6 Complications and Patient Safety

Recognize changes and reassess

During IV therapy, compare the patient’s current condition with baseline and look for new respiratory, circulatory, neurologic, or infusion-site changes. Trend vital signs, oxygen saturation, intake and output, weight, relevant laboratory results, and the prescribed infusion rate.

Adults receiving IV fluids need regular reassessment. Monitor more frequently when the patient’s condition or fluid and electrolyte needs are changing.

Fluid overload

New breathlessness, cough, falling oxygen saturation, crackles, tachycardia, raised blood pressure, restlessness, edema, or a rapidly positive fluid balance may indicate Fluid overload. Patients with cardiac or kidney impairment may be especially vulnerable.

If fluid overload is suspected, stop or pause the infusion and urgently escalate according to the patient’s condition and local protocol. Sit the patient upright if tolerated, then assess airway, breathing, circulation, vital signs, oxygen saturation, lung sounds, and fluid balance. Give oxygen and other treatment as prescribed or directed by emergency protocols. Do not independently restart the infusion or administer a diuretic without an order. Document the assessment, actions, response, and notification.

Prevent fluid overload by verifying the fluid, prescribed volume and rate, pump settings, and patient identity. Use a pump when indicated, account for all fluid sources, and reassess the patient and fluid balance—especially after rate changes or for patients with cardiac or renal disease.

Infusion reactions and anaphylaxis

Infusion reactions may involve flushing, rash or itching, fever or chills, nausea, chest or back discomfort, dizziness, or changes in pulse or blood pressure. Airway swelling, wheezing, breathing difficulty, hypotension, or reduced consciousness may signal anaphylaxis, a medical emergency.

Stop the suspected infusion and summon urgent help for severe symptoms. Assess airway, breathing, and circulation; monitor vital signs and oxygen saturation; and follow the emergency protocol. For suspected anaphylaxis, activate the emergency response and ensure prompt intramuscular epinephrine is given under the applicable protocol. Do not delay while seeking IV access.

If access is needed, maintain it with a separate compatible setup as directed; do not flush the suspected infusion into the patient. Record the product, timing, symptoms, actions, and response. Do not restart the infusion unless an authorized clinician directs it.

Prevent harm from rapid sodium correction

Correcting chronic or duration-unknown hyponatremia too rapidly can cause osmotic demyelination syndrome, a potentially serious neurologic injury. Adult correction limits depend on clinical circumstances and the governing protocol. One major guideline recommends avoiding a sodium rise greater than $10\ \text{mmol/L}$ in the first $24$ hours and greater than $8\ \text{mmol/L}$ in each subsequent $24$-hour period. Some high-risk patients need a stricter limit.

These limits are for treatment, not routine nursing targets. Follow the prescribed plan and ordered laboratory-monitoring schedule. If results show sodium rising faster than the prescribed limit, or the patient develops new neurologic changes, escalate immediately, verify the result and infusion details, and increase observation as directed. Do not independently prescribe a sodium-lowering treatment.

Administer IV potassium safely

IV potassium requires controlled administration. Concentrated potassium must be diluted and given by controlled infusion, never as an IV push. Cardiac and laboratory monitoring depend on the dose and patient risk.

If an order directs concentrated potassium by direct IV push, do not administer it. Clarify the order and follow the approved diluted, controlled-infusion procedure. Potassium given too rapidly can cause life-threatening arrhythmias.

Apply the response priorities

For new dyspnea, crackles, and falling oxygen saturation during IV fluid administration, stop or pause the infusion, assess airway and breathing, sit the patient upright if tolerated, and urgently escalate. Monitor vital signs and oxygen saturation; provide oxygen and further treatment according to orders and emergency protocol. These findings may indicate pulmonary fluid overload.

For hives and wheezing during an infusion, stop the suspected infusion, activate emergency help, assess airway, breathing, and circulation, and follow the anaphylaxis protocol, including prompt intramuscular epinephrine. Wheezing with hives may indicate anaphylaxis, so treatment must not be delayed.

If sodium rises beyond the prescribed correction limit during treatment of chronic hyponatremia, escalate immediately, verify the result and infusion details, and follow directions for further monitoring and treatment. Corrective treatment requires clinician-directed management because excessively rapid correction can cause neurologic injury.

Coordinate prevention and response

Recognize changes early, stop a potentially harmful infusion when indicated, assess and escalate promptly, and monitor the patient’s response. Prevent complications by checking the prescription and pump settings, accounting for total fluid intake, and following patient-specific electrolyte correction and monitoring plans. Use local emergency protocols and authorized orders for treatment.