bleeding from IV site with patient on blood thinners

[liltapper21]

Hi! I am a nursing student currently, on my 2nd year and I have a question. Just to say, I am always trying to learn, and even if it's something that simple, please any advice, ideas or thoughts is well appreciated. I just want to do what's right and what's best. So here is the situation.

I just started the cardiac rotation of my clinicals and theory. I had a patient who was on blood thinners and her IV site (where the port and tubing is resting against the skin). When I came in that morning, her IV's transparent dressing was peeling and the site was bleeding all over, not like gushing, but would not stop. I told the primary nurse, she went in, we cleaned the site and she put a new transparent dressing on it, but the bleeding never stopped and it was just filling up under the dressing. until it leaked out again. What should/could be done to get the bleeding to stop from the IV site? or will it never? should it have been pulled? I would think the blood pooling under the dressing would just be a haven for bacteria. Any input is greatly appreciated. Thank you!

[SquishyRN, BSN, RN]

The IV should have been taken out and pressure applied to the site until the bleeding stopped as with any IV removal. You would just have to apply pressure longer because of the increased bleeding time. To help keep it from bleeding again I would have done a pressure dressing instead of just a band aid. Then start a new IV at a different site. The nurse was just being lazy and didn't want to start a new IV by doing what she did.

[akulahawkRN, ADN, RN, EMT-P]

Well, two things: One is what SquishyRN stated. Second thing is to check the patient's labs for coag issues. It could very well be that the patient is too well anticoagulated...

[loriangel14, RN]

Pressure and an ice pack helps stop the bleeding.

[Lev, MSN, RN, NP]

I had a guy with a pneumothorax whose chest tube drainage was pink (not clearing to straw color). That was keeping him in the hospital. He was a dialysis patient and the dialysis nurse called the next day and said he was bleeding from his dialysis catheter site. I changed the pressure dressing a couple times. Then I came in and saw he was bleeding from scabs that he picked. Bleeding abnormally long. So blood in chest tube, dialysis catheter site, and scabs... This guy is in a hypocoagulated state. It turns out his sub q heparin was making him bleed. Dialysis patients don't metabolize drugs properly and many times do not excrete drugs in urine so drugs stick around longer. Your patient sounds like their coag levels were high. Coumadin should have been held.

[icuRNmaggie, BSN, RN]

Get an order for surgicel and thrombin spray.

[AnnieOaklyRN, BSN, RN, EMT-P]

This can also be a sign of infiltration, especially if the fluid leaking is lighter than normal blood! Look for swelling around the area and if the soft tissue is cool to the touch if there is fluid running.

HPRN

[iluvivt, BSN, RN]

The leaking IV site should have been pulled and pressure held until bleeding stopped. A new IV should have been started above that site if you must use the same arm.Use a small catheter and try to keep the tourniquet loose or not use one at all.Try to find a vein in an area where the skin is thicker. Next as others have stated check the coags. I see this all the time especially as the dwell time is getting longer and you always resite the PIV unless of course the blood came from a loose connection.

[IVRUS, BSN, RN]

As ILUVIVT said, resite it if it is a short term peripheral catheter and investigate coags. However, if it was a type of central line, such as an implanted port, and the bleeding is occurring, then I'd wonder if the needle was rocked while in place and causing the constant bleed. Also, there are Hemostatic agents like Bioseal which may by purchased and used to stop the bleeding for long dwelling IV catheters.

[liltapper21]

Wow. you are all so wonderful. Thanks so much for replying. I didn't come across this problem today on the unit. I do know when she changed the dressing a third time and used a little bit of 2x2 gauze torn around the site. I think the patient had a potential discharged that day and it was from a peripheral line. I understand trying to save it, as opposed to resticking the patient when it may not be necessary especially if they are potentially being discharged that day. But I would not think I would want a patient to bleed non-stop , especially since this has been over multiple minutes of time. I did remember see a high value I think it was a coag lab (but not what I am used to seeing like PT, PTT or INR) something new to me, and the value was pretty high like 500-600 and I had meant to talk to my instructor about that that day which they ended up pulling off the unit and we had to go. something I have learned to keep an eye on and consult in the future. but I have made notes of all the advice all of you have given and I will use that and apply it if/when a situation arrives again. thanks so much!

[firstinfamily, RN]

Also, the pt with dialysis catheter that is leaking. Theoretically, that pt is receiving heparin through his dialysis catheter, so should he also be receiving it subq?? Sounds like his coags need to be checked also. Most renal patients have low Hgb and Hct because they cannot produce erythropoietin. He needs to be watched closely also.