Updated: Mar 4, 2020
Published Feb 9, 2019
My patient last night had an IV in their forearm running ns @83 mL/hr. Pump ran w/o any alarms and patient stated no problems with pain or discomfort at the site. Around midnight I noticed that the patient's arm was abnormally swollen. Again, patient expressed no concerns with pain or discomfort and did not want to loose the IV because they did not want to have a new one started. I obviously took out the IV and started a new one in the other arm, but the original arm was swollen beyond belief.
My question is this; has anyone else experienced this? I was always taught that pain and/or discomfort were the first signs of infiltration. Please help!
iluvivt, BSN, RN
No, not necessarily and if the patient does have discomfort or pain it may not be the FIRST sign as you stated. If there is discomfort it may only be at the beginning of the infiltration or extravastion and as more fluid enters the tissue the discomfort subsides.I always look for swelling first then I always palate the site and feel for for coolness and feel of the tissue feels taut or tight.Also lift the arm up off of the bed because depending upon the cause of the infiltrate the swelling does not always present as this classic lump proximal to the site. It can be a very diffuse swelling. Then always compare to the opposite. side.A good way to remember this is TLC for touch, look and compare. Also there are no pump alarms for infiltrations. I can explain more if needed
vampiregirl, BSN, RN
A couple of thoughts...
I agree with iluvivt's explanation and recommendations.
Another consideration is blood clots. While this isn't a common senario, I have encountered this once. I cared for the patient after it was diagnosed and was being treated. Cancer patient with liver metastasis so increased risk for clots. No pain, significant edema arm distal to elbow. Radial/ ulnar pulses in the arm were present but weak. Temperature to touch comparative to other extremity was just a little cooler if I recall correctly (but not significantly so). A nurse had noticed this and something "just didn't seem right" from what I understand so a provider was consulted. Clot confirmed via ultrasound and anticoagulation started.
Where I'm going is that as we get more nursing experience our assessment skills grow. We start out with the basics (assessing for pain/discomfort) and grow with experience and continued learning. Good for you for asking questions! If your unit has an educator, maybe also reach out to them. An educator can follow up as to what happened with this patient so they can provide more specific/ accurate responses for this patient.
litbitblack, ASN, RN
There are no pump alarms for it but the machine alarms because of the pressure back up. If the fluid continues to pump into the tissues there is not a back up of pressure so the alarm doesn't go off. At least that is how the machines worked when I worked in the hospital.
On 2/9/2019 at 5:17 AM, iluvivt said: Also there are no pump alarms for infiltrations. I can explain more if needed
Also there are no pump alarms for infiltrations. I can explain more if needed
Thank you iluvit for your information! I am well aware that there are no alarms for infiltration, I was simply pointing out that it was odd to me that there were no alarms. I realize that the pump is only sensitive to back pressure. I only mentioned it to highlight the fact that it wasn't like I was going in every five minutes to silence the alarm (like some nurses do), and then act surprised later when something happens to the IV site.
Not quite the same because my patients don't talk, I'm in the NICU and sometimes that happens to our babies. A puffy arm is really obvious in the really little bubs, but the chubby term ones with a large amount of fluid (like.. 10 ml/hr) can puff up really quickly and we don't see it. These babies cry when we take their temperature!!! I'd think they'd be screaming with an extravasation.. but nope, they don't!
IVRUS, BSN, RN
Most of the time, pain isn't felt with IV fluids as long as the IVF is isotonic, or near isotonic. Pain is often associated with extravasations.. or when a Vesicant or an Irritant medication comes into the tissues. Also, depending on your patient's age, they have a reduced sensitivity with age.
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