Infusion therapy delivers fluids, medication, and nutrients directly into a patient's bloodstream, but it can be associated with various complications. These problems can be categorized into several types, including local complications at the insertion site, systemic reactions affecting the entire body, and mechanical issues related to the equipment.
Local and Site-Related Complications
Most problems with infusion therapy occur at or around the catheter's insertion site. Early recognition and management of these issues are essential to prevent further damage or discomfort.
Infiltration and Extravasation
Infiltration happens when the IV fluid leaks into the surrounding tissue instead of the vein. This most often occurs due to improper catheter placement or if the patient moves and dislodges the catheter. Symptoms include swelling, coolness, and discomfort at the site.
Extravasation is a more severe form of infiltration that involves the leakage of vesicant (tissue-damaging) drugs. This can cause serious tissue injury and, in severe cases, necrosis. Signs are similar to infiltration but may also include burning, blistering, and skin sloughing. Treatment involves stopping the infusion immediately, elevating the limb, and sometimes administering an antidote.
Phlebitis
Phlebitis is the inflammation of a vein, which can be caused by mechanical irritation from the catheter, chemical irritation from the infused medication, or infection. It is one of the most common complications of IV infusion. Symptoms include redness, warmth, swelling, and tenderness along the vein. To prevent mechanical phlebitis, healthcare providers use the smallest possible catheter for the therapy.
Hematoma and Bruising
A hematoma is a collection of blood that leaks from the blood vessel into nearby tissues, appearing as a bad bruise. It commonly forms after the needle passes through the vein wall during insertion or after catheter removal. While typically not serious, a hematoma can be unpleasant and requires pressure to manage. Bruising can also occur simply from the insertion process.
Infection
Breaking the skin's barrier creates a pathway for bacteria to enter the body. Local site infections can occur if aseptic technique is compromised during insertion or if dressings become contaminated. More seriously, bacteria can enter the bloodstream, leading to catheter-related bloodstream infections (CRBSIs), which are a significant risk, especially with central venous catheters. Proper hand hygiene and skin preparation are critical preventative measures.
Systemic and Pharmacological Complications
Infusion therapy can also cause systemic problems, which affect the entire body and are often related to the medication or fluid being infused.
Allergic Reactions
Patients may have allergic reactions to the infused medication, ranging from mild rashes and itching to a severe, life-threatening condition called anaphylaxis. Healthcare providers closely monitor for these reactions and have emergency protocols in place to address them promptly.
Fluid Overload and Electrolyte Imbalances
Infusing fluids too quickly, especially in patients with heart or kidney conditions, can lead to fluid overload (hypervolemia). Symptoms include swelling (edema), shortness of breath, headache, and increased blood pressure. Incorrect fluid administration can also cause imbalances in electrolytes like sodium and potassium, which can have serious cardiac consequences.
Air Embolism
Although rare, an air embolism can occur if air enters the venous system during infusion, potentially blocking blood flow. This is a particularly dangerous risk with central venous catheters. Symptoms can include shortness of breath, dizziness, and chest pain. Vigilant monitoring and proper line priming are essential to prevent this.
Mechanical and Equipment-Related Problems
Problems can also arise from the equipment used to deliver infusion therapy. These issues often relate to infusion pumps or the catheter itself.
Infusion Pump Malfunctions
Infusion pumps are designed to deliver precise medication volumes but can fail due to various issues. Problems include software glitches, battery failures, inaccurate programming, or broken components. Pump errors can lead to over-infusion or under-infusion, with potentially serious consequences.
Catheter Occlusion or Dislodgement
An occlusion occurs when the catheter becomes blocked, stopping the flow of medication. This can be caused by a blood clot or a kink in the tubing. A dislodged catheter moves out of place, causing infiltration or other problems. Regular monitoring of the site and the pump's pressure readings can help detect these issues.
Comparison of Common Catheter Problems
Different types of venous access carry varying risks of complications. The choice of catheter depends on the therapy and patient needs.
| Complication Type | Peripheral Intravenous Catheter (PIVC) | Central Venous Catheter (CVC) |
|---|---|---|
| Infiltration/Extravasation | More common due to shallow placement and potential for movement. | Less common as the catheter is in a deeper, larger vein. |
| Phlebitis | More common due to mechanical or chemical irritation of smaller veins. | Less common, but still a risk, especially from irritation or infection. |
| Infection Risk | Lower risk of serious bloodstream infections (CRBSIs) but still a risk of local infection. | Higher risk of CRBSIs due to deeper placement and prolonged dwell time. |
| Air Embolism | Very rare risk. | Higher risk, especially during insertion, removal, or line manipulation. |
| Insertion | Less invasive, easier insertion, frequent replacement may be needed. | More invasive, requires a trained professional and carries greater insertion risks. |
Conclusion
While infusion therapy is a critical and widely used medical treatment, it comes with a range of potential problems that can be localized, systemic, or mechanical in nature. Common issues like infiltration, phlebitis, and bruising require prompt attention but are often easily managed. More serious risks, such as severe allergic reactions, fluid overload, and air embolism, necessitate careful patient monitoring and immediate intervention. To mitigate these risks, healthcare professionals must adhere to strict aseptic techniques, select appropriate equipment, and ensure continuous patient education and assessment. Empowering patients to report any discomfort or unusual symptoms can lead to early detection and management of complications, ensuring that the benefits of infusion therapy are delivered as safely as possible.
For more information on preventing and managing complications, consult authoritative clinical guidelines such as those published by the National Institutes of Health.
