I V infiltration: Not just a peripheral problem

Nursing, Sep 1999 by Hadaway, Lynn C

Securing central lines

Peripherally inserted central catheters and midline catheters may be taped or sutured in place. Central venous catheters inserted via the jugular or subclavian veins should always be sutured. Inadequate taping or suturing, improper dressing removal techniques, and patient activity may dislodge the catheter, increasing the possibility of inflammation, thrombosis, and infiltration. Support, secure, and protect port access needles to prevent leakage into the port pocket.

Treating Mr.Tucker

Now let's consider Mr. Tucker, who was introduced at the beginning of this article. To determine the pathway of the fluid infusing through Mr. Tucker's central venous catheter, the physician orders a cathetergram, which reveals that the fluid is leaking out of the insertion site. The physician removes the catheter. In other circumstances, the physician might try to salvage the catheter by infusing a thrombolytic agent over several hours to dissolve the fibrin sheath on the catheter's outer surface. But this option is contraindicated for Mr. Tucker because of the risk of bleeding from surgical sites.

If Mr. Tucker needs only a few more days of fluids and antibiotics, a short peripheral catheter may be sufficient to complete his therapy. However, he'll need another central venous catheter if he'll receive therapy for more than a few days, the medications and solutions have irritating properties, or the availability of peripheral venous sites is limited.

Be prepared

No treatment can take the place of good assessment skills and problem prevention. But in instances when infiltration occurs despite your best efforts, you're prepared to act correctly and rapidly to minimize tissue damage.

SELECTED WEB SITES

Intravenous Nurses Society: http://www.ins .org

League of I.V. Therapy Educators:

http://www.lite.org

Lynn Hadaway Associates:

http://www.hadawayassociates.com

National Association of Vascular Access Networks:

http://www.navannet.org

Last accessed on August 2. 1999.

Meet Lynn C. Hadaway at the Nursing2000 conference in Orlando, Fla., March 29 to April 1, 2000.

SELECTED REFERENCES

Boyle, D., and Engelking, C.: "Vesicant Extravasation: Myths and Realities," Oncology Nursing Forum. 22(1):57-67, January 1995.

Camp-Sorrell, D.: "Developing Extravasation Protocols and Monitoring Outcomes," Journal of Intravenous Nursing. 21(4):232-239, July/August 1998.

Cohan, R., et al.: "Extravasation of Radiographic Contrast Material: Recognition, Prevention, and Treatment." Radiology. 200(3):593-604, September 1996.

Mayo, D.: "Administering Urokinase for Catheter Clearance," Nursing98. 28(12):50-52, December 1998.

Yucha, C., et al.: "Differences among Intravenous Extravasations Using Four Common Solutions," Journal of Intravenous Nursing. 16(5):277-28 1, September 1993.

Yucha, C., et al.: "Effect of Elevation on Intravenous Extravasations:' Journal of Intravenous Nursing. 17(5):231-234, September 1994.

BY LYNN C. HADAWAY, RN,C, CRNI, MEd Hadaway & Associates * Milner, Ga.