate assistance. Monitor vital signs and pulse oximetry.