Thrombus, Catheter Embolus, Speed Shock, Fluid Overload, Air Embolus

what is a thrombus?

a blood clot at or near the IV site, sometimes following phlebitis

what must you never do over a suspected thrombus?

do not rub or massage the area

• the clot could break off and dislodge into the circulatory system

why do we never massage or rub a suspected thrombus?

the clot could break off and dislodge into the circulatory system

what should you do if you feel resistance while flushing an IV?

stop and do not force the flush to avoid dislodging a clot

supportive actions for a thrombus at an iv site

• stop infusion

• warm compresses as ordered

• restart proximal or in another extremity

what is a catheter embolus?

a broken piece of catheter travels in the bloodstream

cues that suggest a catheter embolus

• sudden sharp pain at site

• rough or shortened catheter tip on removal

• chest pain, cyanosis

• tachycardia and hypotension

how to prevent catheter emboluses?

• pulling out the catheter straight out (DO NOT BEND)

• do not reinsert the stylet/move it around too much to prevent puncturing the plastic catheter

key to stopping catheter emoblus

prevention

priority actions if a catheter tip is missing after removal

• apply a tourniquet high on the extremity

• prepare for x-ray and possible surgical retrieval

• save the catheter for analysis

what is speed shock?

systemic reaction when a substance or fluid is infused too rapidly

when can speed shock happen?

when someone is receiving an IV bolus

IV bolus

a larger-than-usual dose of fluid or medication given quickly through an IV to get a fast effect

IV push

giving a medication directly into the IV line with a syringe over a short time (usually seconds to a few minutes) to get a fast effect

if we insert a medication ordered to be given over 5 mins in 1 minute, what can happen?

speed shock

cues of speed shock

• pounding headache, fainting

• rapid pulse, apprehension

• chills, back pain, dyspnea

how do you prevent speed shock?

• use correct tubing and an infusion pump

• monitor and re-check the rate frequently for accurate

• dilute iv push meds in an IV bag instead of iv push syringe when appropriate

what causes fluid overload during iv therapy?

too large a volume and/or too rapid infusion into the circulation

cues of fluid overload

distended neck veins

increased blood pressure

tachycardia

shortness of breath and crackles

edema

how to prevent fluid overload

• monitor the rate of fluid flow

• check rate frequently for accuracy

• use an electronic pump instead of gravity

to prevent fluid overload, what kind of pump should we use?

electronic

immediate nursing actions for fluid overload

• slow or stop the infusion

• put in fowler’s position

• check vitals and pulse oximetry

• notify the provider, follow prescriptions (rate change, diuretics)

• document assessment, actions, and response

for patients with fluid overload, what do we have to eventually monitor?

inputs and outputs

what serious complication can fluid overload lead to in the lungs?

pulmonary edema

pulmonary edema

condition where fluid accumulates in the lungs, making it difficult for the patient to breathe

what is an air embolus in IV therapy?

an air bolus enters the circulation from a break in the iv system above heart level

prevention of air embolus during iv therapy

• prime all tubing before connection

• eliminate air bubbles from tubing and syringes used for flushing or meds

what does priming tubing before connecting to the patient do?

makes sure the IV tubing is clear of air before inserting

who is an air embolus most critical to?

a patient with a central line catheter

immediate response to suspected air embolus

secure/occlude the system

position patient left side with trendelenburg

call for immediate help

monitor vitals and pulse ox