Puncture or sever of a lymph vessel with placement

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Puncture or sever of a lymph vessel with placement Observe the patient at time of insertion and for 2-4 days after insertion; notify the doctor of any signs and/or symptoms Intravascular Tip Malposition : Catheter s internal tip moves out of the SVC position; tip may move into the jugular, double back on itself, or migrate into the right atrium Difficulty with aspirations or irrigations; a rushing sound in the ear when catheter is flushed if tip is in the jugular; jugular vein distention and/or pain; cardiac arrhythmias if tip is in right atrium Increased thoracic pressure, which may push the catheter out of the SVC (i.e. severe coughing, vomiting, or strenuous exercise) Moderate activities to decrease thoracic pressure; continual catheter assessment to determine possible tip migration; notify doctor; possible venogram to verify catheter tip location Sepsis : The presence of microorganisms and their toxins in the blood stream Hectic fevers, chills, elevated leukocyte count, nausea and vomiting Migration of organisms from the skin or catheter hub into the blood stream; poor aseptic technique with catheter placement, care, or maintenance Sterile technique for all insertions and site care; maintain a sterile occlusive dressing over insertion sites; proper skin disinfection with site care Vessel Erosion: The vessel wall tissue erodes away along catheter location in the vein Infiltration or extravasation of infusate at point of erosion; complaint of pain or swelling of the tissue with infusion Continuous contact of the catheter with a section of the vein wall that causes ulceration and erosion of the tissue; an opening in the vein wall results Continual monitoring and assessment of catheter track in the vein via observation, palpation, and attention to any patient complaint of pain with infusion *Always refer to manufacturer s product specific information and directions for use.
I.V. Therapy Education Program 2017 Infusion Knowledge, Inc. 59 C OMPLICATIONS S IGNS & S YMPTOMS C AUSE P REVENTION / N URSING A CTION Thrombosis : Accumulation of a clot in or around the catheter * Superior Vena Cava Syndrome Swelling and impaired circulatory return below the entry point of the catheter; pain along the vein Trauma to the vein intima, which promotes fibrin and platelet collection and continuing buildup; some types of catheter material (i.e. Teflon or polyvinylchloride) are more thrombogenic; extended dwell times on short term subclavians Utilization of biocompatible catheter materials (i.e. polyurethane and silastic); avoid trauma to the vein intima; report any signs and symptoms to the doctor; a venogram may be done to confirm a clot; catheter is usually discontinued in a controlled setting by a doctor due to the loosening of the clot into the blood stream Catheter Occlusion : Blockage of the internal lumen catheter with either a blood clot or drug precipitate Inability to flush or aspirate catheter Inadequate flushing of catheter to remove all drug residue or blood residue Pulsatile

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