d. Phlebitis. Phlebitis is an irritation or injury to the vein. It can be caused by
mechanical, chemical, or bacterial irritation. Signs and symptoms include redness,
pain, and swelling at the infusion site and patient complaints of fatigue together with
fever and a rapid pulse. If signs appear, change the needle to another site and apply
warm moist compresses to relieve discomfort and aid healing. Do not rub or massage
the affected area. You could cause thrombus or emboli and add to the vein damage. A
thrombus is a clot that is formed in the blood vessels. A thrombus is usually a further
complication of phlebitis. A clot formed in the vessels can produce damage to tissue
below the stoppage.
e. Air Embolism. An air embolism is a very serious intravenous therapy
complication. It can occur when a sizeable amount of air gets into the circulatory
system through the intravenous administration set. It can block a vessel so that tissues
are unable to get oxygen. Nutrients and waste products cannot be removed. The air
bubble can cut off cardiac, cerebral, or pulmonary circulation. Symptoms include a fall
in blood pressure, tachycardia (rapid pulse), and loss of consciousness. If a patient has
these symptoms, take his vital signs, place patient on his left lateral side, administer
oxygen, and get immediate medical help. Air embolism can be prevented by removing
all air (bleeding) from intravenous lines, using venipuncture sites below heart level, and
never allowing an intravenous line to run dry before disconnecting or adding another
bottle. The larger the embolus, the greater the danger. Death could result.
f. Solution's Incompatibility. The signs of incompatibility will differ according
to the solution or drug being administered. The effects can vary from neutralizing the
effects of a drug to causing circulatory collapse. Some solutions, such as over 10
percent dextrose or potassium chloride, are very irritating in concentrated doses. Sterile
water, saline, or special dilutants are required for certain drugs and substitutions should
not be made. Incompatible drugs frequently form a precipitate and cause fever,
nausea, vomiting, and intense itching.
3-12. CALCULATING THE INTRAVENOUS DRIP RATE
In order to infuse a solution ordered by the physician, it is necessary to calculate
the infusion rate. A drip rate calculation may be desired for maintenance of trauma
patients that you may not be able to immediately evacuate. During the care under fire
phase of tactical care the appropriate hypovolemic fluid protocols should be followed for
the benefit of your patient and triage of your available supplies.
a. The physician who ordered the infusion for the patient will give you the
The type or kind of fluid to be infused.
The amount of fluid to use.
The time period over which the total amount of fluid is to be infused.