Peripheral IV Therapy Complications
Key Points
- Peripheral IV complications are classified as local or systemic and require prompt recognition.
- High-risk local events include phlebitis, infiltration, extravasation, local infection, hemorrhage, and nerve injury.
- Systemic threats include pulmonary edema, air embolism, catheter embolism, and catheter-related bloodstream infection (CR-BSI).
Pathophysiology
Peripheral IV complications occur when vessel integrity, catheter position, aseptic technique, or infusion volume/rate are not maintained within safe limits. Local tissue and vascular injury can begin with minor irritation and progress to significant inflammation, leakage, or tissue damage.
Systemic complications develop when therapy effects extend beyond the access site, such as circulatory overload from excessive fluid delivery or bloodstream contamination from invasive access. The source emphasizes that early identification and immediate action are central nursing safety responsibilities.
Classification
- Local vascular/tissue complications: phlebitis, infiltration, extravasation, hemorrhage, local infection, nerve injury.
- Systemic complications: pulmonary-edema, air-embolism, catheter embolism, catheter-related-bloodstream-infection.
Nursing Assessment
NCLEX Focus
Priority questions test first action when an abnormal infusion site finding or sudden respiratory deterioration appears.
- Inspect and palpate IV sites on schedule and before IV push medication administration.
- Monitor for pain, redness, swelling, coolness, leakage, altered flow quality, and alarm patterns.
- Assess for systemic deterioration: dyspnea, crackles, oxygen desaturation, tachycardia, hypotension, altered mental status, or jugular venous distension.
Nursing Interventions
- Stop infusion immediately when infiltration or extravasation is suspected and follow medication-specific policy.
- Remove and culture catheter/purulent material when infection is suspected.
- For possible air embolism, occlude air source, position left-side Trendelenburg if appropriate, apply oxygen, and notify provider immediately.
- For pulmonary edema, raise head of bed, apply oxygen, collect vital signs, and escalate urgently.
Escalation Trigger
Sudden respiratory compromise during infusion is an emergency and requires immediate intervention and provider notification.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| antibiotics | Agent selected after cultures | CR-BSI management typically requires IV antimicrobial therapy. |
| vesicants | High-tissue-injury infusates | Prefer central access when required; extravasation response must be immediate. |
Clinical Judgment Application
Clinical Scenario
During a peripheral infusion, a patient develops new site swelling and cool skin, then reports shortness of breath.
Recognize Cues: Local infiltration signs plus evolving respiratory concern. Analyze Cues: Both local and systemic complications are possible. Prioritize Hypotheses: Immediate safety threat is respiratory compromise. Generate Solutions: Stop infusion, assess airway/breathing/circulation, provide oxygen, and escalate. Take Action: Implement emergency response while preserving evidence for site-related diagnosis. Evaluate Outcomes: Respiratory status stabilizes and complication-specific treatment pathway begins.
Related Concepts
- peripheral-iv-access - Safe insertion and maintenance reduces adverse-event risk.
- infiltration-and-extravasation - Distinguishing nonvesicant versus vesicant injury guides treatment.
- air-embolism - Rapid recognition and positioning are time-critical interventions.
- pulmonary-edema - Fluid overload requires urgent respiratory and hemodynamic management.
- catheter-related-bloodstream-infection - Preventable adverse event linked to aseptic failures.
Self-Check
- Which findings distinguish infiltration from extravasation at the bedside?
- What are the immediate nursing actions for suspected air embolism?
- Why must IV site patency be verified before IV push medications?