Troubleshooting | Right Decisions

Damaged catheter

Problem	Damaged catheter
Possible findings	• Line dressing is wet • Fluid leaking from catheter
Possible causes	× Not removing the clamp before infusion or flushing, causing excessive pressure to the catheter × Break or puncture to the catheter × Use of an unapproved clamp × Excessive pulling on the catheter × Defect in the catheter × Scissors used near the catheter and accidentally cut it × Excess force used to administer solution
What to do	✓ Immediately clamp the catheter between the break & exit site ✓ Suspect infection ✓ Call medical staff
Preventative action	✓ Secure all connections without over tightening. Tighten until you meet resistance ✓ Tape the catheter to the body to prevent tension being applied ✓ Use only approved non serrated or padded catheter clamps ✓ Never use scissors near the catheter ✓ Never use force to administer solutions ✓ Use supplies only as instructed. Do not make substitutions.

Blood in catheter / leaking

Problem	Blood in catheter/leaking
Possible findings	• Blood in catheter/tubing • Leaking of solution/blood
Possible causes	× Connections are loose or disconnected × Catheter or extension tubing is damaged (see Damaged Catheter section above) × Too much pressure used when tightening catheter and cap
What to do	✓ Check for catheter / extension tubing damage. (If found, see Damaged Catheter section on previous page) ✓ Check all connections for secure fit ✓ Check the catheter / extension tubing looseness. It may need to be replaced ✓ Change Smartsite. It may have been accessed too many times and need to be replaced
Preventative action	✓ See Damaged Catheter section above.

Air embolism

Problem	Air embolism
Possible findings	• Coughing • Shortness of breath • Chest pain • Loss of consciousness
Possible causes	× Disconnected IV tubing or end cap × Incorrect flushing or heparinisation
What to do	✓ Clamp the catheter/ extension tubing ✓ Stop infusion ✓ Lie patient on left side with their head down ✓ Dial 2222 to put PET call out
Preventative action	✓ Use locking (luer-lock) connections ✓ Remove all air from tubing and syringes before infusing or injecting into the catheter ✓ Clamp the catheter whenever you change your injection cap.

Solution not infusing

Problem	Solution not infusing
Possible causes	× Pump failure × Catheter obstructed × 3-in-1 PN bag (no filter should be on the giving set for this PN bag)
What to do	✓ Observe the catheter for any occlusion ✓ Checked that the bag is spiked completely ✓ Check that the pump has been started ✓ If pump failed, replace with different one ✓ Check that all clamps are opened appropriately and tubing is not kinked ✓ Call medical staff ✓ Check for a filter on giving set

Fever noted during infusion

Problem	Fever noted during infusion
Possible causes	× Bacterial infection of catheter × Other bacterial/viral infection × Contaminated solution × Infusing cold solution too fast
What to do	✓ Stop infusion ✓ Heparinise the catheter ✓ Observe the catheter site for signs & symptoms of infection (redness, swelling, drainage) ✓ Check patient’s temperature ✓ Call medical staff ✓ Follow suspected line sepsis flowchart below

Hyperglycaemia

Problem	Hyperglycaemia
Possible findings	• Weakness • Nausea • Polydipsia, polyuria • Headache • Irritability • Abdominal pain • Fruity smelling breath • Unconsciousness
Possible causes	× Blood sugar level is too high × Solution is being infused too fast × Insulin which is being produced by the body is not enough for the level of sugar in the blood × Infection
What to do	✓ Test blood glucose level ✓ Call medical staff

Hypoglycaemia

Problem	Hypoglycaemia
Possible findings	Sweating • Tingling in fingers or toes • Nausea • Dizziness • Headache • Paleness • Feeling of Nervousness • Shakiness, trembling, irritability, Personality change • Drowsiness • Blurred vision • Hunger • Unconsciousness • Coma
Possible causes	× Blood glucose level is too low × PN infusion was stopped too quickly × Insulin is still being produced by the body at high levels after PN has stopped
What to do	✓ Test blood glucose level ✓ Call medical staff ✓ Give child something to eat, if they are allowed to eat ✓ Taper-down aqueous infusion at the last hour, according to pharmacy instruction

Fluid retention

Problem	Fluid retention
Possible findings	• Swelling of feet, ankles or abdomen • High blood pressure • Shortness of breath
Possible causes	× Extra salt in the body × Retaining fluid
What to do	✓ Call medical staff

Nutrient imbalance

Problem	Nutrient imbalance
Possible findings	• Muscle cramps • Any unusual feeling or change in physical status • Bone pain • Skin changes (dryness, rash) • Excessive hair loss • Change in mental status • Heart fluttering
Possible causes	× Many causes
What to do	✓ Call medical staff