Blood in the IV

[sunshineonleith]

Hi all -

I'm about ready to graduate from an ADN program (june!) and I work in the ER as a tech. Last time I worked I noticed a pt.'s iv had backed up all the way up the IV tubing, FILLED the pump cassette, and was making its way towards the bag. As tech's, we're not allowed to do ANYTHING involved IV's except d/c them after the nurse has d'cd the fluids. Of course I let the pt's nurse know about the line asap, and later asked him what he did to solve something like that. He said, "Oh, you just flush it back in". ??!?!?!

Now, I see lines backed up a lot in the ED where I work, but only to the heplock, and it is obvious that the blood has mixed significantly with whatever fluids were there when it was heplocked. I've seen nurses flush those before and I feel like I would be fairly comfortable flushing a similarly heplocked line. But this kid's line - it was RED. How on earth could I be sure it hadn't clotted?

what would you do? why?

also, could someone explain to me how a line can get that backed up?

thanks so much!

[Elle.p.enn]

If the blood was red, and it had backed up into the cassette, wouldn't that be a new arterial line?

[sunshineonleith]

thank you all for your replies - i'll give some more background information on the story.

the pt. in question was a 12-13 year old M in for n/v/d, and he was constantly getting up to go to the bathroom (taking his bag off the pole, holding (or having me hold it) up while he walked to the bathroom, etc. so for those of you who explained about gravity and excessive movement causing the line to back up, this makes more sense to me now. it was just further that i've ever seen a pt. back a line up before.

for all of those adding your insight on when to keep the line/when not, thanks you. whlle it makes complete sense to me to keep an IV that is still patent (flushable) i think when it comes up for me i'll get rid of the tubing and start over.

just a question: could it have backed up so much because it wasn't on a pump? like i said, it was pump tubing - had the cassette and all, but it was just flowing through gravity.

i think i irritated the nurse by pointing it out, but it really did look like the kid was getting a transfusion!

[Gromit]

If it were an arterial line, it should have been obvious to whomever put the line in -it would have started backing up the line from the very moment the drip was hung (seen that happen once. Was pretty wicked :)) -no, I didn't start the site.

I think you've been given plenty of good info already. So long as you're allowed by protocol to flush the line, that is (dunno what techs are allowed to do in your facility).

[burn out]

If it were an arterial line, it should have been obvious to whomever put the line in -it would have started backing up the line from the very moment the drip was hung (seen that happen once. Was pretty wicked :)) -no, I didn't start the site.

I think you've been given plenty of good info already. So long as you're allowed by protocol to flush the line, that is (dunno what techs are allowed to do in your facility).

Seen this one time. the patient came back from surgery with what was suppose to be a RIJ but instead turned out to be Right carotid artery. First signal something was wrong was that the IV pump kept beeping occlussion

second, when tubing was taken off the pump the blood pulsated back up in the tubing. Third we connected the line to pressure tubing and cable and sure enough a beautiful art line wave form on the monitor. Notified the doc, he said pull it, the nurse did, pt stroked eventually died. Can we say sentinel event.

[Mulan]

Seen this one time. the patient came back from surgery with what was suppose to be a RIJ but instead turned out to be Right carotid artery. First signal something was wrong was that the IV pump kept beeping occlussion

second, when tubing was taken off the pump the blood pulsated back up in the tubing. Third we connected the line to pressure tubing and cable and sure enough a beautiful art line wave form on the monitor. Notified the doc, he said pull it, the nurse did, pt stroked eventually died. Can we say sentinel event.

who put it in? the doc? maybe he should have been the one to take it out

[Gromit]

Oh yeah. Bigtime sentinel event. I would not have pulled that. I'd have told him that a doc was gonna have to do it. In a vein, sure -do 'em all the time. Arterial? Not a chance. Not up there, anyway. But so long as it was according to protocol, the nurse SHOULD be covered. Hell of a thing to have happen, though! It would make me feel a bit sick (and I'm sure the RN was).

yeah, I'll never forget watching that blood pulse up the tubbing, fill the drip chamber, and begin to seep into the bag -my first actual comment was "Isn't THAT odd!", then I reached over, and clamped the line. :)

[Altra, BSN, RN]

seen this one time. the patient came back from surgery with what was suppose to be a rij but instead turned out to be right carotid artery. first signal something was wrong was that the iv pump kept beeping occlussion

second, when tubing was taken off the pump the blood pulsated back up in the tubing. third we connected the line to pressure tubing and cable and sure enough a beautiful art line wave form on the monitor. notified the doc, he said pull it, the nurse did, pt stroked eventually died. can we say sentinel event.

wow.

i had a patient with nothing worth trying for peripheral access. md was trying using ultrasound guidance and ended up with an arterial puncture. immediate spurting - looked like a bad movie, made worse by the patient's moving about asking, "what?? what??" when she heard the doc's muttered, "$#*!"

[teeituptom, BSN, RN]

the line may not have had a directional flow valve in line. Some brands still dont. most do some dont

[Gromit]

the line may not have had a directional flow valve in line. Some brands still dont. most do some dont

This is true. But if the line has a piggyback, the piggyback is beyond the directional flow valve, and the problem can occur then. The flowvalve will only work if its a single line. (ok, more accurately, it will still work as nothing will back up into the main bag, but it can back up into the piggyback)

[Dallas_RN, BSN, EMT-P]

Also seen this w/ patients with B/P monitor programed to cycle every 5-10minutes provided the cuff is on the same arm as the IV.

[Larry77, RN]

If I was the nurse and you pointed this out to me, I would be happy to fix it and give you a brief explanation on why this may have happened as we did here but a little advice...

I had a nursing student/tech tell a patient that because I did not put positive pressure into the saline-lock that the nurses up on the floor would have to start a new one because if they flushed the line with some blood in it that they could have a lethal stroke. This tech was cross-training in our dept and the staff tech came back from the pt transfer and took me in a room and told me a story about what happened. Needless to say I had a stern talking to this "person" then sent a email to my boss and this "person" is never to step foot in our dept as a result.

So please go to the nurse and do not say anything to, or in front of, the patient (as it sounds like you did).

[sunshineonleith]

the parents had asked me about the line, and i said that i often see blood in the line (true). i also added that as a tech, i don't do anything with ivs except take them out. they were satisfied (or at least didn't ask more questions) and i left the room. i just called the pt's nurse right away to let him know. it really sucks to have your scope of practice, whatever it is, undermined in front of your patients, so i try to never do that to anyone. if i have questions, i ask out of the pts earshot.