Infiltration question for ya. Answer needed.

Nurses General Nursing

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Ok, here is the story and why I am posting this question out there for you guys.....

My sister in law is currently preg. with her third child. On Sunday she went into premature labor at week 28. What a nightmare for my sister in law. Anyways, I noticed while she was in the room that she had no ID band on and she was getting meds left and right. I know that she was the only laboring person there at week 28, but still that isn't quite legal, or so I thought. Well, the thing that made me uneasy once the crisis was over was her IV site. It had all the signs of infiltration. I told my SIL that it wasn't a good thing to have infiltration and that it should be switched to the opposite arm. I alerted the nurse to look at it (given that I am only a student:o). The nurse looked at it and admitted that it was cool to the touch and looked a little swollen, but she wasn't positive. She went and got a second opinion. She came back and said no, it wasn't. The other nurse didn't come and look at it. So, the nurse told her that they could switch arms, but it would be up to my SIL. My SIL said "no" and it was left at that.

So, nearly a week later, she has a bruise over the IV site that I saw. I asked her about it and she said it still bugged her a little. Today, she calls me and tells me that the bruise was spreading and it felt like she had a knot underneath the site. I asked her about the pain and she said that it was kind of tingly and uncomfortable distal to the site. She asked me what to do and I said I had no clue. I mean, I know what to do once you see it with the line infusing, but after the fact. Would ice be good? Anyways, I told her to keep an eye on it and if it got worse to go to the ER and have them look at it. I told her I would try to look it up...so that is why I am here. I couldn't find anything in my books. She called the hospital and they told her to come in. My question I suppose is, could this possibly lead to an infection? And if so could this be related to an IV site that looked infiltrated to my unexperienced eyes? I guess I am worried because she has a Hx of premature delivery and I am worried about her health and the health of this baby.

Thanks to all those who respond to this post. Your input is greatly appreciated.:)

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Definately get it checked out. Infiltration or no, it could quite possibly be phlebitis and could lead to further complications she doesn't need, especially in light of her pregnancy and history. I'd recommend going to her family physician over the hospital though, she'll have to wait longer if she goes to ER.

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Agree. She needs it checked out. The sooner the better.

If it were me on duty, I'd come in and try to aspirate blood, or flush the IV cath to make sure it was patent. Especially if I was putting any meds through the line. Follow your instincts. Student or not, don't let your inexperience or insecurity stop you from asking questions (How can you tell it's not infiltrated from the nursing stations, would have been a good question to ask), or getting insistent when you think something is wrong.

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Thanks for the replies. An update: she called the hospital and they told her to come to the ER (9:00 pm). They told her it was a hematoma and the bruising would continue to spread throughout the week. Is this a normal occurence?

Youda, that totally makes sense to flush the cath. I wonder why the nurse didn't. I will keep that in mind the next time I have questions about an IV stick that I think may be infiltrated.

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it is not unusual to have hematomas develope. it may or may not have been infiltrated. but it would have been a good idea if the nurse would have tried to aspirate and flush iv to check patency. sometimes what appears to be infiltration is just a little irritation or such. a lot depends on the infusion rate and how caustic the drugs she is getting is to the vein.

well good luck hope all goes well for her.

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Specializes in Maternal - Child Health.

I'm glad she got it checked. Hematomas can occur even if an IV is in proper position and not infiltrated. I am one of the unfortunate patients who gets a nasty hematoma with almost every IV, no matter how skillfully placed and well maintained. Also be aware for signs and symptoms of phlebitis or cellulitis.

What really concerns me though, is that she was being treated for pre-term labor with a questionable IV. At 28 weeks, it is imperative that a mom in pre-term labor gets the IV fluids and meds necessary to stop contractions. Running these fluids and drugs through a questionable IV is just plain poor practice. Drugs used to treat pre-term labor are of no use to the patient or her baby if they are delivered to her subcutaneous tissue rather than her bloodstream. Not to mention that many of them are quite irritating to the tissues, and could have contributed to the problem she now has.

I can't judge the patency of the IV she had, but I do advise her in the future to ask the staff to restart any questionable IV, possible changing the old site to a hep-lock if she is a hard stick. Sometimes, resting a site for a while will enable the nurse to better evaluate it's patency.

Good luck to her and her baby. Let's hope for a healthy, full-term delivery!

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Thanks for your reply Jolie, She was given Terbutaline by injection. I can't remember if it was SQ or IM. She actually got no meds through her line. It was LR going in at 125/hr and that was for the emergency C-section she almost had. What a nightmare. She also got steroids IM and SQ morphine. At first when she showed up in OB, she was complaining of pains in her lower abdomen. They were concerned about placentae abruptio (or abruptio placentae...can never get it straight) and were freakin' out. They prepped her for an emergency C-section. They were waiting for ultrasound to show up. Finally, the doctor decided they couldn't wait until ultrasound got there and decided to pull baby right then and there. As they were getting everything set up in OR, here comes ultrasound. Turns out no detachment of the placenta at all, just contractions causing her pain. If that ultrasound had been 5-10 minutes later, we would have had a preterm baby for no reason. Uugggg! I get so mad when I think about it.:(

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Sometimes you just have to make a judgment call. You'd have been more upset if the Doc had waited and the baby died from lack of oxygen or your sister bled to death. Prepping for a C-section was the prudent thing to do. In that situation, you only have a couple of minutes to save lives, not 5-10 of them.

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Great link to an article about IV sites; you can earn CEU's too:

http://medicalproducts.au.com/research/articles/iv_infiltration.htm

Once at the site, go to Professional Development & CEU's and click on the link. Then type in "IV Infiltration" in the SEARCH window.

Choose the article called "IV INFILTRATION: NOT JUST A PERIPHERAL PROBLEM" for a really informative article about IV infiltration, and potential CEU's.

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You are right, I understand that the condition is life-threatening. However, I was mad at the ultrasound people. They had been called 45 min beforehand, and that is when the doctor decided he couldn't wait any longer since my SIL's contractions were getting stronger and the baby's heart rate jumped down to 90 at one time. (should have mentioned that in the previous post...sorry). I totally understand the doctor and his reasoning, he was also my OB. I just get so fed up with that particular hospital at times (not a bad hospital, but sometimes they can be a little too laid back). Well, that is about it, I guess.

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Specializes in Maternal - Child Health.

Dear Kimmicoobug.

Your SIL's experience is downright frightening to me! I understand that many hospitals do not have the luxury of 24 hour access to ancillary services such as U/S. I agree that the OB was prudent in preparing for a C/S while awaiting confirmation of a suspected abruption. But had he actually performed a PRE-TERM C/S without confirming an abruption first, I would have been apalled! Any marginally competent OB or midwife ought to be able to perform a cursory U/S in order to confirm or rule out complications such as placenta previa, abruption, cord rupture, and determine fetal presentation. And any OB unit ought to have 24 hour access to an U/S machine, if not a technician, for such cases.

Your SIL may want to discuss her care with her OB to insure that such a near-tragedy never occurs again. Also, since she is now high-risk, she may want to consider using a different hospital with high-risk OB services which would have access to ancillary staff on a 24 hour basis.

As for her meds, terbutaline is given sub-q, and steriods are an IM injection, so it seems that she did not receive any IV meds, just fluids, which are vitally important in the management of pre-term labor.

Sorry to get so indignant, but 11 years in the NICU has made me a ferocious advocate for preemies, especially the ones who come to the NICU because of poor medical judgement and management.

Good luck to your family. Let us know when the baby arrives.

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