Troubleshooting IV Complications

Decreased or No Infusion Rate
■ Assess IV site for infiltration.
■ If IV insertion site is close to a joint, straighten extremity.
■ Use a padded arm board to help maintain alignment.
■ Inspect entire length of tubing for kinks or holes.
■ Inspect stopcocks and other flow-control devices.
■ Ensure that burette (pediatrics) contains correct amount of fluid.
■ If not using an infusion pump, raise the height of the IV bag.
■ Attempt to flush with 3 mL of NS, but if a significant amount of resistance is encountered, notify the IV therapy team or RN. If IV therapy is unavailable, discontinue IV and restart a new one, preferably on the opposite arm.

Pain at the IV Site
■ Assess IV site for infiltration, phlebitis, and irritation from tape.
■ Ensure adequate stabilization of IV catheter.
■ If IV insertion site is close to a joint, straighten extremity.
■ Use a padded arm board to help maintain alignment.
■ Consult the pharmacy or Davis’s Drug Guide to ascertain if a medication being infused can cause pain or irritation.
■ Notify the IV therapy team or RN if unsuccessful at relieving pain or discomfort.

Blood Backing Up into the IV Tubing
■ Two common causes are allowing the IV bag to run dry (corrected by changing to a new bag) or hanging the IV bag at a level that is lower than either the IV insertion site or the Pt’s heart (corrected by increasing the level of the bag).
■ Note: If bag is allowed to run dry, the tubing may fill with air. After changing to a new bag, the air in the tubing can be removed by inserting a large syringe into the port distal to the air and aspirating, as the tubing is re-primed.
■ Occasionally, an artery is cannulated. If this is suspected, palpate for a pulse under the insertion site and inspect for pulsation of blood in the tubing (D/C IV and hold direct pressure for at least 5 minutes).

Leaking Fluid at the IV Site
■ Assess IV site for infiltration.
■ Inspect the connection between the tubing and IV catheter.
■ If all connections are patent, err on the side of safety and assume that the site is infiltrating, even if the IV is infusing freely. Call for an IV therapy consult.