Intravenous Fluid Therapy Administration Troubleshooting Intravenous Infusions Procedure Guidelines
1. To troubleshoot IV infusions, prepare by determining the patient s level of comfort and
expected response to IV therapy. 2. During your planned assessments, which should occur every 1 to 2 hours, evaluate the patient s vital signs, fluid status, and intake and output.
3. Systematically assess the IV infusion. To determine if the correct amount of IV solution
has infused, review the infusion pump record or check the time tape on the IV container. 4. If the infusion volume is behind the amount that should have been instilled by this time, check for possible causes. First, check the flow rate on the infusion pump or count the
drip rate. 5. If the rate is slower than ordered, look for kinks in the tubing, which can easily occur if the patient lies on the tubing or if it becomes caught in a side rail. Make sure the entire length of the tubing is patent and intact. 6. Assess the IV device. The tubing-and-catheter hub connection should be intact with no signs of leakage or bleeding. 7. Bleeding may be caused by the following: A. Tubing disconnection from the IV device B. Bleeding disorder C. Anticoagulant therapy
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Procedure Guidelines
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8. Inspect the dressing, which should be dry and intact. Also inspect the insertion site for color changes, swelling, or purulent drainage. 9. Palpate along the vessel and around the insertion site to detect venous cords, and note the skin temperature. 10. Be alert for signs of phlebitis and infiltration. If you detect any, use a phlebitis or infiltration scale to grade the severity of the problem. A. On the phlebitis scale, a zero represents no signs or symptoms. Symptom severity increases up to a score of 4, which reflects pain, redness, and swelling at the site; streaking; a palpable venous cord more than 1 inch long; and purulent drainage. B. On the infiltration scale, 0 represents no signs or symptoms. Symptom severity increases up to a score of 4, which reflects blanched, translucent skin; tight skin with leaking; discolored, bruised, swollen skin; more than 6 inches of swelling in any direction; deep pitting edema; circulatory impairment, moderate to severe pain; and infiltration of any amount of blood product, irritant, or vesicant. 11. Intervene appropriately. For phlebitis or infiltration, stop the infusion as shown in the Video Skill, Discontinuing Intravenous Therapy. Also, insert a new IV device in a
different location (if ordered), elevate the affected extremity, and wrap it in a warm towel for 20 minutes while it is elevated. 12. As part of your follow-up care, document any complications and your corrective actions.
Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.
