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Anesthesia

Intravenous Catheter Complications

About 25 million Americans have intravenous catheters placed each year. Intravenous catheters (or IVs) are a very important part of medical treatment for acute illnesses, cancer, surgery, anesthesia, and trauma, allowing medications to reach as quickly and effectively as possible, via the bloodstream, the parts of the body where they work.

IV catheters can be placed in a hand, arm or leg. These are known as "peripheral" IVs. IVs placed in the central circulation, like the internal jugular vein (neck) or subclavian vein (just beneath the collar bone), are known as "central lines". The rest of this article will deal with peripheral IVs, the most common type of IV.

During the placement of an IV, a needle is inserted through the skin and into an accessible blood vessel. A Teflon (plastic) cannula is then slid over the needle, which is withdrawn. No needle remains in your body. (So-called "butterfly" needles are an exception to this). Some healthcare providers use a little bit of local anesthetic beforehand, with a very tiny needle, to numb the area of skin where the IV is inserted. Local anesthetic cream is sometimes applied 45-60 minutes beforehand to achieve the same effect. This is particularly helpful in the care of children.

Complications

Serious complications related to peripheral IVs are uncommon, but problems do occur, especially with prolonged use. That is why there are guidelines in different hospitals about the recommended duration that a peripheral IV should be in place.

As with any side effect or complication of health care procedures, early detection, and good communication between the patient and healthcare provider are important. Listed below are complications of IV catheters and their treatments.

Phlebitis

Phlebitis is a term that means inflammation of a blood vessel. Phlebitis occurs quite commonly after the insertion of intravenous catheters. The exact frequency of phlebitis is anywhere from 2.5 to 45% or more. The frequency depends on how phlebitis is defined, the site of IV insertion, the duration that the IV has been in place, the type of material that the IV is made of, the length of the IV catheter, and on the existence of other disorders as diabetes.

In phlebitis the inflammation causes localised redness and warmth at the IV insertion site and perhaps a short distance along the course of the vein in which the IV has been placed. Most times, phlebitis is no more than a minor inconvenience.

Thrombophlebitis

Thrombophlebitis is similar to phlebitis but a thrombus (or clot) is in addition involved. As the IV cannula stays inside your body, it may irritate the vein leading the body to trigger its clotting mechanisms.

You may notice a hardened area corresponding to where a clot has formed in the vein. This kind of small clot does not have the same potentially life-threatening consequences as blood clots in the deeper and larger veins in the body. Thrombophlebitis is not usually associated with infection.

Treatment - Treatment of phlebitis and thrombophlebitis is aimed at relief of the symptoms including: anti-inflammatory medicine, such as ibuprofen, acetaminophen for pain, or local heat. If the condition worsens, especially if pain or the area of redness increases, medical attention should definitely be sought.

Septic Thrombophlebitis

In more serious cases the vein can become infected. This is a rare condition, known as septic phlebitis or septic thrombophlebitis, which can spread infection throughout the body via the bloodstream.

One sign of infection is the presence of enlarged lymph nodes under the arm on the affected side. This can occur with simple phlebitis but should cause you to seek medical attention, especially if you have a fever and feel generally unwell.

Treatment - If you suspect an infected vein, see your healthcare provider immediately. Hospitalization may be needed and antibiotics will be used to control the bacterial infection.

Local Infection

In any case where there is an open wound on the body, disrupting the protective lining of skin, an infection can occur. A microscopic organism may use the tiny hole in the skin created by the IV catheter to find its way into the body, and cause an infection. Common signs of local infection ("abscess") include a large lump that is painful and hot to touch.

Treatment - If you suspect an infection, see your healthcare provider immediately. Antibiotics may be used to control the bacterial infection. 

Infiltration

This occurs when the catheter unintentionally enters the tissue surrounding the blood vessel. In this case the IV fluid and associated medications will go into the tissues and there will be a lump where the IV has been inserted. It would be cool to touch (this differentiates it from inflammation due to infection, which is warm to the touch).

Treatment - If you notice this inform your healthcare professional and they will administer appropriate care immediately. Infiltrated IVs are not a big problem usually unless the medication being administered is very irritant, such as certain chemotherapy and circulatory medicines. The intravenous infusion must be stopped, obviously, to avoid putting any more fluid or medication into the tissues. Another IV may need to be started elsewhere.

Hematoma

A hematoma is a collection of blood caused by internal bleeding. This happens when the catheter punctures through the vein and causes a hematoma. Hematomas generally occur with unsuccessful IV insertion but can also happen when an IV is taken out. This is why pressure must be applied to the insertion site, to try to make the hematoma as small as possible.

A hematoma may appear as a visible bruise or a lump.

Treatment - A hematoma normally recovers over time (a few hours or days) without treatment.

Nerve Damage

It is also possible for the IV needle to penetrate and injure a nerve, and for bruising and bleeding to irritate a nerve. Nerves are invisible from the skin surface so it?s easy to understand how this could happen. If you feel a sudden sharp pain radiating along your arm as the IV is inserted, let your healthcare provider know immediately as this may be a sign that the needle has come into contact with a nerve.

A 1996 study of 419,000 blood donations showed that 1 in every 6300 donors had a nerve injury. Fortunately, most got better within a month. The symptoms included excessive or radiating pain, and loss of arm or hand strength. Fifty-two of 56 donors achieved a full recovery, and 4 other donors had only a mild, localized, residual numbness.

Treatment - Nerve damage tends to repair itself in a few weeks to a few months. If you suspect a nerve injury contact your doctor. In rare instances (such as persistent weakness) specific treatment, even surgery, may become necessary.

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Last Reviewed: Oct 05, 2010

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University