By: Ryan MacArthur |

Quick read:

IVs are the most routine invasive hospital procedure, with an overall failure rate of ~50%. Types of IV failure include: phlebitis, dislodgement and infiltration. Phlebitis:  inflammation from IV placement. Dislodgement: any unintentional removal of the IV. Infiltration: leaking of fluid outside of the vein into the surrounding soft tissue.

Full story:

Intravenous (IV) therapy is the most common invasive hospital procedure in the world today. However, the overall failure rate for IVs sits at 50 percent, even at the best treatment facilities. With more than 300 million IV catheters sold each year and 80 percent of hospital patients requiring IV therapy, that’s a lot of people experiencing complications.

The three most prevalent types of IV failure are phlebitis, dislodgement and infiltration.

Phlebitis

What is it?

Phlebitis is inflammation in the vein where the IV was placed. Signs of phlebitis include pain, swelling, and reddening of the skin around the IV insertion point.

What causes it?

Phlebitis is usually caused by irritation in the vein, often from placing an IV. The inflammation can be caused by the formation of a blood clot, leading to pain and swelling.

How is it treated?

Treatment begins with the IV’s removal. Depending on the severity, phlebitis may require medication to heal a resulting infection.

What happens after?

After receiving treatment for any subsequent complications, if there are any, a caregiver will insert an IV catheter into a different location. To prevent future incidents of phlebitis, extra attention should be paid to dressing placement and care, catheter stabilization, cap and connector cleaning and use, and the monitoring of the IV catheter.

Dislodgement

What is it?

Dislodgement is simply the unintentional removal of an IV catheter, which can happen for a variety of reasons.

What causes it?

There can be multiple causes that lead to an IV being dislodged including excessive movement. The catheter may also inadvertently get caught on clothing, or something close by.

How is it treated?

The caregiver will either replace the catheter into the original insertion site or start a new IV all together. After re-attaching the catheter, the tube will be secured with tape or a clear adhesive.

What happens after?

The catheter may need to be re-secured to prevent it from moving. One strategy is to apply an extension tube to give the patient more slack, preventing the catheter from popping back out.

Infiltration

What is it?

Infiltration results from an IV infusing medication or fluids outside of the vein into the surrounding soft tissue.

Infiltrations are responsible for 23% of all IV failures, making them one of the most common types of IV failure patients experience. Every infiltration is also a medication dosing error, meaning patients do not receive the full amount of the medication they need.

One key indicator of infiltration includes inflammation at or close to the insertion site. The skin may feel cool to the touch around the IV site.  Patients may experience pain, discomfort, or complications like nerve damage and amputation.

What causes it?

The main causes of infiltration include:

  • Catheter dislodges or punctures the vein wall
  • Leakage through the insertion site
  • Catheter backs out
  • Leakage through opposing vein wall
  • Increased vein porosity

How is it treated?

Similar to treating phlebitis, the first course of action is to remove the catheter from the patient. The extremity should be raised with a warm (or cold) compress applied to the infiltration site to help absorb the fluid.

What happens after?

Once the catheter has been removed, most clinicians will assess the site to determine the extent of the swelling from the infiltration. An infiltration can cause a significant amount of damage to the surrounding tissue depending on the swelling, medication, or length of time the infiltration before detection.

Depending on the severity, it may be necessary to receive additional IV therapy, or undergo surgery to treat the afflicted area and regain full use of the extremity.

For more on the causes of IV infiltration, check out our Causes of Infiltration video here.

 

 

 

References:

Accepted, But Unacceptable: Peripheral IV Catheter Failure – http://www.wisconsinvascularaccessservice.com/webdocuments/accepted-but-unacceptable-peripheral-iv-catheter.pdf

Infection Resulting in Amputation Raises Questions About Asian Immigrants’ IV Use – http://www.nytimes.com/2013/12/27/nyregion/infection-resulting-in-amputation-raises-questions-about-asian-immigrants-iv-use.html

Why IV Lines Fail – A Crazy Little Thing Called Dislodgement – https://dowlingdennis.wordpress.com/2017/02/16/why-do-iv-lines-fail-a-crazy-little-thing-called-dislodgement/

Phlebitis – https://www.emedicinehealth.com/phlebitis/page2_em.htm

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