Thrombophlebitis



Cause

1-Injury to vein during venipuncutre , large-bore needle or catheter use , or prolonged needle or catheter use.

2-Irritation to vein due to rapid infusions or irritating solutions (eg, hypertonic glucose solutions, cytoyoxic agents )

3- Clot formation at the end of the needle or catheter due to slow infusion rate.

4-More commonly seen with synthetic catheters than steel needles.


Clinical Manifestations

-Tenderness at first , then pain along the vein.

-Swelling , warmth , and redness at infusion site , the vein may appear as a red streak above the insertion site.


Prevention Measures

1-Change the insertion site at least every 72 hours.

2-Use large veins for irritating fluid because of higher blood floe , which rapidly dilutes the irritant.

3-Sufficiently dilute irritating agents before infusion.


Nursing Interventions

1-Apply cold compresses immediately to relieve pain and inflammation.

2-Follow with moist , warm compresses to stimulate circulation and promote absorption.

3-Document interventions and assessments.

Causes

1-Prolonged placement of I.V device( cathtere or needle , tubing , solution container).

2-Nonsterile I.V insertion or dreesing change.

3-Cross-contamination by the patient with other infected areas of the body .

4-A critically ill or immunosuppressed patient is at greater risk of bacteremia.


Clinical Manifestations

1-Elevated temperature , chills

2- Nausea , vomiting

3-Elevated WBC count

4-Malaise , increased pulse(Tachycardia)

5-Backache , headache

6- May progress to septic shock with profound hypotension

7-Possible signs of local infection at I.V insertion site ( redness , pain )


Prevention Measures

1- Use strict sterile technique when inserting the I.V or changing I.V dressing.

2-Solutions should never hang longer than 24 hours.

3-Change the insertion site at least every 48 to72 hours.

4-Change continuous I.V administration sets every 24 hours.

5-Change the I.V dressing every 48 to 72 hours.

6- Maintain integrity of the infusion system.


Nursing Interventions

1-Discontinue infusion and I.V cannula.

2-I.V device should be removed and the tip cut off with sterile scissors, placed in a dry sterile container , and immediately sent to the lab for analysis.

3-Check vital signs

4-Obtain WBC count and assess for other sites of infection ( urine , sputum , wound)

5-Start appropriate antibiotic therapy immediately after receiving order.

6-Document interventions and assessment.

Circulatory Overload



Cause

1-Delivery of excessive amount of I.V fluid ( especially a risk for elderly patients , infants or patients with cardiac or renal insufficiency)


Clinical Manifestations

1-Increased BP and pulse.

2-Increased CVP , venous distention.

3-Headache , anxiety.

4-Shortness of breath , tachypnea , coughing.

5-Pulmonary crackles.

6-Chest pain(if history of coronary artery disease)


Prevention Measures

1-Know whether patient has existing heart or kidney condition.

2-Closely monitor the infusion flow rate. Keep accurate intake and output records.


Nursing Interventions

1-Slow infusion to a ( keep-open) rate and notify the health care provider.

2-Monitor closely for worsening condition.

3-Raise patient head to facilitate breathing.

4-Document interventions and assessment.

Air Embolism


Causes

1-A greater risk exist in central venous lines, when air enters catheter during tubing changes ( air sucked in during inspiration due to negative intrathoracic pressure)

2-Air in tubing delivered by I.V push or infused by infusion pump.


Clinical Manifestations

1-Drop in BP, elevated heart rate.

2- Cyanosis , tachypnea.

3-Rise in CVP.

4-Changes in mental status, loss of consciousness.



Prevention Measures

1-Clear all air from tubing before infusion to patient.

2-Change solution containers before they run dry.

3-Change I.V tubing during expiration.


Nursing Interventions

1-Immediately turn the patient on his left side and lower the head of the bed ; in this position, air will rise to right atrium.

2-Notify the health care provider immediately.

3-Administer oxygen as needed.

4-Reassure the patient.

5-Document interventions and assessment