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<< Vascular Access in Pediatric Patients in the Emergency Department: Types of Access, Indications, and Complications

Complications

Peripheral Intravenous Access

Common complications with placement of a PIV catheter include pain, failure to access the vein or get blood return, difficulty advancing the catheter over the needle and into the vein, and difficulty infusing fluids after the catheter is placed in a vein.23 Often, these complications require no intervention beyond removal of the catheter and making another attempt. Less common but more serious complications can include arterial puncture, peripheral nerve palsy, compartment syndrome, and skin and soft-tissue necrosis, which require more intensive intervention.23,50 Thrombophlebitis is a more common serious complication of IV cannulation; recommendations to help avoid this include replacing and alternating sites every 72 to 96 hours, avoiding wrist and scalp vein use, and selecting a 24-gauge catheter.87 Thrombus formation can be mitigated by using heparin flushes and splinting the cannulated area. This should be done for all PIV catheters to help ensure longevity.87,88

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