Hey there Sign in to join this conversationNew here? Join for free

Tissued cannulas/subcutaneous tissue- clinical issue

Announcements Posted on
Post on TSR and win a prize! Find out more... 10-04-2014
Interview Discussion 30-01-2014
    • Thread Starter
    • 0 followers
    Offline

    ReputationRep:
    Im just wondering, i administered IV abx to a patient on sunday, and my mentor noticed her hand started swelling, we got the reg to look at it just to make sure, and it was fluid, meaning the cannula had tissued, so- I took it out, and it was bleeding a LOT, and I mean a LOT, it really surprised me as i've taken out thousands of cannulas and never seen so much blood! Anyway, when the f1 arrived to re-cannulate, I asked how long it'd take for the swelling to go down, and he said 3-4 days as there is fluid in the subcutaneous tissue, fair enough, however reflecting on the incident has lead to more questions!

    I've tried reading up on the subcut tissue, and im wondering, how DOES the fluid get in the tissue, through what process does the fluid leave the tissue, and also where does it go? Finally would if this happens again, would I have to readminister the drug again, or would it still be signed off?

    Thanks!
    • 1 follower
    Offline

    ReputationRep:
    (Original post by Cup of Inspiration)
    through what process does the fluid leave the tissue, and also where does it go?
    can;t help with the other questions but at an educated guess to this one I'd say that it gets reabsorbed into the circulating lymph tissues, plus abit into the blood stream by osmosis etc
    • Thread Starter
    • 0 followers
    Offline

    ReputationRep:
    (Original post by JackieS)
    can;t help with the other questions but at an educated guess to this one I'd say that it gets reabsorbed into the circulating lymph tissues, plus abit into the blood stream by osmosis etc

    so would it be taken up as a dose of antibiotics then, as it'll be in the blood stream?
    • 1 follower
    Offline

    ReputationRep:
    (Original post by Cup of Inspiration)
    so would it be taken up as a dose of antibiotics then, as it'll be in the blood stream?
    I doubt it...............reabsorbtion would happen over a number of days rather than circulating straight through like it would have done if it'd gone into the right place in the first instance........I'm not a nurse but at guess I would imagine it would not count as a given dose and therefore would need to be regiven.......but like I said, I don't do drugs and the like! I do phlegm and coughing lol
    • 1 follower
    Offline

    ReputationRep:
    http://en.wikipedia.org/wiki/Extrava...intravenous%29

    and

    " Extravasation
    The infusion of fluids or drugs into the tissues instead of the venous circulation is termed extravasation, (or tissueing). This occurs when a cannula is dislodged from a vein or there is leakage between the cannula and the wall of the vein,(15). A study of 16,380 patients revealed some extravasation in 22.8% of those receiving intravenous infusions, of these 0.24% resulted in significant tissue damage,(16). The commonly presenting features of such tissueing are localised swelling and pain. The risk of extravasation going undetected are greater in patients who cannot communicate with their carers eg. children, the elderly and patients with reduced states of consciousness. It is interesting to note that extravasation occurs more frequently at night than during the day,(16).

    Fluids which are acid, alkaline, vasoconstricting, cytotoxic or hypertonic may be particularly irritating to tissues and may cause local necrosis. Such fluids are termed vesicant and should be monitored particularly carefully. If extravasation occurs the infusion should be stopped and medical advice taken. The limb may be elevated to encourage lymphatic drainage and checks made for tissue damage, impaired circulation and nerve damage. An important aspect in the prevention of extravasation is good visualisation of the entry site. This precludes dressings which prevent visualisation so transparent dressings are ideal. Any localised blistering may indicate tissueing. If the integrity of a cannular is in doubt it may be tested with a small volume of injectable saline as this is non-vesicating."
    • Thread Starter
    • 0 followers
    Offline

    ReputationRep:
    (Original post by JackieS)
    http://en.wikipedia.org/wiki/Extrava...intravenous%29

    and

    " Extravasation
    The infusion of fluids or drugs into the tissues instead of the venous circulation is termed extravasation, (or tissueing). This occurs when a cannula is dislodged from a vein or there is leakage between the cannula and the wall of the vein,(15). A study of 16,380 patients revealed some extravasation in 22.8% of those receiving intravenous infusions, of these 0.24% resulted in significant tissue damage,(16). The commonly presenting features of such tissueing are localised swelling and pain. The risk of extravasation going undetected are greater in patients who cannot communicate with their carers eg. children, the elderly and patients with reduced states of consciousness. It is interesting to note that extravasation occurs more frequently at night than during the day,(16).

    Fluids which are acid, alkaline, vasoconstricting, cytotoxic or hypertonic may be particularly irritating to tissues and may cause local necrosis. Such fluids are termed vesicant and should be monitored particularly carefully. If extravasation occurs the infusion should be stopped and medical advice taken. The limb may be elevated to encourage lymphatic drainage and checks made for tissue damage, impaired circulation and nerve damage. An important aspect in the prevention of extravasation is good visualisation of the entry site. This precludes dressings which prevent visualisation so transparent dressings are ideal. Any localised blistering may indicate tissueing. If the integrity of a cannular is in doubt it may be tested with a small volume of injectable saline as this is non-vesicating."

    interesting, although i dont trust wiki! We didn't elevate it, or redress it! Just left it, as the doctor told me to leave it, im back in again on wednesday, so if she's still in i'll have a look :beard:
    • 1 follower
    Offline

    ReputationRep:
    (Original post by Cup of Inspiration)
    interesting, although i dont trust wiki! We didn't elevate it, or redress it! Just left it, as the doctor told me to leave it, im back in again on wednesday, so if she's still in i'll have a look
    not sure about the redressing but as a physio I've seen quite a few pts with this problem, its quite common, we always elevate if the nurses haven't done so, helps with drainage

    check out the intranet of the place where you work, thereis likely to be a policy about cannulation in which is should be mentioned what to do if this occurs.....if your guidelines say elevate, then do so
    • Thread Starter
    • 0 followers
    Offline

    ReputationRep:
    (Original post by JackieS)
    not sure about the redressing but as a physio I've seen quite a few pts with this problem, its quite common, we always elevate if the nurses haven't done so, helps with drainage

    check out the intranet of the place where you work, thereis likely to be a policy about cannulation in which is should be mentioned what to do if this occurs.....if your guidelines say elevate, then do so

    well my mentor didn't seem concerned, neither did the F1, but..the f1 has only been working there a week or so and my mentor has only been qualified 3 months (was unoffical as my normal one wasn't in lol)- i may drain it JIC in the future, makes sense, it would be good to see some evidence, and no guidelines on cannulation on the nurses intranet! grr
    • 1 follower
    Offline

    ReputationRep:
    (Original post by Cup of Inspiration)
    well my mentor didn't seem concerned, neither did the F1, but..the f1 has only been working there a week or so and my mentor has only been qualified 3 months (was unoffical as my normal one wasn't in lol)- i may drain it JIC in the future, makes sense, it would be good to see some evidence, and no guidelines on cannulation on the nurses intranet! grr
    I'd check the trust wide intranet.....

    as for draining - not sure why that'd be necessary unless it was causing a major problem.........it just gets reabsorbed naturally in a day or two anyway......it doesn't shout as being a big deal unless you've been infusing cytotoxic drugs or others like that
    • Thread Starter
    • 0 followers
    Offline

    ReputationRep:
    also, could the amount of fluid there, been a reason for the heavy bleeding, or may that have been my fault, may have been a bit rough taking it out or something?!
    • 1 follower
    Offline

    ReputationRep:
    (Original post by Cup of Inspiration)
    also, could the amount of fluid there, been a reason for the heavy bleeding, or may that have been my fault, may have been a bit rough taking it out or something?!
    not the foggiest! There's a reason I'm a physio lol! Gimme phlegm any day haha!
    • 1 follower
    Offline

    ReputationRep:
    (Original post by Cup of Inspiration)
    how DOES the fluid get in the tissue,
    oh and I guess the answer to this question is: you put it there! lol! You missed vein and got the subcutaneous tissue instead. So when you started to IV running its seeped into the subcu tissue
    • Thread Starter
    • 0 followers
    Offline

    ReputationRep:
    (Original post by JackieS)
    oh and I guess the answer to this question is: you put it there! lol! You missed vein and got the subcutaneous tissue instead. So when you started to IV running its seeped into the subcu tissue
    so, how does fat absorb fluid, i thought it didn't...:beard:

    god im stupid
    • 1 follower
    Offline

    ReputationRep:
    (Original post by Cup of Inspiration)
    so, how does fat absorb fluid, i thought it didn't...

    god im stupid
    why would the fat have absorbed the fluid? Surely you've just turned it on and through the process of fluid movement its ended up in the tissues........the osmotic gradient would mean that fluid was drawn into the tissue from the bag you've got draining

    or am I being slightly dense
    • Thread Starter
    • 0 followers
    Offline

    ReputationRep:
    (Original post by JackieS)
    why would the fat have absorbed the fluid? Surely you've just turned it on and through the process of fluid movement its ended up in the tissues........the osmotic gradient would mean that fluid was drawn into the tissue from the bag you've got draining

    or am I being slightly dense

    i just keeo thinking the term 'hydrophobic' when the term fat comes up :confused:
    • 1 follower
    Offline

    ReputationRep:
    (Original post by Cup of Inspiration)
    i just keeo thinking the term 'hydrophobic' when the term fat comes up
    its nothing to do with fat bein hydrophobic..basically fluid is just leaking out of the cannula..........nothing more complicated to it than that as far as I can tell!
    • Thread Starter
    • 0 followers
    Offline

    ReputationRep:
    (Original post by JackieS)
    its nothing to do with fat bein hydrophobic..basically fluid is just leaking out of the cannula..........nothing more complicated to it than that as far as I can tell!
    yeahh..im too tired to think, any more help would be appreciated!
    • 1 follower
    Offline

    ReputationRep:
    i think you're over thinking it!

    http://www.ich.ucl.ac.uk/clinical_in...uideline_00080 - there is a good bit down the bottom "management of extravasation"

    The recommended immediate management is:

    * Immediately stop the infusion/injection (NEIS 2001, Kassner E 2000) (Rationale 122)
    * Explain the procedure to the child & family (Rationale 123)
    * Aspirate as much of the residual drug as possible & if possible draw back blood from the device (Rationale 124)
    * Under no circumstances should the device be flushed (Rationale 125)
    * Leave the cannula / port needle in situ (Rationale 126)
    * Retain administration set or syringe containing drug (Rationale 127)

    Urgently, day or night, contact child’s SpR who will contact the Duty Plastic Surgery SHO on Bleep 633, giving the following details (Rationales 128, 129 and 130):

    * Time of injury
    * Distal Circulation
    * Area & site of injury
    * Local Examination
    * Details of the drug/fluid

    The SpR should prescribe pain relief as required. (Rationale 131)

    Administer analgesia as required/prescribed.

    Contact the necessary multidisciplinary teams e.g., child’s doctor, CSP, IV therapy team. (Rationale 132)

    If a limb is affected it should be elevated. (Rationale 133)

    Document the incident in the child’s health care records and complete an incident form. (Rationales 134 and 135)

Reply

Submit reply

Register

Thanks for posting! You just need to create an account in order to submit the post
  1. this can't be left blank
    that username has been taken, please choose another Forgotten your password?

    this is what you'll be called on TSR

  2. this can't be left blank
    this email is already registered. Forgotten your password?

    never shared and never spammed

  3. this can't be left blank

    6 characters or longer with both numbers and letters is safer

  4. this can't be left empty
    your full birthday is required
  1. By completing the slider below you agree to The Student Room's terms & conditions and site rules

  2. Slide the button to the right to create your account

    Slide to join now Processing…

    You don't slide that way? No problem.

Updated: August 24, 2009
Article updates
Reputation gems:
You get these gems as you gain rep from other members for making good contributions and giving helpful advice.