Complications and Interventions
Local complications
Phlebitis presents as erythema, warmth, tenderness, or a palpable cord; stop the infusion and remove the catheter. Infiltration is fluid entering tissue (cool, pale, blanched, taut); extravasation is a vesicant or irritant doing the same - burning, pain, blistering. For extravasation: stop the infusion immediately, do not flush, aspirate residual drug through the catheter per policy, remove the catheter (unless policy directs otherwise for a specific antidote), apply the agent-specific antidote and compress, elevate the limb, mark and photograph the area, and document and report.
Occlusion and thrombosis
Occlusion may be mechanical (kink, clamp, pinch-off), positional, or thrombotic. Never force a flush against resistance - you risk catheter rupture and embolism. Reposition, have the patient cough or raise the arm, and use declotting agents only per policy and prescriber order.
Systemic complications
Air embolism: sudden dyspnea, chest pain, hypotension, decreased oxygen saturation. Place the patient in Trendelenburg with the left lateral decubitus position, give oxygen, clamp the line, and call for help. Catheter-related bloodstream infection: fever, chills, hypotension, erythema or drainage at the site - obtain cultures per policy before antibiotics. Speed shock from too-rapid infusion causes flushing, headache, chest tightness, hypotension, and arrhythmia. Circulatory overload causes dyspnea, crackles, jugular venous distention, and weight gain.
Trap: questions that reward "stop the infusion and assess the site" for every problem. Air embolism and anaphylaxis need positioning and airway support, not site inspection.
Worked example: During a vesicant push the patient reports burning and the site is blanched. Correct first action: stop the injection immediately; do not flush.