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Discussion

Fixing occluded peripheral IVs

Hello everyone,

I would like to know if it is OK to fix an occluded peripheral IV by using a 3 cc syringe instead of a larger syringe. I know that smaller syringes exert more pressure into the lumen and are not OK to use with PICCs, but I am unclear as to whether or not this is OK for plain old peripheral IVs.

My facility does not have any rules against it (and, no, we don't need a doctor's order lol!) and my Google searches only turn up results for PICCs.

Also, I'd like to hear your tips and tricks on fixing IV locks that have occluded despite regular flushing and all the usual standard care.

Thanks guys!

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    • Guides

    I've been out of bedside practice for only a couple of years, but never heard of declotting a peripheral IV or saline lock. When a PIV/SL clots off, you either change the site or get the doc to D/C it.

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    • Author

    On second thought, declotting is probably not the best word for it.

    I am talking about fixing an IV that does not flush or aspirate. Sometimes it is difficult to put a new one in and I want to "save" it before having to start a new one.

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    What system or brand of cannula / tubing do you use?

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    • Experts

    I have only "fixed" one, on a guy that the off-going nurse warned me that it took a handful of nurses to stick him and to guard the site with my very life! She told me that the site was sensitive to hand positioning and the pump was constantly going off, but a hand reposition fixed it.

    It was fixable beyond repositioning. I could see through the tegaderm that somehow the catheter had kinked outside the entry point. I would suspect it had happened as the successful nurse put on the tegaderm. I VERY carefully removed the tegaderm, straightened out the catheter, and reapplied a new tegaderm. Voila! Fixed.

    Sometimes blood return isn't the best way to assess patency. Valves could close, the vein could be small and sensitive to aspiration pressure, etc. However, if it doesn't flush, and there are no catheter kinks (admittedly, I think that's a rather rare occurrence), you need a new site. The only things I could think of that would prevent a flush are clots. Sluggish flushing could be that the catheter has migrated out of the vein, and you'll see leaking or a small bump form upon flushing.

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    I've been out of bedside practice for only a couple of years, but never heard of declotting a peripheral IV or saline lock. When a PIV/SL clots off, you either change the site or get the doc to D/C it.

    Considering the fact that small clots are usually what occlude a peripheral IV, I think it's odd that you would just change the IV site instead of flushing it to get the clot to move. I am constantly flushing clotted lines to get them to run again (usually thanks to other nurses leaving my patients high and dry when they don't replace the bags before the end of their shift). I use either a 3cc or a 10cc, whatever is in my pocket. I use the 10cc for piccs, of course.

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    • Guides

    I was trained to start a new IV whenever a saline lock became occluded because of the risk of forcing fibrin clumps into the circulation, or damaging the vein by pushing against resistance. Like I said, I've been out of bedside nursing for a while....things change.:)

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    • Experts
    Considering the fact that small clots are usually what occlude a peripheral IV, I think it's odd that you would just change the IV site instead of flushing it to get the clot to move. I am constantly flushing clotted lines to get them to run again (usually thanks to other nurses leaving my patients high and dry when they don't replace the bags before the end of their shift). I use either a 3cc or a 10cc, whatever is in my pocket. I use the 10cc for piccs, of course.

    I've seen nurses slam 'em. I'm not comfortable doing that.

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    • Experts

    Smaller syringes exert less pressure not more.

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    The smaller syringe exerts more pressure than the larger syringe. It's fine to use a 3cc on a PIV. Remember to visualize the PIV itself -- it's only about 1-1/4" long give or take, depending on brand and gauge size.

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    • Author
    What system or brand of cannula / tubing do you use?

    We recently switched to Clearlink tubing systems. I am not sure what brand IV catheters we have now but they are just the standard over-the-needle ones.

    Clearlink requires the lock to be clamped when not in use. The previous system did not. An unclamped Clearlink allows a little bit of blood to get backed up into the lock. I am sure this is a huge reason why I am having to fiddle with IVs lately.

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    • Author
    Smaller syringes exert less pressure not more.

    Think of blowing into a straw coffee stirrer vs. a garden hose. Lots more pressure in the teeny tiny hole of the stirrer.

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    • Author
    The smaller syringe exerts more pressure than the larger syringe. It's fine to use a 3cc on a PIV. Remember to visualize the PIV itself -- it's only about 1-1/4" long give or take, depending on brand and gauge size.

    This was my thought as well. PIVs are much shorter and will theoretically "relieve" itself of pressure through its end much more readily than a long PICC. With PICCs, the excessive pressure can build up through the entire length and cause it to rupture.

    Regardless, I have no intention of using a more aggressive 3 cc flush as the first line of defense. I'll continue to be routine IV care-happy. I'll ask around work to try to get an "official" answer.

    Thanks everyone :)

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