General observation of the insertion site:
(1) The needle insertion site should be kept clean but should not be covered; this allows the site to be observed at all times.
(2) Minimize displacement of the needle by immobilizing the site and stabilizing the tubing (not the needle shaft).
(3) If the patient is conscious then monitor the site for pain.
(4) Monitor for the surrounding tissue for swelling associated with extravasation of infusate.
(5) Make sure that the line is not used for infusion of inappropriate solutions (cytotoxic agents, hypertonic or alkaline solutions).
Potential complications:
(1) bacterial cellulitis or osteomyelitis
(2) chemical injury from cytotoxic, hypertonic or alkaline fluids
(3) distal gangrene if the restraining straps are too tight
(4) damage to the epiphyseal growth plate
(5) compartment syndrome
(6) needle breaking off
(7) bone fracture
Causes of extravasation:
(1) insertion into a fractured bone
(2) excessive pressure applied to enhance infusion
(3) opening in the cortical bone greater than the diameter of the needle
(4) failure to insert the needle tip into the medullary space
(5) withdrawal of the needle from the medullary space
(6) pushing the needle tip entirely through the bone
Monitor for occlusion, with decreased flow and/or excessive pressure required::
(1) from fat or soft tissue
(2) from fibrin clot
(3) embedding the tip into cortical bone
