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Complications of Intravenous (IV) therapy

Intravenous (IV) therapy is a treatment based on infusing various fluids (e.g. medications or blood products) directly into a vein. Approximately 80% of in-hospital patients receive IV therapy.1

IVs are categorised as either peripheral or central.2

  1. Peripheral IVs: Peripheral intravenous catheters (PIVC) are the most commonly used intravenous device in hospitalised patients. They are primarily used for therapeutic purposes such as administration of medications, fluids and/or blood products as well as blood sampling.3

The midline catheter (i.e. long peripheral catheter) is an IV catheter placed into a peripheral vein, with the distal tip located just proximal to the axilla. Midline catheters can range from 10 to 25cm in length, have a single or double lumen, and placed using the Seldinger’s technique or ultrasonography.4

  1. Central IVs: Central Venous Catheter (CVC) is a thin, flexible tube inserted into a vein, usually below the collarbone. It is guided (threaded) into a large vein above the right side of the heart called the superior vena cava. A needle is inserted into a port outside of the body to draw blood or give fluids. A central IV may stay in place for weeks or months and helps avoid the need for repeated needle sticks.5 Tunnelled central venous catheter, a peripherally inserted central catheter (PICC) and Sub cutaneous Ports are common types of CVC.6

The Common complications of IV therapy are7

  1. Phlebitis is an inflammation of the vein that can occur when, for example, the cannula is too large for the vein or there is cannula movement. Length of therapy, the property of the IV fluid, speed and method of IV delivery are known to impact the risk for developing phlebitis. Warmth, swelling, pain, and redness around the vein area are some of the symptoms of phlebitis.
  1. Hypervolaemia is an abnormal increase in blood volume. Risk groups for developing hypervolaemia are elderly, children and patients, pregnant women and patients with cardiac/pulmonary/renal or cerebral disease or injury. Tachycardia, hypertension and deteriorating respiratory status are a few of the symptoms of hypervolaemia
  1. Extravasation is the leakage of IV fluids to the tissue surrounding the vein. It can happen when there is inadequate securement of the cannula, vein injury while inserting the cannula, if the cannula size is too large for the vein or there is a constriction of the vein above the infusion site due to clothing or bandages. Pain, burning or stinging sensations and blister formation are some of the symptoms of extravasation.
  1. Flare reaction can occur due to administration of an irritant drug. Local urticaria, oedema, stinging sensations and inflammations along the track of the vein are some of the symptoms.
  1. Air embolism is seen when air bubble(s) enter the vein. It can lead to fatal consequence if not actioned upon early as the air bubble can travel to the patient’s lung, brain or heart. Difficulty in breathing, coughing and wheezing, chest and/or shoulder pain, neurological findings consistent with cerebrovascular accident are some of the symptoms of air embolism.
  1. Anaphylaxis is an allergic reaction. Cardiovascular signs of anaphylaxis are, for example, low blood pressure, tachycardia and skin manifestation like urticaria, oedema etc.
  1. Cellulitis is an inflammation of the tissue which happens if bacteria enter the insertion site and passes along the extra luminal pathway of the cannula. Erythema, pain, tenderness and swelling are signs and symptoms of cellulitis.
  1. Infection can be caused by lack of aseptic measures. Local infection at the catheter skin entry point may progress to HABSI. Redness, swelling, purulent discharge, pain, sever systemic infection are all symptoms of infection.

References:

  1. Kaur, P., Rickard, C., Domer, G. S., & Glover, K. R. (2019). Dangers of Peripheral Intravenous Catheterization: The Forgotten Tourniquet and Other Patient Safety Considerations. In Vignettes in Patient Safety-Volume 4. IntechOpen.
  2. Waitt, C., Waitt, P., & Pirmohamed, M. (2004). Intravenous therapy. Postgraduate medical journal, 80(939), 1-6.
  3. Thomas, M. (2018). Peripheral intravenous (IV) device management. Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Peripheral_Intravenous_IV_Device_Management/
  4. Rezaie, S. (2020, February 13). Midline IV Catheters, REBEL EM blog. Retrieved from https://rebelem.com/midline-iv-catheters/
  5. National Cancer Institute (n.d.). Central venous access catheter. Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/central-venous-access-catheter
  6. Canadian Cancer Society (n.d.). Central venous catheter. Retrieved from https://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/central-venous-catheter/?region=on
  7. Canterbury District Health Board. (2019, May 22). Complications of Peripheral Intravenous Therapy. Retrieved from https://edu.cdhb.health.nz/Hospitals-Services/Health-Professionals/CDHB-Policies/Fluid-Medication-Manual/Documents/Complications-Of-IV-Therapy.pdf
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