Fearful of infiltrating IV's

jmgrn65, RN · Dec 2, 2005

You will worry less, but really as far as IV's you never stop worrying because sometimes the iv just isn't right but flushes good, all you can do is watch it closely. But make sure you know what is running and don't take chances with meds like dopamine which can cause alot of tissue damage.

veegeern, BSN, RN · Dec 2, 2005

I've been an RN for almost 2 years now, and for me the fear lessened with time. It didn't help that 2 nurses on my unit were called in for a depositon r/t an infiltration right after I was hired. After checking my site and connecting my fluid/IVPB, I make sure that it is infusing without difficulty. Also, I use two fingers to occlude the vein above the infusion. If the drip stops and then restarts when I release, then I have more confidence in the integrity of the site.

Bill_ER, BSN, RN · Dec 2, 2005

It's good to be vigilant and never totally stop worrying. Sometimes the catheter will suck against the venous tissue or be against a valve, restricting blood return upon aspiration, but still be a patent line.

My practice (especially when I'm unable to aspirate blood), is to palpate the tissue just beyond the IV catheter with two fingers as I flush. You can actually feel the saline flush thru the vein under your fingertips. Of course, one of the most tell tale signs is usually just watching the tissue around the site as you flush. Most times you can see the tissue expand with less than a 1/2 cc in most cases, and if you're not convinced even though it still looks good, then flush 5 cc's more if needed. Thirdly (and important to me), is watching the patient's reaction as I begin to flush, 95% of the time, the patient begins to grimmace and feel pain with a 1/2 cc or less if it's infiltrating.

Regardless if I'm confident in the line or not, I always return to check the site after starting fluids. I think that's just good practice, and will help your confidence in the long run. *** The worst thing is when you acually have a good line and send your patient to CT, and they blow the line with pressurized IV contrast. I hate that! :angryfire

Altra, BSN, RN · Dec 2, 2005

*** The worst thing is when you acually have a good line and send your patient to CT, and they blow the line with pressurized IV contrast. I hate that! :angryfire

You got that right ... :smackingf

To the OP, yes I think you'll get more confident in time. Just continue to assess as you have been - IMO, signs of infiltration are fairly easy to spot.

veegeern, BSN, RN · Dec 2, 2005

It's good to be vigilant and never totally stop worrying. Sometimes the catheter will suck against the venous tissue or be against a valve, restricting blood return upon aspiration, but still be a patent line.
My practice (especially when I'm unable to aspirate blood), is to palpate the tissue just beyond the IV catheter with two fingers as I flush. You can actually feel the saline flush thru the vein under your fingertips. Of course, one of the most tell tale signs is usually just watching the tissue around the site as you flush. Most times you can see the tissue expand with less than a 1/2 cc in most cases, and if you're not convinced even though it still looks good, then flush 5 cc's more if needed. Thirdly (and important to me), is watching the patient's reaction as I begin to flush, 95% of the time, the patient begins to grimmace and feel pain with a 1/2 cc or less if it's infiltrating.
Regardless if I'm confident in the line or not, I always return to check the site after starting fluids. I think that's just good practice, and will help your confidence in the long run. *** The worst thing is when you acually have a good line and send your patient to CT, and they blow the line with pressurized IV contrast. I hate that! :angryfire

I agree with all of the above...especially CT

Daytonite, BSN, RN · Dec 2, 2005

In the old days before we had drop counters and pumps on ALL our IVs it was a lot easier to assess for a developing infiltration. The easiest way to assess for infiltration is to clamp the tubing and very simply remove the IV tubing from the pump or drop counter. Open up the roller clamp and watch the drip chamber to see what happens. A patent IV will drip nicely. If it doesn't, you can adjust the patients position to assess if the IV is positional. While you have the tubing out of the pump you simply place two of your fingers about two to three inches above where the tip of the cannula is and press down. If the IV is patent, the IV will stop dripping immediately. Lighten up on your fingers and you will see see the dripping start again. This is how we always checked the patency of a newly inserted IV before letting the IV fluids rip. Re-thread your tubing into the pump or drop counter and let the IV continue. This is not a full proof test, however, since the tip of the IV cannula could be partly sitting out of the vein and part of the IV fluids are going into the vein while the rest of them are going into the tissue.

Another way to assess for inifiltration is to compare both arms, hands or wrists according to whatever site the IV is in. It is often much easier to see a subtle infiltration occuring by doing this. If your IV is in the hand, have the patient put both hands side by side and look at them. If the IV hand looks a little more rounded, if you can't see other veins in the IV hand and you see them peeking out all over the non-IV hand--be suspicious and try doing the assessment in the paragraph above!

A third way to assess for infiltration is to gently place your finger or thumb near the IV site. As you apply downward pressure and then remove your finger or thumb there will sometimes be pitting of the patient's tissue. Remember also, that swelling is a symptom of inflammation, as in phlebitis. So, if you can elicit skin pitting (or pain) anywhere near the IV site, you either have an infiltration or a phlebitis. Either way, you need to remove the IV and re-start it. (NOTE: symptoms of phlebitis are redness, swelling, warmth and pain. One, any, or all of these may be present in phlebitis. Don't let the fact that one of the four cardinal signs of inflammation is absent distract you into thinking that there is no phlebitis going on. You just happened to catch it in it's very early stages.)

Hope you find these tips from an old IV therapist helpful.

veegeern, BSN, RN · Dec 2, 2005

In the old days before we had drop counters and pumps on ALL our IVs it was a lot easier to assess for a developing infiltration. The easiest way to assess for infiltration is to clamp the tubing and very simply remove the IV tubing from the pump or drop counter. Open up the roller clamp and watch the drip chamber to see what happens. A patent IV will drip nicely. If it doesn't, you can adjust the patients position to assess if the IV is positional. While you have the tubing out of the pump you simply place two of your fingers about two to three inches above where the tip of the cannula is and press down. If the IV is patent, the IV will stop dripping immediately. Lighten up on your fingers and you will see see the dripping start again. This is how we always checked the patency of a newly inserted IV before letting the IV fluids rip. Re-thread your tubing into the pump or drop counter and let the IV continue. This is not a full proof test, however, since the tip of the IV cannula could be partly sitting out of the vein and part of the IV fluids are going into the vein while the rest of them are going into the tissue.
You explained this so much better than I did..

Daytonite, BSN, RN · Dec 2, 2005

You explained this so much better than I did..

Yes, but look at all the words I used! :chuckle Not really concise.

christvs, DNP, RN, NP · Dec 2, 2005

In the old days before we had drop counters and pumps on ALL our IVs it was a lot easier to assess for a developing infiltration. The easiest way to assess for infiltration is to clamp the tubing and very simply remove the IV tubing from the pump or drop counter. Open up the roller clamp and watch the drip chamber to see what happens. A patent IV will drip nicely. If it doesn't, you can adjust the patients position to assess if the IV is positional. While you have the tubing out of the pump you simply place two of your fingers about two to three inches above where the tip of the cannula is and press down. If the IV is patent, the IV will stop dripping immediately. Lighten up on your fingers and you will see see the dripping start again. This is how we always checked the patency of a newly inserted IV before letting the IV fluids rip. Re-thread your tubing into the pump or drop counter and let the IV continue. This is not a full proof test, however, since the tip of the IV cannula could be partly sitting out of the vein and part of the IV fluids are going into the vein while the rest of them are going into the tissue.
Another way to assess for inifiltration is to compare both arms, hands or wrists according to whatever site the IV is in. It is often much easier to see a subtle infiltration occuring by doing this. If your IV is in the hand, have the patient put both hands side by side and look at them. If the IV hand looks a little more rounded, if you can't see other veins in the IV hand and you see them peeking out all over the non-IV hand--be suspicious and try doing the assessment in the paragraph above!
A third way to assess for infiltration is to gently place your finger or thumb near the IV site. As you apply downward pressure and then remove your finger or thumb there will sometimes be pitting of the patient's tissue. Remember also, that swelling is a symptom of inflammation, as in phlebitis. So, if you can elicit skin pitting (or pain) anywhere near the IV site, you either have an infiltration or a phlebitis. Either way, you need to remove the IV and re-start it. (NOTE: symptoms of phlebitis are redness, swelling, warmth and pain. One, any, or all of these may be present in phlebitis. Don't let the fact that one of the four cardinal signs of inflammation is absent distract you into thinking that there is no phlebitis going on. You just happened to catch it in it's very early stages.)
Hope you find these tips from an old IV therapist helpful.

As usual daytonite, you gave really great advice and tips. I'll have to remember those when I go to work. :)

cjblu · Dec 2, 2005

Thank you all for such helpful advice! I can't wait to go into work tomorrow and try these new tricks. :) This site is really supportive and is helping my confidence...Thank you thank you!

AtlantaRN, RN · Dec 15, 2005

sometimes the only way you get blood return is to turn off the fluids and place a tournaquet...if it flushes well, without resistance you can be confident that you have a good vein...

linda