Blood in the IV

  1. Hi all -
    I'm about ready to graduate from an ADN program (june!) and I work in the ER as a tech. Last time I worked I noticed a pt.'s iv had backed up all the way up the IV tubing, FILLED the pump cassette, and was making its way towards the bag. As tech's, we're not allowed to do ANYTHING involved IV's except d/c them after the nurse has d'cd the fluids. Of course I let the pt's nurse know about the line asap, and later asked him what he did to solve something like that. He said, "Oh, you just flush it back in". ??!?!?!

    Now, I see lines backed up a lot in the ED where I work, but only to the heplock, and it is obvious that the blood has mixed significantly with whatever fluids were there when it was heplocked. I've seen nurses flush those before and I feel like I would be fairly comfortable flushing a similarly heplocked line. But this kid's line - it was RED. How on earth could I be sure it hadn't clotted?

    what would you do? why?

    also, could someone explain to me how a line can get that backed up?

    thanks so much!
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  2. 23 Comments

  3. by   TazziRN
    The only time I've ever seen a line get backed up with blood farther than the t-extension is when the tubing wasn't primed.

    You don't know it hasn't clotted until you gently try to push saline with a syringe, but if the blood had gone that far back, I probably would have gotten another bag and line and superimposed it to the existing lock. If it still didn't flow, then it's time to restart the IV.
  4. by   purple_rose_3
    Quote from sunshineonleith
    Hi all -
    I'm about ready to graduate from an ADN program (june!) and I work in the ER as a tech. Last time I worked I noticed a pt.'s iv had backed up all the way up the IV tubing, FILLED the pump cassette, and was making its way towards the bag. As tech's, we're not allowed to do ANYTHING involved IV's except d/c them after the nurse has d'cd the fluids. Of course I let the pt's nurse know about the line asap, and later asked him what he did to solve something like that. He said, "Oh, you just flush it back in". ??!?!?!

    Now, I see lines backed up a lot in the ED where I work, but only to the heplock, and it is obvious that the blood has mixed significantly with whatever fluids were there when it was heplocked. I've seen nurses flush those before and I feel like I would be fairly comfortable flushing a similarly heplocked line. But this kid's line - it was RED. How on earth could I be sure it hadn't clotted?

    what would you do? why?

    also, could someone explain to me how a line can get that backed up?

    thanks so much!
    This can happened when a patient is using the arm that has the IV in it to move around. If the IV fluids aren't on a pump, which in most ER's aren't sometimes if they aren't up high enough in the air this can happen d/t gravity.
  5. by   KellNY
    Quote from purple_rose_3
    This can happened when a patient is using the arm that has the IV in it to move around. If the IV fluids aren't on a pump, which in most ER's aren't sometimes if they aren't up high enough in the air this can happen d/t gravity.
    All the way into the cassette? I have some very ambulatory Pts, and I've seen them take the bag off the pole, and put it on the floor while they pee. Still, never saw it go more than a foot, foot and a half tops.

    Sounds like to displace all that fluid, there'd need to be some pressure there. I could be way off base, but it seems odd to me.
  6. by   nursemary9
    Quote from KellNY
    All the way into the cassette? I have some very ambulatory Pts, and I've seen them take the bag off the pole, and put it on the floor while they pee. Still, never saw it go more than a foot, foot and a half tops.

    Sounds like to displace all that fluid, there'd need to be some pressure there. I could be way off base, but it seems odd to me.

    I agree; Does sound very odd. I, too, have seen blood back up a LONG way---but never that far!!
  7. by   strn96
    The only time I've ever seen this is when one of the nurses I was working with loaded the tubing through the pump backward and the pump was actually pumping blood out of the pt into the tubing/bag instead of from the bag to the pt!! (We have the type of IV pumps that you just run the tubing through the pump) It sounds like the pump the OP is describing has a cassette, however, and I don't think you can load those backward.
  8. by   CritterLover
    some possible thoughts:

    1. was the bp cuff on that arm, taking freuquent bps? esp if the bp is high, the amount of pressure the cuff would have to pump up to could cause the blood to back up quite a ways once the fluid has infused.

    2. was the bag down fairly low? if the bag isn't on a pole (or maybe on the stretcher pole, but not raised in the air) it wouldn't be that odd. also, the bag could have fallen on the floor and the blood would backed up that far very easily, then someone could have put it back on the pole.

    3. really high venous pressure, such is in end-stage chf or bad cardiomyopathy.

    4. inadvertent arterial puncture?

    i wonder what kind of pumps they use, because it is really odd to find this when the line is on a pump (would almost have to be a pump malfunction) or was the nurse just using pump tubing and opening up the clamp so it runs via gravity?

    as for what to do, any time blood backs up, i toss the bag/tubing. then i try to aspirate blood. if i get blood return, i'll keep the iv. if i don't, then they really need a new one if the still need the iv.
  9. by   NicoleRN07
    Its a gravity thing. If that happens, (rarely, b/c I don't allow my fluids to run completely empty), I just d/c the IVFs, flush the heplock, and hang another bag of fluid in it's place.
  10. by   cheshirecat
    This happened to one of my patients yesterday. We received a patient from another ward. When I went to to assess him his IV was bloodstained right up to the chamber. He had come to our ward in a wheelchair with no drip stand - IV bag was placed on his lap!!!!I had also never seen this before in 25 years of nursing. I set up a new IV line and solution. I never would have attempted to flush the line.
  11. by   burn out
    To the op I have never seen blood back up that far unless the bag has been lowered. Are you sure that maybe the patient hadn't received blood and the line was being flushed? Just a thought.
  12. by   mediatix8
    In nursing school this happened to one of my patients. I forgot what the circumstaces were but I let her go to the bathroom with her IV bag and without the pump so it backflowed all the way into the bag and it didn't take a long time for that to happen. I changed everything... the bag and tubing, More so because it looked weird.
  13. by   veegeern
    I have seen this with gravity flow, especially with INTs in the upper arm or when a patient is gettiing out of bed. Have only seen this happen with a pump when the MD ordered a rate of 20 ml/h, and then it only was partially up the tube.
  14. by   Elle.p.enn
    If the blood was red, and it had backed up into the cassette, wouldn't that be a new arterial line?

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