Intravenous (IV) therapy delivers fluids, medications, and nutrients directly into the bloodstream for rapid administration. However, the IV catheter can sometimes stop working correctly, an issue termed “IV failure.” This can involve a range of complications, from minor issues to more serious problems that require immediate attention.
Causes and Risk Factors for IV Failure
The reasons an IV may fail involve both patient-related and procedure-related factors. A person’s physical condition plays a role, as individuals with fragile, small, or rolling veins are more susceptible. Dehydration can make veins collapse and difficult to access, while certain medical conditions or medications can weaken vein walls.
The specifics of the IV insertion also contribute to the risk. A catheter that is too large for the vein can cause damage. The location is another consideration, as sites near flexible joints like the wrist or elbow are more likely to become dislodged.
Patient movement can cause the catheter to puncture the vein wall or become dislodged. The risk of complications can also increase the longer an IV remains in place. Finally, some fluids or medications are more irritating to the veins than others, influencing the likelihood of failure.
Recognizing Different Types of IV Failure
Different types of IV failure present with distinct symptoms. Paying attention to the area around the insertion site is the most direct way to spot a problem early.
One of the most frequent complications is infiltration, which happens when IV fluid leaks from the vein into surrounding tissue. The area may appear swollen, feel cool, and the skin might look pale or taut. A person might also notice pain or tightness at the site, and the IV pump may alarm due to a blockage.
Extravasation is a more serious version of this issue where the leaking fluid is a “vesicant,” a medication that can damage tissue. Symptoms can be more severe, including intense burning pain, significant swelling, and blistering. In some cases, tissue death can occur if the problem is not addressed quickly.
Another issue is phlebitis, which is the inflammation of the vein. Signs include redness, warmth, and tenderness along the vein’s path. The vein may also feel hard or cord-like, and the cause can be catheter irritation, the medication, or an infection.
A blocked IV catheter is called an occlusion, which prevents fluid from flowing correctly. An occlusion is likely if the IV pump continuously alarms or if blood backs up into the tubing. This can be caused by a kinked tube or a small clot at the catheter’s tip.
Dislodgement occurs when the catheter is partially or completely pulled out of the vein. This can happen if the IV is accidentally bumped or if the tubing gets caught on something and is pulled.
Immediate Actions and Medical Interventions
If you suspect your IV has failed, alert a nurse or another healthcare provider right away. Do not try to fix the problem yourself by adjusting the pump or moving the catheter. Promptly reporting any pain, swelling, or other changes allows for a swift assessment and response.
Once notified, a healthcare provider will stop the infusion to prevent more fluid from entering the tissue. They will then assess the site to determine the type and severity of the complication, which guides the next steps for treatment.
Following assessment, the provider will remove the failed catheter. For infiltration, elevating the limb and applying a warm or cold compress can help reduce swelling. In cases of phlebitis, a warm compress is often used to soothe the inflamed vein.
For more serious complications like extravasation, specific interventions may be necessary, such as administering an antidote to counteract the leaked medication. After the issue is managed, the provider will insert a new IV catheter in a different location, often on the opposite arm, to continue therapy.
Strategies for Preventing IV Complications
Preventing IV failure is a collaborative effort. As a patient, you can help protect your IV site by taking several steps:
- Be mindful of the catheter and avoid bumping it or catching the tubing on objects.
- Limit excessive movement of the limb with the IV to keep the catheter stable.
- Keep the IV tubing from becoming tangled or kinked.
- Pay attention to how the site feels and looks, informing your nurse of any discomfort, redness, or swelling.
The clinical team also employs several strategies to minimize risks:
- Carefully selecting the vein and using the smallest appropriate catheter size.
- Properly securing the IV catheter to prevent it from becoming dislodged.
- Performing regular checks of the IV site and the infusion rate.
- Following strict hygiene protocols, such as cleaning the skin before insertion, to prevent infections.