Vascular Access Complications PDF

## Complications of Vascular Access ### Causes of Phlebitis * Vessel trauma from insertion or pistoning * Vessel weakening due to infusate characteristics (vesicant, irritant, extreme pH, hyperosmolar) * Inadequate device securement * Traumatic insertion * Multiple venipuncture attempts * Use of pr...

## Complications of Vascular Access ### Causes of Phlebitis * Vessel trauma from insertion or pistoning * Vessel weakening due to infusate characteristics (vesicant, irritant, extreme pH, hyperosmolar) * Inadequate device securement * Traumatic insertion * Multiple venipuncture attempts * Use of pressure injection for contrast * Dislodged non-coring access needle in implanted port * Less than 50% of PIV in vessel ### Prevention of Phlebitis * Use ultrasound (US) guidance for all CVAD insertions and US or other vein visualization technologies for difficult peripheral IV insertions * Ensure patency prior to any infusion * Proactive maintenance * Early detection and correction of dysfunction * Use of ultrasound to ensure the PIV catheter is long enough that greater than 50% of the catheter lies within the vessel * Ensure proper tip location * Routine flushing protocols * Adequate stabilization and proper dressing management * Choose type of VAD appropriate for infusate qualities. Consider pH and osmolarity of ordered Infusate * Frequent site assessment and careful administration of vesicants * Avoid administration of vesicants, such as Dilantin, Phenergan, and vesicant chemotherapy agents into VADs placed on the dorsal surface of the hand or areas of flexion ### Symptoms of Phlebitis * Fluid leakage from insertion site * Swelling * Pain * Tenderness * Induration * Erythema * Coolness ### Treatment of Phlebitis * Stop Infusion immediately * Do not flush * Aspirate fluid from the vascular access device. * Removal of the device should only occur after instillation of drug specific antidote if required * Elevate affected extremity * Do not apply pressure * Monitor site and area distal to the site carefully * In the case of extravasation, notify the licensed independent practitioner immediately * The use of cold or warm compresses and administration of antidotes will vary depending on drug specific information, institutional policy, and provider orders. Consider use of: * Hyaluronidase * Phentolamine * Nitroglycerin (topical) ### Causes of Phlebitis * Chemical administration of infusates or solutions that are acidic, alkaline, or hyperosmolar * Mechanical: insertion of large gauge cannula into a small vessel, vessel trauma during insertion, excessive movement or manipulation of cannula, Inadequate securement * Infectious: inadequate skin asepsis, break in aseptic technique, migration of organisms from exogenous source into catheter insertion site ## M. Phlebitis ### Definition Inflammation of the vein, most commonly in superficial vessel ### Causes * Chemical administration of infusates or solutions that are acidic, alkaline, or hyperosmolar * Mechanical: insertion of large gauge cannula into a small vessel, vessel trauma during insertion, excessive movement or manipulation of cannula, Inadequate securement * Infectious: inadequate skin asepsis, break in aseptic technique, migration of organisms from exogenous source into catheter insertion site ### Treatment of Phlebitis * Stop Infusion at the first sign of phlebitis * For chemical phlebitis consider altering the medication, the dilution, or rate of infusion. If symptoms persist, remove catheter. * For mechanical phlebitis focus on catheter stabilization, use heat and elevate extremity and monitor for alleviation of symptoms. If symptoms persist, remove catheter * For suspected bacterial phlebitis remove catheter Immediately * Discontinue failed PIV catheter and restart at a new site * Consider alternative VAD ### Non-Acute Care Considerations * Reinforce to patients and caregivers to immediately report any leaking, swelling, discomfort or other signs or symptoms of complications to their medical team ## Prevention of Venous Thrombosis * In short, long peripheral and midline catheters, administer non-irritant and non-vesicant infusates * Use proper skin prep and venipuncture techniques * Use caution and monitor closely when infusing a single dose of a vesicant or irritant medication" * Use of engineered stabilization device, tissue adhesive, and proper dressing management * Insert appropriate size catheter based on patient's vessel size and prescribed therapy * Routinely assess insertion site and surrounding tissue for complications (per institutional policy) ### Symptoms of Venous Thrombosis * Edema * Pain * Tenderness * Induration * Erythema * Presence of red "streak" along vessel * Palpable cord * Warmth ### Treatment of Venous Thrombosis * Stop Infusion at the first sign of phlebitis * For chemical phlebitis consider altering the medication, the dilution, or rate of infusion. If symptoms persist, remove catheter. * For mechanical phlebitis focus on catheter stabilization, use heat and elevate extremity and monitor for alleviation of symptoms. If symptoms persist, remove catheter * For suspected bacterial phlebitis remove catheter Immediately * Discontinue failed PIV catheter and restart at a new site * Consider alternative VAD ### Non-Acute Care Considerations * Reinforce to patients and caregivers to immediately report any leaking, swelling, discomfort or other signs or symptoms of complications to their medical team ## N. Venous Thrombosis ### Definition The formation of fibrin along the vessel wall causing a clot to form within the vessel; fibrin production is stimulated by vessel injury or presence of a catheter ### Causes of Venous Thrombosis * Excessive vessel trauma during vascular access insertion * Too small catheter to vessel ratio * Hyper-coagulopathy (may be due to neoplasm, infectious process, pregnancy, renal disorders, medication, recent surgery, critical care patients, etc.) * Immobility * Excessive movement/exercise (effort thrombosis, or Paget-Schroetter Syndrome refers to axillary subclavian vein thrombosis associated with strenuous and repetitive activity of the upper extremities) * Catheter tip malposition * Physiological predisposition for clotting (Factor V Leiden thrombophilia) ### Non-Acute Care Considerations * Patients and caregivers require development of and documentation of plan for ongoing assessment and evaluation of VAD complications, including Information regarding monitoring for worsening signs/symptoms, and who to contact and when emergency medical attention should be sought