ASIDE from a few well-packaged items in the cafeteria and some of the dulleredged greeting cards in the gift shop, nothing is completely safe in the hospital. Even starting an intravenous (IV) line, which is done dozens or even hundreds of times each day in any medical center, can have its dangers. Intravenous catheter placement can result in infection, cause or dislodge blood clots, and puncture arteries. Moreover, pieces of the catheter can break off and travel through the vein into the heart and pulmonary circulation. There, it can lodge itself in the heart, causing abnormal heart rhythms or heart attacks or block the circulation of blood to parts of the lung, potentially leading to serious problems and even death.
Therefore, even though you consider yourself a well-seasoned veteran at IV line placement, be careful and vigilant each time you do it. It only takes one mistake, one defective catheter, or one unfortunate event for the catheter to break.
WHAT TO DO
If you encounter resistance when removing an IV line, stop pulling, cover the area with sterile bandages or pads to prevent infection, and apply warm compresses to the area to relax the vein. After a short while, try removing the line again. If you still have resistance, contact vascular surgery or interventional radiology immediately.
If the catheter breaks, your goal is to prevent the broken piece from migrating up the vein to the patient's pulmonary circulation and heart. Keep the arm still and below the level of the heart. Place a venous tourniquet around the patient's arm close to his or her armpit (axillary area) to inhibit the piece from flowing through the vein toward the heart. Check the patient's wrist pulse to ensure that the tourniquet isn't so tight that it blocks blood flow to the patient's arm. Don't inject anything into the broken catheter. Immediately contact vascular surgery or interventional radiology to remove the piece. Don't attempt to remove it yourself.
WARNING!!!!!! Leakage of fluid or a popping, burning, or stinging sensation in the patient's arm when fluid passes through the IV line suggests that the catheter is torn.
PREVENTION AND PREPARATION
To avoid this mishap, use catheters carefully and properly. Don't cut, twist, or overmanipulate them. When injecting fluid into the catheter, don't apply too much pressure. Because the size of the injection syringe barrel is inversely proportional to the amount of pressure applied to the catheter (smaller barrel, greater pressure), you should refrain from using syringes that are too small for the catheter you're using. (For example, for a PICC line, you shouldn't use a syringe smaller than 10 mL.)
Carefully inspect the catheter for breaks and damage before using it. Keep scissors and other sharp objects away from the catheter.
Of course, hundreds of IV lines are started each day without complications. You shouldn't be paranoid; just don't take seemingly simple procedures for granted. Take a cue from Tiger Woods, who takes every short putt seriously, and Michael Jordan, who tried to concentrate on every single free throw, and remember that there is no such thing as a "gimme" or a "no-brainer."