srg4784. . .I was an IV therapist for many years. I don't want you to worry about this. You did nothing wrong. There is nothing wrong with the patient. There are two possible reasons that a patient does not bleed when an IV catheter is removed:
- The tissues around the IV cannula were already in a state of inflammation and swelling and the cannula was probably keeping the walls of the vein expanded. The minute the cannula was removed, the local swelling caused the walls of that vein to collapse flat which effectively cut off any potential swelling. It will heal. If you want to know the pathophysiology of this, look at the inflammation response of the body and how the body reacts when there is an introduction of a foreign body into it. Every person's body reacts to the presence of foreign bodies and substances. This is one of the reasons why the INS (Intravenous Nurses Society) standard is that every IV site should ideally be changed every 24 hours. By 72 hours, the policy that most hospitals say each IV site should be changed by, evidence of phlebitis (the inflammation response) should be present to some degree. Redness isn't the only sign or symptom of a phlebitis. The swelling doesn't necessarily have to be massive either. If you start having patients hold both arms together and really looking at and comparing the arm with the IV and the one without the IV, you will start to see the very subtle changes in an arm with an IV that is 72 hours old.
- Within 24 hours of any foreign body residing in tissue, particularly the veins, the body forms a biological sheath of slime around it. This is a protective barrier and one of the body's homeostatic mechanisms as it attempts to wall it off from the body. As the IV cannula is being pulled out, the skin edges of the puncture wound (remember the skin is elastic) act like a squeegee and milk that biological sheath off. What you can't see on the other side of that puncture wound that the IV just came out of may very well be a little clump of this stuff just large enough to form a nice obstruction preventing any blood from leaking to the outside. The longer an IV cannula is in a vein the more developed this biological sheath is. These sheaths cause all kinds of problems in central lines because as they form they sometimes form flaps that interfere with the flow of IV fluids through the distal holes of the catheters. More commonly, when nurses try to aspirate blood from a central line, these little suckers get pulled over and into the catheter opening very effectively obstructing them so no blood can be aspirated from the line.
Anticipating your third question, will the swelling heal and what will happen to this lump of biological slime if it is present? Again, don't worry. The minute a foreign body is removed the inflammation response begins to reverse itself. As for that lump of biological slime, it is absorbed into the body over time. There is no danger of blood clots forming around them. Keep in mind that this is a peripheral vein. The blood pressure in them in nothing compared to the blood pressure in the deeper veins.
Now that you know the answer to your question. Go out and inform the world and I don't want to hear anything about you losing any sleep over this tonight. The patient is going to be just fine.
Oh, by the way, that person who looked at you like you were dumb when you were asking your questions did that because they didn't know the answers. The look on their face was covering up their own ignorance.
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When removing an IV
so all day I've been worried if I somehow left a needle in the client. I didn't feel anything hard around the site like what I'd expect a needle to be and when I asked someone else they just looked at me like I was dumb so after two looks like that I just felt really stupid. The PCS was super busy since there was only two nurses on the floor today so I never even found time to ask them and when I observed the site later on still no bleeding on the gause and no swelling or redness so I figured it was okay. I did tell the oncoming tech about this and left a sticky note for the PCS on her door to check it ASAP. Is this normal, should there or shouldn't there have been a needle removed?
