Pausing IV, clotting?

Nurses Medications Nursing Q/A

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Question from a past clinical rotation. IV kept occluding, couldn't walk away before it was beeping even after. As a student at the time, I was not allowed to do any IV care without the RN or instructor other than pause, reset, adjust kinks out of tubing, etc. RN and Instructor not available to fix, so I paused the IV (NS).

Told RN, she was fine with that and said she'd be in shortly. Found instructor to help with new IV site. Was scolded for pausing the IV because it would clot she said.

So the question is...how is a paused line with NS different from a saline lock...I mean, why wouldn't a saline lock clot but a paused IV (no air, I checked) would clot? And really it was constantly occluded and not running anyway, so did my pausing it hurt anything?

17 Answers

advsmuch08

81 Posts

If the fluids aren't running and the j loop isn't saline locked then blood can back up in the line and clot off. If the pump keeps beeping check to see if there is air in the line, the tubing is kinked, if the tubing is positioned correctly in the pump, or if it clamped off somewhere. With the IV itself unhook it from the tubing and try to flush it. Check to see if it is uncomfortable for the patient, if there is any redness or swelling or leakage of fluid from the site. A lot of times if the IV is in the AC as soon as the patient bends their elbow it gets occluded. I know as a student you're limited in what you can do but just listed some things for the future.

RunBabyRN

3,677 Posts

Specializes in L&D, infusion, urology.

Some people do clot VERY easily (I have one of these patients in my infusion work), and their IVs have trouble. Plus, it could have been one of those very touchy IVs, where even the smallest thing makes it occlude, and the pt may have been a really tough stick. Now, that said, if the RN was cool about it, then ok. Could have been that your instructor wasn't happy that you adjusted it for the reasons I listed.

Usually if someone has an IV, you'd want to keep it on KVO at the very least, if you're not doing a SL.

AJJKRN

1,224 Posts

Specializes in Medical-Surgical/Float Pool/Stepdown.

I would just add that sometimes, instead of flushing the IV, I check for flashback of blood before I flush the line. If you can get flashback then it's pretty safe to say the IV's still in the vein. Smaller IV catheters won't always give flashback though like a 22g and 24g.

When you flush a saline lock, the saline within is under a tiny bit of pressure. I always clamp the line just before the last cc of saline goes in, while I'm still pushing. That makes for a bit of pressure in the primary line. It's just enough to keep the line open. When I think it through, it seems like it wouldn't make a difference but somehow it does. This is a very good question you asked, by the way, for a new nurse :) I'm surprised your teacher didn't provide you with an explanation.

Specializes in Emergency, Trauma, Critical Care.

Either way they aren't getting fluids, but clamping prevents backflow. Pausing would not, although some pumps now have a pressure which would help

VANurse2010

1,526 Posts

The line could theoretically clot, but it's a stupid thing for your instructor to scold you about, assuming a scolding is what it was.

I totally agree the instructor over-reacted, I guess she scolded you because you adjusted the machine without a professional present, and those were her ground rules, so I can see it in a way. She should have explained to you why the IV may/may not be clotting. Always look at the insertion site, if it is inflammed or swolled, the site needs to be changed. It could have been an old site, it could have been positional, the IV cannula could have been very small(#24), the tubing could have been kinked somewhere, any number of things. If a professional is not available, I think you did the right thing---who wants to hear a pump beeping and it would upset the patient to know no one is doing anything!!!

blackvans1234

375 Posts

Heplocks don't have constant fluids running through them...wonder what your instructor thinks of those clotting off

:cyclops:

Hate the AC IVs, but they are the easiest to slap in for the ER nurses.

And, they seem to be the least likely to clot off, even with the IV pump just turned off :yes: . This has something to do with the larger IV catheter and larger bore vein. Your instructor's lack of on the ground experience shows more than anything, but it was a valuable learning moment, wasn't it?

We have a Posey product that wraps around the elbow area with velcro straps that keeps the elbow mostly straight and usable by the patient. They prevented a lot of beeping.

RunBabyRN

3,677 Posts

Specializes in L&D, infusion, urology.

IVs in the AC constantly set off pumps. Even the most A&O patient can make this happen, but it's even worse if the patient is confused. Really, it's a site that should be avoided unless you have an emergent situation or no other choice, for this reason exactly.

Specializes in Med Surg.

The stupid IV wasn't working anyway. Coulda been infiltrated, coulda been on a valve, coulda been any number of other reasons why it didn't work. None of them affected by pausing.

That being said, if you are at clinical and the staff RNs tell you to do something: Freakin' do it.

IVRUS, BSN, RN

1,049 Posts

Specializes in Vascular Access.

But please remember that not ALL IV catheters should be flushed this way. How one flushes, depends on the Needleless connector on the end of the IV catheter. There are three different types of needleless connectors: Positive Displacement type, Negative and Neutral. For the Negative type, you would do just as gooselady wrote: Clamp as you are pushing the last amount of flush into the IV catheter. This is called positive pressure flushing. For the Positive Displacement type, one should NOT clamp before removing the syringe, but rather remove the syringe after flushing, wait a short amount of time (5-10 seconds) then clamp.

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