EMS Medication Administration - Intravenous (IV) Catheter Complications

EMS Providers need to be aware of the potential complications associated with IV catheter placement, their presentations, and how to manage them.

Here’s an overview:

1. INFILTRATION

Definition: Leakage of IV fluid into the surrounding tissue.

Presentation:

• Swelling at the insertion site
• Coolness to the touch
• Pallor (pale skin)
• Discomfort or pain

Management:

• Discontinue the IV immediately.
• Elevate the affected limb.
• Apply a warm or cold compress based on patient comfort and solution infiltrated.

2. EXTRAVASATION

Definition: Leakage of vesicant (irritating) fluids into the surrounding tissue.

Presentation:

• Similar to infiltration, but with more severe symptoms
• Pain or burning at the site
• Blistering or tissue necrosis

Management:

• Stop the IV immediately.
• Elevate the limb and apply a cold compress.
• Notify medical control for further treatment recommendations, which may include specific antidotes.

3. OCCLUSION

Definition: Blockage of the IV catheter, preventing fluid flow.

Presentation:

• Difficulty or inability to infuse fluids
• Backflow of blood into the IV line

Management:

• Check for kinks or clamps on the tubing.
• Attempt to flush the catheter gently.
• If occlusion persists, discontinue and restart IV at a different site.

4. HEMATOMA

Definition: Collection of blood outside the vessel due to vein damage during insertion.

Presentation:

• Swelling and bruising at the insertion site
• Tenderness and discoloration

Management:

• Apply direct pressure to the site to stop bleeding.
• Apply a cold compress to reduce swelling.
• Avoid using the same site for subsequent IV attempts.

5. CATHETER SHEAR

Definition: A rare but serious complication where part of the catheter breaks off inside the vein.

Presentation:

• Sudden pain during insertion or movement of the catheter
• Potential for embolization of the catheter fragment

Management:

• Avoid using excessive force during insertion.
• If suspected, discontinue IV immediately and contact medical control for further instructions, which may include imaging to locate the fragment.

6. VASOVAGAL REACTIONS

Definition: Reflex reaction to pain or anxiety causing sudden drop in heart rate and blood pressure.

Presentation:

• Dizziness or lightheadedness
• Nausea
• Pale skin and sweating
• Fainting or near fainting

Management:

• Lay the patient flat and elevate the legs.
• Loosen any tight clothing.
• Provide reassurance and monitor vital signs.

7. PHLEBITIS

Definition: Inflammation of the vein.

Presentation:

• Redness and warmth along the vein
• Tenderness or pain at the site
• A palpable cord-like vein

Management:

• Discontinue the IV.
• Apply a warm compress.
• Use anti-inflammatory medications if appropriate.

8. INFECTION

Definition: Introduction of bacteria at the insertion site, potentially leading to local or systemic infection.

Presentation:

• Redness, warmth, and swelling at the site
• Purulent drainage
• Fever and chills (systemic infection)

Management:

• Discontinue the IV.
• Clean the site and cover with a sterile dressing.
• Notify medical control for possible antibiotic treatment.

PREVENTION TIPS

• Aseptic Technique: Always use aseptic technique during insertion.
• Proper Site Selection: Choose an appropriate site and avoid joints or areas with poor circulation.
• Securement: Secure the catheter well to prevent movement.
• Monitoring: Regularly check the IV site for signs of complications.

By recognizing and managing these complications promptly, EMS Providers can ensure patient safety and improve outcomes during IV therapy.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Hantke, J (2022) IV Placement and Management. Appropedia. Accessed May 22, 2024.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey:  Wiley Blackwell