Chapter 27 ■ Peripheral Intravenous Line Placement 145

C

A B

D

E F

Fig. 27.4. Method for securing peripheral IV cannula with adhesive tape. A, B: Place an adhesive transparent tape over the cannula. C: Place tape 1 behind cannula as shown, with adhesive side up. D, E: Fold

tape 1 anteriorly across the catheter–hub junction. F: Hold in place with tapes 2 and 3. The area of skin entry

can be dressed with semipermeable sterile transparent dressing. Avoid obscuring with opaque dressing.

146 Section V ■ Vascular Access

When peripheral lines are used for parenteral nutrition,

the coinfusion of a lipid solution with the hyperosmolar

total parenteral nutrition solution prolongs the life of

the vein (21,22).

3. Infiltration of subcutaneous tissue with IV solution.

(For management of this complication, see Chapter

28.) Unfortunately, this is a common complication of

peripheral IV infusion. Extreme vigilance and avoidance of hyperosmolar IV solutions will help to reduce

the incidence to the minimum possible.

a. Superficial blistering (Fig. 27.5)

b. Deep slough, which may require skin graft (Fig. 27.6)

c. Calcification of subcutaneous tissue due to infiltration of calcium-containing solution

Note that there may be some extravasation into

adjacent tissues even though blood can be aspirated

from the needle/cannula.

4. Infection (23–25)

 There is an increase in the incidence of both phlebitis and infection when a needle remains in place longer

than 72 hours (8) and is heavily manipulated (25). An

increase has also been reported with film-type dressings, but this remains controversial (1–5,19). Catheters

made with Teflon or polyurethane appear to be associated with fewer infections in adults than catheters made

with polyvinyl chloride or polyethylene (19).

Polyurethane catheters appear to have an approximately 30% lower risk of phlebitis than Teflon catheters

in adults (19). Batton et al. (18) failed to confirm a difference in the incidence of infection when 25-gauge

needles were compared with 24-gauge Teflon cannulas.

However, the Teflon cannulas remained functional

three times as long as steel needles, with no apparent

increase in complications.

5. Embolization of clot with forcible flushing

6. Hypernatremia, fluid overload, or heparinization of the

infant due to improper flushing technique or solution;

also electrolyte derangements from IV fluid infused at

an incorrect rate

7. Accidental injection or infusion into artery, with arteriospasm and possible tissue necrosis (Fig. 27.7)

8. Burn from

a. Transilluminator (Fig. 27.8; also see Chapter 13)

b. Compress used to warm limb prior to procedure

c. Prolonged povidone–iodine or isopropyl alcohol

application to very premature skin

9. Air embolus

10. Ischemia or gangrene of lower extremity, complicating infusion into saphenous vein; mechanism unclear

(25)