Been worked for 7months but sill making IV mistakes..

dawniepoo · Sep 17, 2016

Did you flush it before restarting the infusion? I don't understand why you feel you can't face the parents. Maybe the IV needs to be changed to a different area.

GE90 · Sep 17, 2016

I did and it was flushing well. Then gradually started getting slightly puffy and the reason I felt so guilty was because of the 2 reasons I listed above....and apparently as soon as it gets puffy I should have removed that cannula...

roser13, ASN, RN · Sep 17, 2016

I guess I'm surprised that your mind didn't immediately go to infiltration when the puffiness started. After all, 2 year olds are hardly the best reporters of symptoms (you mentioned "no complaints from patient").

Oh well, I'm sure you will be all over IV's after this.

brownbook · Sep 17, 2016

When the area around an IV site is puffy there is a 99.9% probability it is infiltrated. A patient may not complain because just mild "puffiness" does not cause pain. Even an alert oriented adult patient may not complain of any pain when an IV is infiltrated.

Inflammation means reddened, swollen, hot, painful. So the area would not get red, hot, or even painful unless an infiltrated IV was left in for several days and the area eventually became infected. Of course the area is swollen, that is what infiltrated means. And if it became extremely swollen it would start to cause pain.

Infiltrated IV fluid is gradually absorbed into the subcutaneous tissue. The site looked less puffy as you slowed down the IV because the body was absorbing the fluid.

Google subcutaneous IV fluid. There is times when IV fluid is intentionally infused subcutaneously in people, and it is often used in animals. You were giving a subcutaneous IV infusion

Puffiness is a concern no matter what type of fluid you are infusing.

Sometimes it is hard to tell if an IV is infiltrated. Comparing the extremity, the area with the IV, to the other non IV extremity, is a helpful way to tell if you are not sure.

When in doubt, take it out. Or ask for a second pair of eyes to look at a questionable IV site.

GE90 · Sep 17, 2016

Thx for the reply guys. I did think about infiltration right after noticing the puffness. I told the doctor what I saw and she said just turn the rate down, it was dead wrong for me to assume just because the fluid went in and puffness gradually it must have meant the cannula was still intact...anyway, lesson learned! :)

Btw here in Australia peds nurses don't normally start IV, let alone on a 2yr old....would be awesome if we were allowed to do this

brownbook · Sep 17, 2016

PS, I don't mean to sound like a know it all. I struggled with IV's for years. That is why I know all the problems they cause. You did fine, learned a lesson, came here to ask for advice, the patient wasn't harmed. We have all had to face patients/ families after errors. It is hard.

KatieMI, BSN, MSN, RN · Sep 18, 2016

OP, next time just think:

- you are pushing the fluid in where? Of course, in the patient as a whole.

- if you are pushing it in the whole patient, then why only one hand must get puffy instead of whole body? It kinda not sounds logical, isn't it? So... it MUST be something not quite right.

- if what is near your eyes doesn't sound logical, think again. Like if you see a label "a lion" on an enclosure in a zoo with a giraffe in it. It can be something innocent, a honest mistake, but still not what it is supposed to be.

Hands, as almost any part of human body, have a lot of space under skin. You were just giving the fluid SQ, which is pretty much the same thing as IV, only slower. It is still done in veterenary here in the US and in human medicine everywhere outside of the Big Seven. If you saw videos of Haiti or Sudan with many people with IV lines, please know that most of them are getting fluids SQ, not IV, just for easiness and speed of the process. You did not do any harm to patient. Next time, either check blood return or, if you deal with a tiny or deep vein, check "runoff" (finger over where end of catheter should be, inject 5 cc of normal saline with some force; if IV is working properly, you'll feel fluid "rushing" under your fingers and patient quiet; if no "runoff" is felt, you instead feel tissue filling with fluid and patient says "ouch", it is infiltrated).

iluvivt, BSN, RN · Sep 18, 2016

Yes subcutaneous infusions of fluids is known as hypodermoclysis Some medications can also be given this way such as Morphine Sulfate.In your case the IV fluids were ordered to be given intravenousely so yes the others are correct that you should have assessed this as an infiltration.The site will be puffy as you stated or swollen.cool to touch and may be pale.You should always compare to the opposite side.A blood return is NOT an absolute verification that you are in the vein because the cannula can be partially in and out.Infiltrations can cause complications especially large ones or ones that impinge on nerves or other structures so it is best to assess frequently and take action.

cleback · Sep 18, 2016

I have never heard of puffiness being normal or to turn down the rate when it happens. Whoever taught you that dud you a disservice. Always think infiltration instead.

If it makes you feel any better though not too long ago I was giving potassium IV and the IV infiltrated. I didn't catch it right away though because 1) potassium infusions can sting with a good IV and 2) the patient had tissue skin and while there was no swelling in the immediate area surrounding the IV, there was under neath her arm (gravity I suppose). Another nurse caught the swelling. I felt like an idiot but now I check the whole extremity for the dreaded puffiness. Lesson learned!

pluckyduck, MSN, NP · Sep 18, 2016

Puffiness is always a first sign of infiltration and with kids they can't tell you so you have to be super vigilant about checking IV sites with them. Next time, try drawing back with a syringe to check for blood return as confirmation the cannula is in the vein. An infiltrated IV can still flush in to the surrounding tissue so that's not always a good indicator. If infiltrated next time, remove the IV and apply a hot pack to help with swelling.

NICUNurseEliz · Sep 18, 2016

Puffiness is always a first sign of infiltration and with kids they can't tell you so you have to be super vigilant about checking IV sites with them. Next time, try drawing back with a syringe to check for blood return as confirmation the cannula is in the vein. An infiltrated IV can still flush in to the surrounding tissue so that's not always a good indicator. If infiltrated next time, remove the IV and apply a hot pack to help with swelling.

Before applying heat to an infiltrated site, be aware of what type of fluid was running when the IV infiltrated. Hypertonic, hyperosmotic, and vesicant solution infiltrations may worsen when heat is applied to the site.

Also, to the OP, when you have a bad infiltrate, let the provider know before pulling the PIV as they may order a solution such as hyaluronidase to aid in reabsorption.