Flushing a clotted IV??

I am a newly appointed supervisor in a medical research clinic and I have an emplyoee who flushes his clotted IV's to "get them working again". Where would I find data on this practice ( or shall I say malpractice)??? I would rather confront him with solid data than with simple reason.

Thanks in advance!!

I have used TPA on picc lines with a doctors order. What is he/she doing to flush these lines? If lines are flushed twice a shift (12 hour) normally there isn't a problem. It sounds like a standard for flushing lines needs to be set up.

A few month ago I had a pt with a swanz who was HIT. Every qd, we have to recalibrate the CCO. Because I had to draw back slowly to get an accurate mixed venous, she developed a clot on the end of the cath and TPA is not an option. I went home sick with dread (happened @ 0400). The doc d/c'd the SC and luckily she didn't develop a PE. I consulted with my Clinical Resource Nurse and she assured me that I was not at fault. Still....any thoughts out there? Experienced ICU RN's, any input??

If he's flushing by just pushing the clot through, he's endangering his pt. If it's using a thrombolytic with a doc's order (and this shouldn't be done with a periph IV) then that's a different story.

I kind of wondered about that practice, but I have seen multiple nurses do this in the clinical setting, so this nurse is not the only one. If you come up with data - one way or the other - I would love to hear about it.

OP: Are we talking about peripheral IVs or central lines?

peripheral IVs that we pull blood from and flush every 5,10,15,30min and again at the 1,2,3,6,8,12 hour marks. I know that this is incorrect to do in ones practice but I want to teach this person the correct way rather than dictate to him what he will be doing.. I beleave this will benifit him as well as our unit and out patients...

Thanks for the replys!!!!!!!

peripheral IVs that we pull blood from and flush every 5,10,15,30min and again at the 1,2,3,6,8,12 hour marks. I know that this is incorrect to do in ones practice but I want to teach this person the correct way rather than dictate to him what he will be doing.. I beleave this will benifit him as well as our unit and out patients...

Thanks for the replys!!!!!!!

In my unit, unless there was no choice, we were not supposed to draw blood from an peripheral IV, only central lines or art line. A peripheral will clot off easily if blood is being drawn from it. I have seen nurses use a 1cc syringe to clean out a line that was clotted off and not only is this wrong, it can blow the line above the clot and now you may have a line that infiltrates. When I see a nurse do this I let them know. My concern is the patient and not if someone will get upset at me. I get along well with the nurses I work with and I help, even when i am swamped but I still give my opinion when I see anything that is not correct procedure. We also have an excellent educator and I consult with this person all the time for continual updates and edification.

I was ready to flush a cordis, but prior to doing it, I pulled back because there was visible blood in the line, I literally aspirated a huge long clot the size of the catheter that was at least 4 inches long.

By the way, the Cordis was clamped off (heplocked). I don't think these should ever be without some type of TKO fluids continuously running.

I also believe that if a cordis is not in use, it doesn't need to be in.

A peripheral will clot off easily if blood is being drawn from it.

We routinely draw labs from #20 A/C INTs (ICU setting) if they don't have an art or central line. When drawing, we draw just as you would off any other line. Never had any problems with them clotting off.

I have drawn a number of times myself when blood draws could not be done by the tech because she/he could not find a vein but my charge nurse, if she found out, always got upset with me. Flush well, draw easy and flush well and I don't see any problem but again, where I worked they had a tabu against it. I have seen other IV's that nurse had drawn from clot off because they did not flush well with turbulance and this is the main reason we were not supposed to do it. From practice I agree it can be done without a problem but it seems, at least where i was, a number of nurses did not flush in such a manner as to keep the IV open. This was on locked IV's that I am talking about.