IV Infiltrates, Iodine Pushed

[AnthonyM83]

For any techs and nurses out there, I was wondering how bad it is for a patient to receive iodine into an infiltrated IV.

Had a crappy event last night during clinicals. Not my fault, but linked to me.

IV start was ordered. I poked, but couldn't draw blood. Asked the RN to for help guiding it in. He couldn't, but said it was fine to leave it, and we would draw blood from a different site. I told him she was getting a CT, though, and was getting contract. He said it was fine. The contrast would still go in. I asked "Even though we can't get blood out?" He said yes, as he started on a different site on hand for blood.

It still seemed off to me, so asked again, "So, you're SURE the contrast will go in fine, EVEN THOUGH we can't get blood out? Shouldn't we be able to draw blood if it's patent?" Again, he said it would work for fluids in, not fluids out. (It was in left AC).

At this point, he's taken over, I'm just handing him needles and wipes. He does blood draw on hand. After, he sees a big bubble at site of first IV and says similar to "Oh, look. Yeah, gotta do another one" and gets to work on right forearm (not quite AC...was told it needed to be actual AC for CT scan?). He's still doing it, and I walk out and go about my other stuff.

Awhile later, a nurse asks me if I started the IV in that room. She says they took her to CT, the pushed contrast, and now has huuuge infiltration. Then apparently, nurse put the a cold pack instead of warm pack when he discovered it, which made it worse(?)

Anyway, bottom line, I'm worried on this coming back to me. Even if it's not found my fault (nurse didn't want me to remove the IV when I was in room, he noticed it infiltrated, then took over and I left, then patency of line wasn't checked before injecting contrast, and apparent wrong tx for it when discovered), the story is still going to be "yeah, medic student started a bad line and it got infiltrated with iodine" to staff and next oncoming shifts. Heard people talking about it, too...yet no one officially approached me (maybe b/c night shift and no supervisors on the floor?)

So, just venting. And also wondering how much chance for necrosis there is. Will body just absorb it?

[ncmedic309]

Just a question - did the initial IV appear patent and was it flowing fluids? I know you remarked about not being able to pull blood from the line which is sometimes an indicator that the line is not patent. You can occassionally still have a good line and not be able to pull blood but you should still be able to flow fluids without any problem. If it's an AC stick, I like to put at least 50 mLs of fluid through the line before I attempt to push any medication. It can take that much at times in some ACs depending on the size of the patient before it's obvious that the line has infiltrated or is no longer patent. If your ever unsure about something you've done in the future, in this case with the IV - pull it! It's your best option. Even today - if there is ever the slightest doubt about patency of an IV - it comes out and I look for another site. It should be fairly obvious in most cases but if it has your name attached to it, you want to ensure that it's good and working appropriately.

I'm not sure about the Iodine infiltration. I'll leave that one for somebody that knows more about it...

[AnthonyM83]

Just a question - did the initial IV appear patent and was it flowing fluids? I know you remarked about not being able to pull blood from the line which is sometimes an indicator that the line is not patent. You can occassionally still have a good line and not be able to pull blood but you should still be able to flow fluids without any problem. If it's an AC stick, I like to put at least 50 mLs of fluid through the line before I attempt to push any medication. It can take that much at times in some ACs depending on the size of the patient before it's obvious that the line has infiltrated or is no longer patent. If your ever unsure about something you've done in the future, in this case with the IV - pull it! It's your best option. Even today - if there is ever the slightest doubt about patency of an IV - it comes out and I look for another site. It should be fairly obvious in most cases but if it has your name attached to it, you want to ensure that it's good and working appropriately.

I'm not sure about the Iodine infiltration. I'll leave that one for somebody that knows more about it...

On the original, I had a good flash. I was able to aspirate blood when setting up the flash. When, I actually taped it down and then tried to get blood, it wouldn't go...so I was thinking positional? Either way, I asked for help (thinking he could help me reposition). The nurse decided it was a good line, though, just couldn't draw blood. Said to leave in place.

After he drew blood from hand (2nd site), he did noticed the AC had a bubble. He went to start a new line, though, rather than taking it out. At this point he was running the show. I was in the doorway just watching as he started on the 2nd one, then left (I had seen my attempt as a fail and was going to let him just do it). But like you said the line had my name on it, so I should have just gloved up again and taken it out anyway.

[FireMedic65]

More than likely the IV had the good flash because it was in the vein, but when withdrawing the needle the catheter either when through the vein or came out. You had a good flash, but then couldn't draw blood. At first I was thinking it was positional or a collapsed vein, but then you were talking about infiltration, which leads me to believe my previous statement.

Now for your question about the iodine being a problem with infiltration. My guess would be that it could cause some damage since it is a cleaning solution and has chemicals to kill bacteria. Warnings on the box say no for internal use. Most likely, depending on how much was there and not properly taken care of, could have some necrotic effects, and inflammation but don't quote me on that. It is a very interesting question and I would like to see a better answer than my own. I will look it up myself to see what I can find and report back if no one else does.

As for you being liable, I don't believe so. You are a student and under direct supervision of the nursing staff. It would be on their ass in my opinion. When I was in clinical, I was not allowed to start an IV or draw labs without an RN or MD/DO with me, a lab tech didn't cut it. You are there for training and skills, and are under the supervision of the nurse. If they didn't see a "problem" that is their fault.

Edited May 20, 2009 by FireMedic65

[joesph]

I don't know as much as most of these yucks but I would recommend documenting every thing you can because your account implies to me that the nurse pooched it and is trying to slip the blame on you. as far as the iodine I'm not positive but will check that there is a required drying time before needle insertion when iodine is used to clean a site.

[MedicRN]

Now for your question about the iodine being a problem with infiltration. My guess would be that it could cause some damage since it is a cleaning solution and has chemicals to kill bacteria.

He's not referring to "cleaning" iodine. It's actually IV contrast.

[FireMedic65]

He's not referring to "cleaning" iodine. It's actually IV contrast.

Oh right... my bad.

In that case, try this article I found

http://imaging-radiology-oncology-technolo...he-Patient.aspx

Edited May 21, 2009 by FireMedic65

[mobey]

This EXACT thing happened to me.....

The iodine is nothing to be too conderned with. Some intermittent hot packs with elevation was the only Tx. A few days and a HUGE bruise later, and all was fine.

They even x-ray'd the forearm...... it looked awesome!

[fiznat]

Someone else answered but to reaffirm: the line can still be patent even though it doesn't draw. Usually good lines will draw blood, but not always.

As far as who's fault this was, I think you already know the answer. Of course it is the nurse's fault. Not only from the specifics of your story, but also because as a student you are working underneath that nurse who is responsible for everything you do. That said, who gets the BLAME will be a different story. You are the low man on the pole and even though it is unfair you will most likely get blamed for the whole thing. There really isn't anything you can do about it. As long as it doesn't effect your ability to continue working and learning, I think you may have to just suck it up and move on. It really isn't that big of a deal anyways.

[FL_Medic]

On you getting a flash.

When starting an IV you get a flash of blood when the open, beveled end, of the needle enters the vein. If you look at an IV catheter you will notice that the actual plastic catheter does not cover the entire needle. There is a very small measure between the end of the catheter and the needle. This requires that after you get a flash that you advance another "smidge". If not, your catheter may not advance and will probably kink up. The downside to this is possibly penetrating through the other side of the vein. This is the most common cause of a blown vein. You can still get a flash, and then blow it. An AC usually isn't as obvious when blown due to the amount of tissue in the area. Hands are very apparent and swell up nice and big for us before we get to the ER.

The nurse in the room with you.

A true cretin. The idea of fluids in but not out is only valid if you check it with a flush. The AC, as stated before, might require a larger flush. If you can't get blood out, you usually aren't in. What's the patients BP? If you have distal perfusion, you should have peripheral return right?

On the nurse asking you if you started an IV.

This doesn't matter at this point. We all miss IVs and I can't stand it when people try to point out others' misses. I don't know a single clinician that hasn't missed numerous IV starts. This nurse that asked you has no tact. You were doing a clinical, mistakes are expected! What do we do whenever we are administering anything into an IV line? Penetrate the medication access port, pinch the line, aspirate to check patentcy, and then push the med. Whoever administered the contrast was at fault and wanted to divert the blame.

Don't worry about this. I know that feeling you have though.