IV Question

Let me answer your questions first and then I can explain why....YES.... you should have at least stopped the infusion and better yet discontinued it. next because you are describing and infiltration you should have elevated the patient's arm to their comfort level and applied a warm compress. Warmth in this case would be acceptable since you were infusing an isotonic IV fluids (warmth is OK for isotonic or near isotonic IV fluids,use cool for hypertonic or hypotonic).

Next IV pumps do NOT have an infiltration detector..remember it this way......YOU are the infiltration detector. The pump will alarm for the usual things such as air in the line,upstream or downstream occlusions,completion of secondaries or preset alarms such as VTBI infused complete.

The look of an infiltration or extravasation on a peripheral IV may vary depending upon a variety of reasons such as location of the cannula,length of the cannula, location on the vein where the cannula has exited the vein, size of the patient's arm,just to name a few. I once knew an IV nurse that threaded her catheters without ever pulling her needle back until she had the entire catheter in the vein. They always infiltrated about 12 hours later medial and lateral to the cannula. It was a very strange infiltration pattern until I saw how she started her IVs. What she did was scrape the vein on both sides while inserting..this so irritated the vein on both sides and that is exactly how her IV infiltrations looked.

Just because it was soft at the insertion site DOES not mean you did not have an infiltrate. Fluid being pumped into the tissue will have to go somewhere and it does always appear as a classic lump above the site. It will often appear as generalized edema of the arm and taut translucent skin. An old IV trick is to apply a tourniquet above the site..IF the IV stops..it is in the vein...if it keeps dripping..it is not. This only works as a gravity and of course, with some IVF you can safely run at a decent rate for a bit. I prefer to instruct nurses to ALWAYS compare to the other arm and compare them.

One other important thing that nurses get a bit confused about blood return and if they are getting a blood return from a PIV they think t is not infiltrating. This is NOT correct..you can still get a blood return and your IV can still be infiltrating. That is b/c your cannula can be partially out of the vein so you are still getting a blood return while the other part of the cannula is infusing into the tissue.

There is absolutely no point in keeping a IV in place that is NO good and especially one that is infiltrated as you described very well. If you are truly in doubt at the absolute minimum stop the IV fluids and lock if you need another to assess it for sure. It does not matter how ill or unstable someone is..if the IV is BAD it's bad. If the patient needs another right away someone needs to restart it. I hope this has helped some.

You may not often have pain with an infiltration whereas a phlebitis hurts like h###.

There is absolutely no point in keeping a IV in place that is NO good and especially one that is infiltrated as you described very well. If you are truly in doubt at the absolute minimum stop the IV fluids and lock if you need another to assess it for sure. It does not matter how ill or unstable someone is..if the IV is BAD it's bad. If the patient needs another right away someone needs to restart it. I hope this has helped some.

Re: The patient might need emergent drugs.

If the patient needs emergency drugs, where do they need to go? They need to go IV. Epi, atropine, whatever, aren't going to work subcutaneous. Which is where they'll go if the IV isn't good. If they need IV access, they need actual IV access into a vein. They don't need a catheter that's sending most to all of what's going into it into the tissue AROUND the vein.

Very educational thread. Thanks for sharing all the knowledge and experience.