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Sunday, May 9, 2021

Intravenous Therapy: Most 8 Complications of IV Therapy Nurses Must know

 Common complications of IV therapy

Common complications of IV therapy

  • Infiltration
  • Thrombophlebitis
  • Bacteremia
  • Circulatory Overload
  • Air Embolism
  • Mechanical Fail
  • Hemorrhage
  • Venous Thrombosis



  • Dispossession of the IV cannula from the vein results in infusion of fluid into the surrounding tissues.
Clinical manifestations

  • Swelling, blanching, and coolness of surrounding skin and tissues.
  • Discomfort, according to the nature of the solution.
  • Fluid running more slowly or ceasing.
  • There is no blood backflow in the IV catheter and tubing.
Preventive Measures

  • Confirm that the IV and distal tubing are properly secured with tape to prevent movements.
  • Splint the patient's hand or arm if required.
  • Observe the IV site frequently for complications
Nursing Interventions

  • Holed infusion immediately remove the IV needle or catheter.
  • Change and restart the IV in the other hand.
  • If infiltration is moderate to severe, provide moist, warm compresses and elevate the limb.
  • If a vasoconstrictor agent or vesicant ( chemotherapy agents) has infiltrated, initiate emergency local treatment as directed. Serious tissue injury, sloughing, and necrosis may result if actions are not taken.
  • Document interventions and assessments.


  • Damage to the vein during venipuncture, large-bore needle or catheter use, or prolonged catheter use.
  • Inflammation to vein due to fast infusions or irritating solutions ( eg. cytotoxic agents, strong acids or alkalis, potassium and others); narrow veins are more susceptible.
  • Clot develop at the tip of the needle or catheter due to slow infusion rates.
  • Most commonly seen with synthetic catheters than steel needles.
Clinical Manifestation

  • Tenderness and pain along the vein.
  • Redness, swelling and warmth at the infusion area; the vein may present as a red streak above the insertion site.
Preventive Measure

  • Attach the needle or catheter properly at the insertion site.
  • Change the catheter site every 72 hours in adult patients ( it may not be suitable to remove catheters in pediatric and neonates patients every 72 hours; however, they should be removed urgently if complications are suspected).
  • Select large veins for irritating fluid because of higher blood flow, which immediately dilutes the irritant.
  • Properly dilute irritating agents before infusion.
Nursing Interventions

  • Provide cold compresses immediately to reduce pain and inflammation.
  • Follow with warm, moist compresses to stimulate circulation and improve absorption.
  • Document interventions and assessments.
  • Participate in facility quality improvement activities regarding phlebitis occurrence rates. One formula that can be used is:.             
          Number of phlebitis incidents
    Total number of IV peripheral catheters=
          = % peripheral phlebitis


  • Contaminated equipment or infused solutions.
  • Prolonged placement of an IV device ( catheter or needle solution container tubings)
  • Nonsterile IV insertion and dressing change
  • Cross-contamination by the patient with other infected areas of the body.
  • A critically ill or immunosuppressed patient is at greatest risk of bacteria.
Clinical Manifestations
  • Elevated temperature, chills
  • Nausea, vomiting
  • Elevated white blood cell (WBC)? Count
  • Malaise, increased pulse
  • Backache, headache.
  • Possible signs of local infection at the IV insertion site.

Preventive Measures

  • Follow the same measures as outlined for thrombophlebitis.
  • Maintain strict sterile technique when inserting the IV or changing IV dressing.
  • Solutions should never hange longer than 24 hours.
  • Change the insertion site every 96 hours in an adult patient and within 48 hours if catheter was placed in an emergency situation.
  • Change continuous IV administration sets no more frequently than every 96 hours and intermittent IV administration sets every 24 hours.
  • Change the IV dressing on a routine basis and immediately if it becomes compromised.
    • Gauze dressing that prevents visualization of the site should be changed every 48 hours.
    • Transparent semipermeable dressing on a peripheral short-term site should be changed at site change or if the dressing loses its integrity.
    • Transparent semipermeable dressing on central line sites should be changed at least every 7days and sos.
  • Maintain the integrity of the infusion system.
Nursing interventions
  • Discontinue infusion and IV cannula.
  • IV device should be removed and the tip cut off with sterile scissors; placed in a dry; sterile container, and immediately sent to the laboratory for analysis.
  • Check vital signs; reassure the patient.
  • Obtain WBC count, as directed, and assess for other sites of infection. (Sputum, Urine, Wound)
  • Start appropriate antibiotic therapy immediately after receiving orders.
  • Document interventions and assessments.


  • Delivery of excessive amount of IV fluid 
Clinical Manifestations
  • Increased BP and pulse.
  • Increased CVP, venous distension ( engorged jugular veins).
  • Headache, anxiety.
  • Shortness of breath, tachypnea, coughing
  • Pulmonary crackles
  • Chest pain
Preventive measures
  • Know whether the patient has an existing heart or kidney condition. Be particularly vigilant in high-risk patients.
  • Closely monitor the infusion flow rate. Keep accurate intake and output records.
  • Splint the arm or hand if the IV flow rate fluctuates too widely with movement.
Nursing Interventions
  • Slow infusion to a "keep-open" rate and notify the health care provider.
  • Monitor closely for worsening condition.
  • Raise the patient's head to facilitate breathing.
  • Document interventions and assessments.

  • A greater risk exists in central venous line when air enters catheter during tubing changes ( air sucked in during inspiration due to negative intrathoracic pressure).
  • Air in tubing delivered by IV push or infused by infusion pump.
Clinical Manifestations
  • Low BP, elevated heart rate.
  • Cyanosis, tachypnea
  • Rise in CVP.
  • Changes in mental status, loss of consciousness.
Preventive Measures
  • Clear all air from tubing before infusion to patient.
  • Change solution containers before they run dry.
  • Ensure that all connections are secure. Always use Luer-lock connections on central lines.
  • Use precipitate and air-eliminating filters unless contraindicated.
  • Change IV tubing during expiration.
Nursing interventions
  • Immediately turn the patient on left side and lower the head of the bed; in this position, air will rise to right atrium.
  • Notify the health care provider immediately.
  • Administer oxygen as needed.
  • Reassure the patient.
  • Document interventions and assessments.

  • Needle lying against the side of the vein, cutting off fluid flow.
  • Clot at the end of the catheter or needle.
  • Infiltration of IV cannula.
  • Kinking of the catheter or tubing.
Clinical Manifestations
  • Sluggish IV flow.
  • Alarm of flow regulator sounding.
  • May be signs of local- irritation-swelling, coolness of skin.
Preventive Measures
  • Check the IV often for patency and kinking.
  • Secure the IV well with tape and an armboard, if necessary.
Nursing Interventions
  • Remove tape and check for kinking of tubing or catheter.
  • Pull back the cannula because it may be lying against the wall of vein or vein bifurcation.
  • Elevate or lower needle to prevent occlusion of bevel.
  • Move the patient's arm to new position.
  • Lower the solution container to below the level of patient's heart and observe for blood backflow.
  • If an electronic flow-rate regulator is in use, check it's integrity.
  • If none of the preceding steps produces the desired flow, remove the needle or catheter and restart infusion.


  • Loose connection of tubing or injection port.
  • Inadvertent removal of peripheral or central catheter.
  • Anticoagulant therapy.
Clinical Manifestations
  • Oozing or trickling of blood from IV site or catheter.
  • Hematoma.
Preventive Measures
  • Cap all central lines with Luer-lock adapters and connect Luer-lock tubing to the cap- not directly to the line.
  • Tape all catheters securely- use transparent dressing when possible for peripheral and central catheters. Tape the remaining catheter lumens and tubing in a loop so tension is not directly on the catheter.
  • Keep pressure on sites where catheters have been removed-a minimum of 10 minutes for a patient taking anticoagulants.


  • Infusion of irritating solutions
  • Infection along catheter may preclude this syndrome.
  • Fibrin sheath formation with eventual clot formation around the catheter. (This clot will eventually occlude the vein).
Clinical Manifestations
  • Slowing of IV infusion or inability to draw blood from the central line.
  • Swelling and pain in the area of catheter or in the extremity proximal to the IV line.
Preventive Measures
  • Ensure proper dilution of irritating substances.
  • Ensure superior vena cava catheter tip placement for irritating solutions.
Nursing Interventions
  • Stop fluids immediately and notify the health care provider.
  • Reassure the patient and institute appropriate therapy:
    • Anticoagulants.
    • Heat.
    • Elevation of the affected extremity.
    • Antibiotics.

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Reference: Lippincott Manual Nursing Practise 

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