IV infiltrate

[dreamrider212]

I work in an infusion clinic setting with long runnning infusions such as Rituxan & IVIG. We had an incident where a pt had fallen asleep during her infusion and was covered with a blanket and several pillows, obscuring her IV site. She awoke shortly before her infusion finished and an infiltrate was observed to her right mid AC. I'm wondering if anyone else has had this problem with sleeping pts or have suggestions how to avoid in the future other than waking them up every 30 mins when titrating. Also, if you are unable to visualize an IV site, do you chart that?

[Jolie, BSN]

I value patients being able to rest, but would manipulate pillows & blankets enough to be able to visualize an IV site, even if it meant disturbing the patient. I believe an hourly check is standard.

[oncivrn]

Do you use pumps? Personally I do not wake patients to assess piv sites and none of the nurses I work with do either. Ivig infiltrate is no big deal, since it can be given sq anyway. Chemo is another matter.

I have had a few infilatrates since working in infusion. Normally the pump beeps distal line occlusion or else the patient will complain of burning.

We have a policy not to give chemo in AC. If it is chemo I would be more worried than an antibiotic or remicade or even rituxan.

[brownbook]

I would assess the IV site every....(depends on how much staff you have, what your protocol is), but at least once an hour look at the IV site. Gently move the blankets and pillows so that you can see the IV site. Perhaps you could have her lie in a position where the IV site is more accessible, easier to look at, hopefully without waking her.

You and she must understand that yes...a good sleep is important for physical and mental health...but if she is sick enough to need an IV, needs the Rituxan & IVIG, then she unfortunately will need to be awoken several times during the infusion.

What do you think nurses who work 11 pm to 7 am do in an acute care hospital? Of course they have to assess their patient's IV site and unfortunately this may necessitate waking the patient.

[iluvivt, BSN, RN]

You NEVER want to chart that you cannot visualize the site because as the RN you are responsible for assessing that site and if a patient has a bad outcome you will be held responsible! I beg to differ that it is no big deal.Infiltrations need to be caught early so as to avoid compartment syndrome and other compression injuries that can cause permanent loss of function and chronic pain syndromes.You must let the patient know that they can sleep but the IV site stays uncovered or covered in such a manner that you can assess it frequently.You have no legal leg to stand on if your excuse is the patient was sleeping and covered and I could not assess it