IV Complications (infiltration, phlebitis, hematoma, extravasation, air embolism)

Okay guys, in this lesson I’m going to talk to you about complications that you could potentially run into when you’re dealing with your IV. There are five of them, infiltration, phlebitis, hematoma, extravasation and air embolism, so let’s take a look at them.

What are the most common complications of IV therapy?

1. Infiltration: leaking of the fluid outside of the IV into the soft tissue of the patient’s extremity.
2. Phlebitis: inflammation of the actual vessel instead of a problem with the IV being inserted in the right place.
3. Hematoma: leaking of blood outside of the vessel into that soft tissue space
4. Extravasation: leaking of a caustic substance outside of the vessel into the soft tissue space.
5. Air embolism: injection of air into the blood vessel.

The first one is infiltration. What infiltration is it’s the leaking of the fluid outside of the IV into the soft tissue of the patient’s extremity. For example, what happens is your patient’s arm or leg or whatever it is maybe swollen, maybe tender, and it could also be cold because of all the fluid that’s accumulated. If the IV is not patent, go ahead and discontinue and make the patient comfortable as possible.

What are the signs of IV infiltration?

Swollen, tender, and cool skin.

The next one is phlebitis and what phlebitis is is its inflammation of the actual vessel instead of a problem with the IV being inserted in the right place. What happens is is the vessel gets really mad and angry and it can actually become red and swollen.

What you need to do for those patients is you need to make them comfortable. That’s using warm compresses and then you can also use things like nonsteroidal anti-inflammatory drugs. With an order to make sure to help reduce that inflammation. Antibiotics typically aren’t needed because it’s usually not an infection. It’s usually associated with just irritation of that IV being in that vessel for so long.

The next complication that you may see is a hematoma and the hematoma is essentially a bruise and what it is is it’s leaking of blood outside of the vessel into that soft tissue space. Sometimes it can get swollen. It’s very not. It’s usually not the complaint. The complaint is that it looks like a lot of bruising. If that happens, discontinue the IV and apply a pressure bandage to the area. The last two that we’re going to talk about are usually the ones that cause the most longterm complications or are the most dangerous.

The first one is an extravasation when extravasation is it’s the leaking of a caustic substance outside of the vessel into the soft tissue space. This is a problem because oftentimes these types of medications will cause tissue necrosis and they have longterm ramifications. Things like surgery or longterm therapies, and what you need to do is anytime you’re giving your patient a potential drug or medication that could cause extravasation, you need to make sure you have a solid IV. You need to check it for patency before you infuse it needed to check it during. You need to check your patient’s comfort levels. This will help you to avoid those types of situations. If you do run into a problem where you have a VESA count, which is one of those drugs that become extra Bay stated and it’s outside of that tissue, you need to stop the infusion as quickly as possible and notify the provider.

Sometimes there are medications that they can do to help alleviate these problems.

The last one and the most potentially harmful complication that we didn’t run into with IVs is an air embolism. When an air embolism is, is it’s an injection of air into the blood vessel through whatever access they have. So it can be either to the IV tubing, it can be an extension tubing set, usually like the J  loop that’s attached to the IV or even the IV itself through an injection. What happens is that the air bubble travels all the way up into the heart. It can get, uh, go to the brain and cause occlusion and can go to the lungs and cause a pulmonary embolism there. That’s why it’s so dangerous. So what happens if your patient is suspected of an air embolism? What you need to do is number one, stop the infusion.

That’s something that you can do that’s within your scope of practice. And then you turn your patient on their left lying side. Here’s what if the air embolism travels to the heart. What happens is because they’re on their left lying side, their right atria is typically above. What will happen is that air will get trapped as an air pocket into that right atrium and it’ll get, it’ll stay there. And then your providers can do whatever they need to to help that patient get rid of the air embolism after you turn them on the left lying side, then call the provider. It’s always great to multitask, especially if you can get one of your colleagues or work buddies to call a provider for you while you’re actually dealing with the patient. Multitasking is something that we’re always worried about in nursing. Something we always work to get better at. So if you can do things like, oh, I’m stopping the infusion, turning my patient, Hey, can you call? You know, so and so to get them here to the bedside so we can address this. That’s always the best thing that you can do. 

I hope that these tips on IV complications have been helpful. Now go out and be your best self today, and as always, happy nursing.