Blood backup in IVs

[dylanmc]

I have a question. So a few days ago I had a patient who was running continuous NS w/ K at 50ml/hr through a chest port, and he also had a PCA pump which only was set up to give bolus doses (not continuous), and they were basically Y-sited with the PCA tubing as is our protocol. Earlier in the night I had disconnected the tubing to give an IV medication, flushed and checked for blood return, gave the med, and flushed again, reconnected everything.

Anyway, I didn't think much about it and I was in the room periodically throughout the night. At about 0430 I changed the PCA vial with another nurse, everything looked fine. At around 0615 I went back into the room to check on the fluids since I figured they were about out and I left to get another bag. Fast forward to shift report at 0700...I go into the room to hang a new bag of fluids with the oncoming nurse and do a handoff. My patient had just gotten up to go to the bathroom and got back in bed, and I noticed his continuous fluids had somehow gotten disconnected from the line connected to the PCA line and were beginning to leak onto the floor - a very small amount of fluid was on the floor so I know it had not been disconnected a long time (not a big deal, it probably was just a loose connection and got unhooked when he stood up). BUT there was a pretty good deal of blood backed up into the PCA line, filing up the filter entirely but not further than that. My charge nurse came in to help us replace the tubing since we had only done it once before. She immediately yelled at me in front of my patient and claimed that the line had been backed up with blood for an "obviously long time", implying I was negligent. So we get all new tubing and begin to hook everything up and turns out we couldn't flush the port and had to call our IV team to check the status of the port and I'm assuming, reaccess it.

My problem is that she yelled at me in front of my patient and claimed that there's no way the line could be that backed up with blood and I must have not checked it in a long time. But the disconnected line had very little fluid leaked onto the floor so I know it could not have been disconnected for very long at all. Did I do something wrong here that I'm missing? It also concerns me that the port wasn't able to be flushed once we reconnected everything.

[NewMurse1014]

1) Because the chest port is closer to the heart, the pressure is higher than peripheral IVs. If the port is not locked and no fluids are infusing, blood can start to back up fairly quickly. The maint IV is what keeping this from happening, and once it's disconnected blood started to back up to PCA tubing.

2) Blood will clog up the port if it's not flushed with heparin regularly http://www.ins1.org/files/public/09_12_Infusion_Spotlight.pdf or the needle catheter is misplaced with pt movement

3) Your charge nurse is unprofessional for yelling at you in front of the pt. It made you, the charge nurse, and the hospital look bad as a whole, a lose-lose situation.

[dylanmc]

Thank you so much! That is the only explanation I could think of, was that it just quickly backed up with blood when the continuous fluids got disconnected. She basically said there was no way that the line could have filled up with blood that fast, saying that it would have had to have been hours for that much to be in the line and the filter. I'm a semi new nurse so I just wasn't sure. Thanks for reassuring me :)

[dylanmc]

I'm guessing when he got up to go to the bathroom he somehow dislodged his port and simultaneously somehow the secondary line which was running continuous fluids came loose too.