Ill} Po"'n" "'110 an: .,..,..,ribod l.V. lherapy an: III nu, f ... u~ly iIIducN injurin." ","",","ie called ial",!<,~,," IIIj ... Po ... ""y I>< .. rill: f ...
complicali.on. or od,· .... e>'UIO' II", ... I( from in .. ",on of • ,~. """"OS dn-;";:" ... a ron_ntc of "",nlain,nB LV. iht"'P)'. '" "'I><n • ~. """"OS dn-i.ce i. ",mo,"«I. Somo of 11>< ""'"'
",",nelll
ron,pllC.uons and od>=s< """nU i""ludo i"f«"lioo. infil"a1"". (hrom"""i ••• " emholl.m. l"'<"moIh" ... and Io<moIhorn, Ri,k for inf..,I,on Iw b<.en di..,u •...J
pre"iou.ly: (Io<",f"... thi."""ion ... ill focu, 0<1 11>< o!II« """" ified ",,.,'plic.,ion •. E<p«1cd
""",om. ,,
i nd udo,10 .. f'II'i,n" ,,;11 rem.in fl'l."C from 110< .. injuri"", comph.,.,ion.'· Nuni.g inlO,wnlioo, ",o1"" """,rid cn,unng Vlg,I .. , .... " .. ,lIonc. and f,,"'lhOling prompt coliabor.I1il'e 0<1;"., ,,'i,h II>< paI;"nl', poy.iei." if .ny of
,1Ir..,
romplie .. ion.""'u,. The nunc .100 pl.n, interven,i"", th"t"re ... " .... '0 docre ... ,I>< lik.lihood IhlIt tho """'plication, "'ill """u'.
InfiltJ2lioo "",ur> "Io<n • ""in
III.,
i.< uoed .. on octeo; •• itc for on l.V. doliY<ry .y ... m """"""" r~ile and .. inJu""" LV . ..,Iu'ion 'IIrn !e.b ,nto tho >WTOII",ling ti ... T1Ii. hopp<no ... commonly ... '1><" oc«u ""';.,;:." .... pIo<<<I in ,,,,,,II«."""" (,.ile ".riph<r.ol >cin. IhlIn ... hen O<Ce>' device> .... pI><cd in C< ... ""ins, The nu"" moni""" 11>< tV oil<
ro.
iofill ... ", .. :\\"llmevudftMi",
""""eo .... """"
\\"lIme>n tho I. V. d<li'~ .)"Itm .. <"""~
\\"lIme>n tho 00[",;"" .. "'" 1\oo.',n8 properly ... ""'"' II on apparmI
-.-.. I.V. Therapy Demystified
WIIe"",ort'" patient complain. of pain 0< . . ode"", .. at the I. V. orre .. ,ite AI inlerval. noted per ogoncy or oo.pitol prolOC<>l
n.e
nu,"" ,hould documen' the pn,."""e or ab",""" of inn[ ,,,,,ion
00 the pat '" nt".record "'ing the infl/lmli"" !Cak' Ill .. i. di",l.yed OIl T.ble 6-2. Wile".,.."
infiltr:atioo i. ""'p<e1ed in a periJ>her:al LV, lioe. the Ii". ,lx>uld be di""""inuM.oo begun "!lain u.ing • different vein. W""" oompre''''' moy be apphed to the site of infiltr:alioo to .n"i ... di",omfon ond edema ond 10 ''''''IUray the <>pcdilious absorption of tbe i"filt ... -Su<pe<ted infil,r.o'ioo of. ",n, ... 1 LV. lioe shoold be
"'J>O'1ed 10 tbe phy.ici.". ond the <lat.
,ha,
,uppo<1 lhi. '"'pi<;oo , .... Id be documm .. d in the I"tien'", recool.Thrombosis ""ru"
"".0
> blood 0101 (i.e". Ihrombu.) form. OIl the ><DOIIS aoceu de'K:e,'1brombi moy fOfTD OIl lUIy lype of ><DOII. aoce» d..,'K:e ""heth.r it u"" • peripheral or cen,,,,1 >r<",. site. Clinical manif"" .. ioo. of Ihrombo>i. "00 to mimic ,""'" of pIllebitis. .00 gooer:ally. the "u"ing int.rven,;on. mim>r the trealmm' for 'lL5pected infil''''tion of perip/><",I .nd centru LV.ore.".
device •.lhat i" "'be",,, ... thrombus foem.';oo i, .u'pected on. ~ripher:ol '..,IlOU.:ocre ..
dev~. the li"" is di«ontinood .• nd. new .ite i. acce.>ed u,ing a fre'" deli,'ery .. tup .00 aoc= device. 1be old acee . . . ite i. t",ate<! with. ""211'11 compress.-Su.p<"<1ed thrombu. formation 00 • centr21 acee .. devic. should be "'ported
promptly to the phy.ician. ODd ,"pponing evide""" .hould be documented in the paticn", record.
Thromboses might be pt"",nted by ~,;ooic.lly flu.hing .,""". device. ~,
ag.ncy 0< hospillil protocol if pat;'n" .re not receiving. continuous infu,ioo.
Flu,he. Nrllmonly u.ed indude ... line (e.g .. 0.9% IlOfTIIlIl saline INS]) ODd heparinized flu.h ",Iutioo (e.g" 100 units heparin/mL). Thrombi can become di,lOOged.oo become emboli. which .... y c.u'" llIrget-<>Ql"" damage, Peripher:ol thrombi """ly "'" """"i.ted ,,'ith ,igniflcant t:ug"'-<>Ql"" dorruoge. H",.,,,,,,,.
thIombi th .. fOfT1l from centr21 ,·"nou. oe<:e>. >ite>ean di.lOOge.nd beeome emboli that then rapidly t" ... "l from the cent ... l "'000' = l .. ure to the right .ide of the .. an ODd into tbe pulmonary v ... l .. ure. c.u,ing pulmonary ischemia. pulmonary inf:m:tioo. ODd .",ntually. pulmonary ,."" ... i •. Thi. "'"y be ,rumife.ted by dy.pnea.
coofu,ioo, bemopty'; •. ODd "''Pi,'''O<)' failure.
Air emboli ""'y form in tbe ""000' ,·""'ul ... whene,'ef .i, in"PP"'!"i.tely infuse. into the .. in vi. the I.V. <leli,..,ry .y.tem. This may occur if tbe .. are ai, bubbl., in the solutioo th>1 are no! flu.hed out hef"", infu.ioo into the patient. A few <mOll .i, bubbl •• """Iy cau", ... y significant complic .. ion, when they infuse into • ~riphe",1 ""in bee"",., """,ular flow bre.h up the ai, bubble hefore it r,,,,,,he. thecentr21 .. ",ulature. If .i, bubbl., infu", into. ""ntnl LV. line. h",.,,,, .. ,.
this can ,,"use serious injury bee,u", a pulmonary .mbolu, ""'y form. leading to a
CHAPTER 6 Intravenous Th erapy
"
pulmonary inforrtioo :and pulmonary _ .... i., Whonem- c<nlnl IV line • ...., initi.,ed. di><:Onn«:1ed. '" di"""'tinliOd, """",I chonJeO ,n ,n' .. """""'"
1""""'"
lIDI. oc<ur du,;nl'ho n:opilat"')' C')'d. <an ~Il in ... bollia dr".'.'n ilM<> lh< ~
" .. , Thi. i. >IKIlIIn key
<au", or."
.mIIol .. fonnolioo. Thi.may
be pr<VftItrd by C<*:hinllh< poll<n11O perf_ 11M: \~I' .. m>nO\I'~ 'O'htne'o'ff' ~ I.V. Ii ...... up .. in.ili2lcd, ciw'lJ«I, 01 di"""" •••••
,!.·
P.""",,,boru
:and htm"tb", . . ..., ... ~ duo con oocur ~i...moo. or •
~_ ...,... de>'a,'
l'l>nI"""horu. .. t...d .. tIM lh<'" I.V. Therap y Demystified
i"trod""".
used to g.'o cen<r.l! venoo. >Cee .. ,nad,-en"o,ly PO""'U"" the pleural space. re,"lting in .if being pulbl into , .... '1""'" and c,using partial Of tot.1 colbp.e of the lung 011 ,be ,ide of the injury. Hernothor:u rruoy occur if . . . ,,,,I i.puf'oCtured during Ill;. J>fOCe ... cau.inE blood 10 fill ,be p\eur:al '1'""" .• 00 ,be lung then ",,!lapses. Both pD<umotho,,,, and berno<hor:u rruoy be fII2Ilife.ted by dy.p"""
''''pin'",), ill'lIe ... hypoxemia. and "..,n,oa! card iopu lmorwy collapse if emerge'"
deci,iYe ",",ion i. not 1»;<0, i""IOOinE the ;n","ion of. ohe>l ,ube.