Hi, I'm Cathy with Level Up RN. In this video, I'll be talking about peripheral and central venous catheters, as well as IV complications. And at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering in this video, so definitely stay tuned for that. And as always, I will be following along with our Level Up RN medical-surgical nursing flashcards. If you have our flashcards, definitely pull them out so you can follow along with me, and pay close attention to the bold, red text on these cards because those represent the most important facts and the things you are likely to see show up on a nursing school exam.
Let's first talk about the difference between peripheral venous catheters and central venous catheters. So a peripheral venous catheter is a catheter that is inserted in a small peripheral vein in the arm or in the hand. So a short peripheral catheter, which is the most common type of IV that you will see, is 3 inches or less in length. A midline peripheral catheter is between 3 inches and 8 inches in length, and the tip of the midline catheter terminates either at or below the level of the axilla, and distal from the shoulder. With a central venous catheter or CVC, the tip of the catheter terminates in the superior vena cava right above the right atrium. A CVC is needed when the patient requires long-term IV antibiotic therapy as well as TPN, so total parenteral nutrition, and chemotherapy, just to name a few examples. So unlike the small, delicate veins in the arms, the vein where the CVC catheter terminates is nice and fat, so it can withstand harsher medications such as vancomycin or chemotherapy. Examples of CVCs include tunneled and non-tunneled central venous catheters, as well as PICC lines and implantable ports.
Let's now talk about some IV complications that are definitely important to know. Let's talk about phlebitis first. So anytime you see that -itis at the end of a word, it means inflammation, and inflammation of whatever's at the first part of the word. So in this case, phleb- is Greek for veins. So inflammation of the veins. So what can cause phlebitis? It may be due to mechanical irritation. So that catheter could be rubbing against the vein, causing that irritation and inflammation. It could also be due to the pH or osmolality of the medication that's being infused. In terms of the signs and symptoms of phlebitis, those will include erythema, which is a fancy word for redness, as well as warmth, pain. You also may find that the vein there is indurated, which is also a fancy term for being hard. So you'll have a hardened vein, and you may see a red streak as well. So those are all symptoms of phlebitis. If your patient is exhibiting these symptoms, you're going to want to discontinue the IV, elevate the extremity, and apply warm, moist compresses.
All right. Next complication is infiltration. This is where IV fluids or medications leak into the surrounding tissue, so they are outside the vein. Symptoms of infiltration include swelling, coolness, dampness, a slowed rate of IV infusion, and fluid may be leaking from the IV site itself. So when I was hospitalized during my pregnancy, which was a lot, and I was receiving IV fluids, my nurse during one shift was very busy, and my IV infiltrated such that my arm was twice as big as my other arm. It was huge, and it was cool to the touch, and it kind of felt damp. And I didn't know at the time that that's what that meant, that my IV had infiltrated, or else I would have discontinued my own IV myself, but I sat there and waited until finally someone came and took that IV out. So in terms of nursing care, you want to discontinue the IV, elevate the extremity, and apply warm or cold compresses depending on what was infusing. So we would use warm compresses for normal or high pH solutions, and we would use cold compresses for low pH solutions.
Next, we have extravasation. So with extravasation, this means infiltration, like we just talked about, but with a vesicant agent, meaning a medication that can really cause tissue damage. So signs and symptoms of extravasation can include erythema, pain, edema, the formation of blisters, you may also see necrotic tissues such as slough, and ulceration may also be present. In terms of nursing care for extravasation, you're going to want to stop the infusion. You're going to want to aspirate any residual medication in the IV line, and then you're going to administer an antidote per facility policy. Then after the administration of that antidote, you can discontinue the IV, elevate the extremity, and apply a warm or cold compress, depending on the solution.
Next, we have a catheter embolus. This is where a IV catheter fragment breaks off into the patient's venous system. So any time we discontinue an IV, we always want to look at the catheter tip to make sure it is fully intact. If we look at the tip, and we see that a piece of it is missing, that is obviously a sign that there may be a catheter embolus present in the patient's venous system. Other symptoms of a catheter embolus include pain along the vein. It may be severe pain. Also, a weak, thready pulse, and hypotension are other symptoms of a catheter embolus. If you suspect that this may be the case for your patient, you're going to want to place a tourniquet high on that extremity and prepare that patient for surgery to remove the catheter fragment. Next, we have an air embolus. This is where air enters the venous system from the IV catheter. And symptoms can include hypotension, tachycardia, tachypnea, and cyanosis. If your patient has an air embolism, you're going to want to clamp the catheter. Place the patient in a Trendelenburg position. So this is where their head is lower than their feet. You're going to want to administer oxygen and notify the provider.
All right. Next, we have a thrombosis, which is a blood clot. So we do all the flushing of peripheral IVs and central venous catheters to help prevent the formation of a thrombosis or blood clot, but sometimes they occur. So when a patient gets a PICC line inserted, for example, when they come back to the floor, there are often standing orders in place for a thrombolytic agent, such as alteplase, that the nurse can use in the event that a blood clot occurs. So when your patient has a PICC line, and you go in the room to try to do a blood draw or to give medications, and you try to aspirate, you're not getting a blood return, then that is definitely a sign that you may have a thrombosis. So you'll need to pull that alteplase or whatever thrombolytic medication is ordered, let it instill in the area for about 30 minutes, and then come back and check the patency of that line.
The last complication I'm going to go over is fluid overload. This is where too much volume is introduced into the circulatory system, such that your patient will exhibit signs such as shortness of breath, crackles, hypertension, jugular vein distention, edema, and tachycardia. If your patient has fluid overload, you're going to want to raise the head of the bed so it's easier for them to breathe. You're going to want to slow the infusion rate, so we're not overwhelming the circulatory system. And then we're going to monitor the patient's oxygen and vital signs, and we may also need to administer diuretics as ordered by the provider.
All right. It's quiz time. I've got three questions for you.
First question. Where does the tip of a central venous catheter terminate?
The answer is in the superior vena cava just above the right atrium.
Question number two. What IV complication can cause crackles and shortness of breath and requires the infusion rate to be decreased?
The answer is fluid overload.
Question number three. What IV complication requires aspiration of any remaining drug and the administration of an antidote?
The answer is extravasation.
All right. That is it for this video. I hope you have found it helpful. If so, be sure to hit that like button. Take care, and good luck with studying.
1 comment
Excellent