IV question

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Last week during my clinical I came into my pt's room and was going to flush her IV. The IV was taped down with many layers of tape so you couldn't see where the J-loop attached to the IV hub (it was a capped IV). I took a couple of layers of tape off and the end that should have been attached to the IV hub fell down against the pt's arm. It had a small dried blood clot partly on the hub and partly on the pt's skin. It wasn't bleeding, but was open to air. Am I wrong in thinking this could have been a major source for infection? What about air getting into her blood stream? Or was it not even in the vein anymore because it wasn't bleeding? I discontinued the IV right then and there and then reported it to the RN. Was that right or wrong on my part?

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As a RN I would have wanted to see the IV before it was d/c maybe it needed to be d/c maybe not, if not the patient got stuck again and charged for something unneeded.

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.

If you're worried about air embolism, I don't think it can happen like that, if I read your post correctly.

We prime prime the line to not actively instill air embolism (the pockets of air) into the bloodstream but if you say that the iv was actually dc'ed then that shouldn't be a problem.

I would imagine that if air embolism can travel into our bloodstream passively, then we would have issues from all sorts of small injuries.

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Specializes in Emergency, Telemetry, Transplant.

I don't know that I'd call it a "major" source of infection (it depends on the pt and your definition of major). The risk of air getting into the vein and causing a problem is pretty low, but it could have been in the vein, but just clotted off--which would also prevent any air from getting in there.

I my mind, that IV did need to be discontinued. Again, not sure it is a major infection risk, but if it is open to air, you then flush it, you are now flushing pathogens into the blood stream (or subQ tissue, etc. if the if catheter is no longer in the vein. As a student, I would have reported it first to the RN (and if he/she did nothing, to the CI) and allow the RN to evaluate it, look at the site, etc. before d/c'ing it.

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Specializes in Emergency Department.

While I doubt there was any risk of air embolism, it sounds like the set had been disconnected from the catheter hub for a while, given that there's dried blood all over. This leads me to think that the catheter has also clotted off and even if you'd connected a new primed extension set, you'd either not be able to clear the line or you'd blow some clots into circulation where they'd end up being filtered out by the lungs. I doubt the patient would even notice such a small embolus... but that's an issue that can be avoided altogether by d/c'ing the IV.

I'd say that you did the right thing. Would it have been nice for the RN to see it before you did? Sure. Would it have been necessary? Probably not.

In any event, since the cleanliness and sterility of the line was now quite suspect, it went from a 72-96 hour replacement interval to 24 hours (or less). At that point, it would have needed to be removed shortly anyway. I would have to say that you did a good job and good thing by removing sufficient tape to be able to visualize the site and verify that the extension set was still attached to the catheter hub. It wouldn't have been good for you to have flushed the line only to have the patient complain that there was now a lot of cool liquid sloshing around or you to discover saline running down an arm...

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