Authorised by:
Charge Nurse - Newborn

May 2006

Complications of Fluid Therapy	Slipped, disconnected, leaking or blocked catheters	Prevention of Haemorrhage	Prevention and detection of Air embolus
	Thrombosis with Embolism	Misplaced CVL

Complications of Fluid Therapy

Sepsis – Intravenous nutrition is an excellent medium for the growth of micro-organisms and small premature infants are at high risk of infection. Foreign material passing through skin may act as a portal of entry for pathogens.
Catheter related problems:
- extravasation
- haemorrhage
Air embolus
Thrombosis with embolisation
IVN complications – infants may develop metabolic imbalances and must be monitored closely.
Hyperlipidaemia
- Intralipid can displace bilirubin from the albumen binding site increasing the risk of kernicterus.
- May result from lipid overdose, occurs more often in the small preterm infants and SGA infants. Complications include platelet dysfunction, eosinophilia, liver abnormalities, pulmonary disposition of lipid in blood vessels.

Slipped out/Disconnected/Leaking/Blocked Intravascular Catheter

Steps	Action
1	Clamp line.
2	Stop infusion and notify CCN/medical staff/NS-ANP

Steps	Action
1	Always use luerlock connections
2	Use snap connection provided to clamp line.
3	Check infusion site appropriately.
4	Check line placement frequently ensuring appropriate RBP used to secure line.

This is a life threatening complication where air has entered the circulatory system and can occur:
- On insertion of the catheter
- At tubing change
- During drug administration
The Nurse observes for the following signs:
- Sudden cyanosis.
- Circulatory collapse.
- Withdrawal of blood from a UAC yielding alternating sections of air and blood.

Step	Action
1	Stop the infusion.
2	Position baby head down, left side down.
3	Notify medical staff/NS-ANP.
4	Resuscitate baby as necessary.
5	ASPIRATE AS MUCH AIR AS POSSIBLE.
6	Record and document vital signs.

This can be life threatening. If a blood clot forms in the circulatory system (thrombosis) a piece may become dislodged (embolism). This may occur in the:

Superior vena cava.

Right atrium.

Inferior vena cava.

Step	Action
1	The Nurse will observe for the following clinical signs and report to medical staff immediately. Constant occlusion alarms. Swelling of the head and neck. Plethora and venous distension of the head and chest. Irritability and crying during flushing of the catheter. Failure to obtain a blood return through catheter. Increased anterior fontanelle pressure. Increased respiratory distress. Swelling of lower limbs.
2	Ensure that infusion fluids are heparinised.
3	Ensure fluids are infused at appropriate rates at all times.

A misplaced central venous catheter may cause.
- Hydrothorax.
- Pericardial effusion and cardiac tamponade.
- Haemothorax (rare).

Assess baby's condition and monitor closely

Look for:

If you cannot see an index above, please press the "Refresh" button of your browser.