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.
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.
If it won't flush, if the pump alarms occlusion repeatedly, or the pt c/o pain, the HL comes out. It's no good. allowing the site to limp along for 7-8 more hrs only means the next nurse will have to change it.
I don't like it when "the next nurse" is me. I try not to do that to someone else.
Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.
I try to flush first, before aspirating for a blood return. I take a good look at the site, too - if it's red or puffy or gross-looking, I won't force it. I have heard that the new guidelines from the society of infusion therapy nurses or whoever don't recommend checking for a blood return, not sure what the rationale behind that is but it might be worth looking into.
I'm pretty awesome at not unlocking the slide clamp, too. But generally to "save" IVs, I do things like put a new Veniguard on, try my best to flush it, reposition the patient's arm, and if all else fails, I restart it in a different location.
Sometimes the part of the saline lock that the syringe screws into goes bad. (The part on your end, not the pt's end.) Occasionally replacing that part works. Ours come off so you can directly attach the SL to the IV fluids if you want - don't know if all SL's have an end the comes off.
Sometimes I take the tape and op site off, pull the catheter a teensy bit out, and it flushes. Maybe it was up against a valve or just a bit at the wrong angle. Or sometimes, like the above poster said, the catheter is a bit kinked.
I hate restarting IV's, so I usually try hard to save it. If the pt's stable or going home in the morning, sometimes I call the doc and see if we can give everything PO and not restart the IV.
I always take down the dressing first, clean the site, then check to see if the cannula is bent or kinked. If so, it might can be saved. If clotted, I would never force a clot thru. When you have a saline lock with a clamp, always flush it, then clamp it while the empty syringe you just flushed with is still connected, then remove the syringe. Don't flush it, then remove the syringe, then clamp it. This will keep any blood from backing back into the cannula and causing it to clot. Ask your nurse manager/charge nurse, etc., to educate the staff on flushing saline locks, and to keep IV's from running dry. A little maintenance goes a long way, and nobody wants to have a patient go bad, then realize their IV is no good.
Another thing to try it just to pull back a little bit on the hub. Not enough to pull the catheter out, but the end of the catheter may be sitting against a valve or the wall of the vein and not actually "clotted off." The little pull back moves it enough to allow the IV to flow again.
TRUE, but only on aspiration.. If you are instilling or flushing an IV catheter, the smaller syringes exert MORE pressure.
But to answer the OP question, I would try hooking on a 5 cc syringe with approx 2 cc NS in it and gently aspirate. then try to flush, gently aspirate, then try to flush. I've successfully, pulled back a fibrin strand in almost 99.9 % of the cases. Then discard the syringe and have a new syringe filled with NSS, and flush it.
common misconception. the physics argues against it, though.
next time you are in the hospital, take a 1cc syringe and a 10cc syringe, fill them both up, aim at the ceiling (not over the computer, please) then push as hard as you can on each. observe how high the water goes.
Ooo! This is a good question. I'm a third semester nursing student and last week, my patient was getting her potassium replaced. I added 10 mg 1% lidocaine and even one of the nurses had to dilute it with an extra 500 ml bag of NS because the pt c/o burning. She had to go down to CT and the doc wanted IV con in addition to PO contrast so the break nurse asked me I could saline lock her. As I was attempting to flush, she winced in pain and I noticed a small area of redness as well as firmness, there was definitely resistance. The break nurse came in and inspected the site, then asked me to d/c the IV which I did. I felt bad because she had been poked four times the day prior and I knew getting another IV site with a vein big enough for the power injector would be an issue. I felt really horrible that I did something wrong because her potassium was infusing without any apparent issues just prior to me saline locking her. Was there anything I could've done differently? The nurses said there was nothing I could really do since we all know potassium is very irritating to the veins and can cause them to blow fairly easy. Any insight would be appreciated, thanks!
If we're talking about occluded PICCs, we use Cathflo/alteplase if there's still a chance you can instill medication.
As for PIVs, I've always felt guilty about pushing through a fibrin clot as Viva has mentioned but sometimes....sometimes it's the only resort I've got. I'll do a few Hail Marys for that tonight.
On the topic of high-pressure/low-pressure syringes... I was wondering: Our 3cc saline syringes switched a couple years ago from the long skinny ones to basically what looks like the same barrel width of a 10cc syringe just shorter. I assumed this relieved the issue of accidentally using a high-pressure syringe on a central line but is there any basis behind my idea?
Wrong. Smaller exert more pressure. Try it. Take an insulin syringe and fill it with one cc. Take a 3cc 23 g and fill it with one cc. Push both plungers at the same time and see which stream goes the farthest.
Clue: The smaller insulin syringe will always go the farthest.
Cuddleswithpuddles
667 Posts
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 :)