HELP! My periepherals always leak after flush

iluvivt, BSN, RN · Aug 25, 2008

Ingy RN, You are probably not doing anything wrong. There is no guarantee that because an IV site was working wonderfully for the previous nurse that it will work that way for you. All IV sites "go bad" eventually. I find that most sites last 48-72 hours in the adult population. Some,that have only isotonic fluids or heparin drips tend to last longer. Let me ask you a few ?s and throw out some suggestions. What patient population are you serving? The elderly tend to have thin skin and fragile veins,especially diabetics and those on long term steroids. In these cases,try to place the smallest shortest catheter that will meet your needs. That way the venipuncture site is small and there is less backtracking. Also make sure you are not taking any BPs above the site as this will congest the vein and can cause leakage...this is particularily true the older the site gets. Also once a site is 72-96 hours old just expect for something to happen soon,such as phlebitis,infiltration or leakage. Be proactive and change the site. Another thing to consider is the syringe size you are using. Smaller syringes generate more pressure with flushing and medication administration. Switch to a 10 ml syringe if you are not using that already. The next key issue is to make sure the cannula is properly secured and that the tension is on the IV tubing and not the site. IV sites that are constantly getting tugged on will leak and usually within 24 hours of insertion. Lastly,avoid areas of flexion,the movement in these areas can cause all the common complication. If you have to use an area of flexion,use an armboard as this still is the standard of care even though many skip this step. I bet you though the sites are just getting old!!!! let me know what you think or provide more info so I can Help!!!

IngyRN · Aug 25, 2008

iluvivt,

Thanks you soo much for all your suggestions. They all make perfect sense! Just returned to bedside after being out for 6yrs. I now work on a neuro med/surg. The population is just as you mentioned elderly, diabetic ( not so much the steroids) and most of the lines were ~72 hrs old (our protocol is to change q92 hrs). I did not take into consideration the BP on that arm. I will certainly keep that in mind. I just assumed I couldnt take the BP over the site (although I have seen others take BP right over a picc or peripheral line- will it cause the same harm to a PICC? ( my preceptor is under the impression that it will not). We have prefilled syringes (5&10 cc) so I use the 5cc. I spend the tomorrow morning w/an IV nurse- I am scared to death-any tips to not drive her crazy?

iluvivt, BSN, RN · Aug 27, 2008

Sorry I missed giving you some tips...hope you learned a lot. The INS (Infusion Nurses Society) recommends PIV site changes every 72 hours and the CDC recommends them every 72-96 hours. The bottom line is though when it is bad..... it is bad....do not try to save an old line...DC it and re-site it. Your thinking is correct with regards to the PICC line....you should avoid taking a BP above a PICC site. You can ,however,take it in the lower forearm with the radial pulse. Taking a BP can increase the risk of clotting and other complications such as thrombosis. So take the BP somewhere else. Sometimes we have had to take it in the leg,especially when we run across apt with only one arm!!! Most infusion protocols recommend this as well. Try my tips and see if this helps you. Also,make sure your co-workers are not leaving you sites that are older than 96 hours...so the work is spread out.If you are about to give something irritating with a ph of less than 5 or greater than 9,such as Vancomycin (approx 2.2) and the site is 96 hours old you should just re-site it. this is a common mistake nurses make. They wait until there is an infiltrate a leaking site or a phlebitis. Always find out how old your site is.... Anything else just ask....Mary

IngyRN · Aug 27, 2008

Thanks for all your help. You are a great resource. I am sure I will have more questions in the future. Thanks again!

iluvivt, BSN, RN · Sep 5, 2008

Just thought of one more thing to tell you. 50% of ALL IV-(PIVs) site related complications occur at areas of flexion,and this includes the ACF. Most nurses are under the impression the ACF is a good site. The reality is the ACF should be avoided (If possible). Not only is it an area of flexion there are nerves and arteries very close to the surface that can be easily damaged with IV therapy related complications. These veins should also be preserved as blood drawing veins. So try to avoid placing IVs at areas of flexion. If you must use the ACF trace the vein up or down and get it close but not in the bend. I realize that these locations are requested by the CT techs and then inpatients come to the units and these PIVS are being used.

IngyRN · Sep 6, 2008

Why is it that PIV's clot off when a running IV completes infusion and is left connected. Like when an IV abx (Vanco in particular) completely infuses but the line is not detached and line line flushed immediately??

iluvivt, BSN, RN · Sep 8, 2008

Think of an IV as a tube inside a tube. When an infusion is complete that tube (catheter) is still sitting inside a vein that has blood flow. Not only can blood refux back into the tube, but remember that any foreign substance can initate the clotting cascade. So what is it going to do......Clot off. The best thing you can go on any PIV or CVC is immediately flush after the completion of any medication. I have even had a 3Fr and 4Fr PICC clot off right after insertion b/c I did not flush it fast enough.