Peripheral and central IV assessment, CLABSI prevention, and complication recognition
Home infusion therapy is one of the most complex clinical responsibilities in home health nursing. Monitoring IV access sites for complications, maintaining central line safety, and recognizing infusion-related emergencies require current knowledge and consistent practice. This lesson reviews the assessment standards and complication recognition skills required for safe home infusion therapy.
At every visit assess the IV site before, during, and after infusion. Check for: redness, warmth, swelling, tenderness, leakage, and catheter patency. Assess the vein pathway above the insertion site for streaking (suggesting phlebitis) or cord-like induration.
Occurs when the catheter tip is displaced from the vein and fluid infuses into surrounding tissue. Signs: pale, cool, swollen tissue around the site; fluid may be felt under the skin; infusion may slow or stop. Action: stop the infusion immediately, remove the catheter, elevate the extremity, notify the clinician, document findings and response.
Inflammation of the vein. Signs: redness, warmth, swelling, and tenderness along the vein pathway. Graded 1+ (mild tenderness, no streak) to 4+ (palpable cord >1 inch, purulent discharge). Action: discontinue the peripheral IV, notify the clinician, apply warm compress, document the Phlebitis Scale grade.
Infiltration of a vesicant medication (e.g., certain chemotherapy agents, vasopressors, phenytoin) into surrounding tissue. Can cause tissue necrosis. Requires immediate cessation, specific antidote per drug protocol, and urgent clinical notification. Vesicant extravasation is a medical emergency.
Central lines (PICC, tunneled catheters, ports) require meticulous care to prevent life-threatening complications. The CLABSI (central line-associated bloodstream infection) bundle includes: hand hygiene, maximal sterile barrier during insertion, chlorhexidine skin antisepsis, optimal site selection, daily review of line necessity, and prompt removal when no longer needed.
Transparent semipermeable membrane (TSM) dressings are changed every 7 days or when wet, loose, or soiled. Gauze dressings under TSM are changed every 48 hours. Use sterile technique and chlorhexidine-based antiseptic. Assess the site under the dressing at every change: redness, swelling, drainage, tenderness.
Air embolism can be fatal. Prevention: position client supine (Trendelenburg preferred) during line access and dressing changes, clamp catheter during disconnection, have client perform Valsalva maneuver during cap changes when possible. Signs of air embolism: sudden chest pain, dyspnea, hypotension, mill-wheel murmur — call 911 immediately.
Systemic complications of IV therapy include: fluid overload (dyspnea, crackles, JVD, rising BP), septicemia (fever, chills, tachycardia, hypotension from a line source), hypersensitivity reaction (hives, flushing, hypotension, bronchospasm). Any of these require stopping the infusion, calling 911 if severe, and notifying the supervising clinician immediately.
Complete this 5-question quiz with 80% or higher to earn your CEU credit for this lesson.