IV Flushing & clots

cayenne06, MSN, CNM · Feb 22, 2012

I have no idea, but I remember the first time I saw an air bubble go into a patient's IV site.... pt was fine but I just about died from fear! I really thought they were going to keel over and die. And this was in a clinic setting, so there wasn't even a code team near by to ease my mind.

I am curious about this as well.

SN22RN · Feb 22, 2012

cayenne06 said:
I have no idea, but I remember the first time I saw an air bubble go into a patient's IV site.... pt was fine but I just about died from fear! I really thought they were going to keel over and die. And this was in a clinic setting, so there wasn't even a code team near by to ease my mind.
I am curious about this as well.

Have you ever had the experience of having a hard time flushing a peripheral IV site on a pt? If so, what did you/your instructor do about it?

KelRN215, BSN, RN · Feb 22, 2012

A peripheral IV catheter is SMALL. A clot that forms at the end of it would be microscopic. You are not going to cause an embolus by flushing a difficult to flush PIV. If a patient had any kind of a significant clot at the IV site, you would expect that they'd have symptoms from it- swelling distal to the site, cool extremities, decreased pulses. There are a lot of tricks to flushing a difficult to flush PIV and it's not always because of a clot that they're difficult to flush. Sometimes we'll put a little (like 0.5 mL of 10u/mL) heparin in them if we can't get the saline to flush. If the IV really won't flush, it should be removed.

MrzAmazingRN · Feb 22, 2012

To add to what KelRN said! Think back to A&P and how the vascular system works. Our veins have valves in them that help keep the blood moving back toward the heart. These valves will close shut instantly if harm to the vein is detected. The introduction of the peripheral IV catheter is an insult/injury detected by the vein's valves. When fluids are running, the valves are open allowing blood and fluids to continue to circulate. If fluids haven't been running for a while, then the valves will close. So, when flushing it takes alittle pressure to open the valves back up. This is why saline locks have orders yo flush them when fluids are not running. As far as air goes, remember we breathe air and oxygen and CO2 are carried in the blood to the lungs and exchanged by the alveoli. If you flush air bubbles into a patient it will not hurt them! It would take a lot of air to cause harm to the patient. However, the air bubbles do freak patients out so they should be minimized, but don't waist medication trying to get all the air bubbles out. Lastly, a piece of personal advice! Try to learn hands on as much as you can during clinicals. If your going to mess something up, chances are its a minor mistake that any veteran nurse could make. Try to overcome the fear of making a mistake and be confident. You are smarter then you think, or you wouldn't be in nursing school!

SN22RN · Feb 22, 2012

Thank you all so much! Makes sense why my instructors are not concerned with pushing the PIV harder...But why do they teach us in school not to push on a difficult PIV because it will cause a blood clot to dislodge and it will kill your patient! Nursing school is so stressful!! Everytime I leave clinical I think I killed my patient...... It's not a good feeling.

psu_213, BSN, RN · Feb 22, 2012

SN22RN said:
Thank you all so much! Makes sense why my instructors are not concerned with pushing the PIV harder...But why do they teach us in school not to push on a difficult PIV because it will cause a blood clot to dislodge and it will kill your patient! Nursing school is so stressful!! Everytime I leave clinical I think I killed my patient...... It's not a good feeling.

Because nursing school always teaches about the worse case senario (these senarios are rare, but they make them seem like common place)....like an air bubble in a flush will cause death by air embolism. Or, every case of pulmonary edema causes the pt to spew pink, frothy sputum and the can't breath. While its important to know about these (the latter would be flash pulmonary edema, which is an emergency), teaching just these senarios cause students to be more afraid and have less confidence in 'normal' situations.

psu_213, BSN, RN · Feb 22, 2012

MrzAmazingRN said:
These valves will close shut instantly if harm to the vein is detected.

That would be nice, but unfortuntely veins aren't that "smart".

What does happen is the end of the cateter can end up lodged against a valve. In that case, to facilitate flushing, just pull back a little bit on the hub--not enough to pull any of the catheter from the vein, just enough to pull the end of the cath off the valve.

Unknown member · Feb 26, 2012

air bubbles freaked me out too...then a nurse told me it would take 20 mL length of air to do any damage! that made me feel better :) lol

sanczar · Oct 11, 2012

In response to the comment: "If you flush air bubbles into a patient it will not hurt them"..... This is not entirely true. Yes, we breathe gas into our lungs, but the exchange of O2 and CO2 is at the molecular level. If you breathe in 300 ml of gas, you are also exhaling 300 ml of gas - it doesn't go into the veins. So the notion that it's ok to inject air bubbles into veins because we breathe in gas is absolute nonsense. While it won't kill a patient if a few little air bubbles get into the blood stream, it is vital that we minimize those little air bubbles. Here's what happens: air bubble enters the blood stream via a vein - it travels to the right heart and into the pulmonary artery which ends up in the pulmonary capillary bed (the capillaries that wrap around the alveoli) where it will likely just dissipate. If a LARGE air bolus enters the blood stream, ie: a syringe full of air, it may get stuck in the right heart and create and air lock which would severely drop the cardiac output and therefore stop perfusion to the heart and end organs. OR the air emobolism may travel through to the pulmonary artery (major blood supply to the lungs) and create severe pulmonary perfusion problems.

So, air is not a good thing in the blood stream...try to avoid it at all costs. Second, in answer to your original question, if you are going to flush a catheter, I would recommend flushing gently, and if it does not flush, try aspirating. If it will not aspirate, don't push the issue...change the IV, or if it a central line, talk to the physician - CathFlo or tPa may be in order.

Nurse Lynette, BSN, RN · Oct 13, 2012

\ said:
Hello,
I was wondering how often or common is it to dislodge a clot from flushing IPIDs? I'm a nursing student and I've had a couple of patient's that I've had a hard time flushing their ipids. I would let my instructors know and they would come in and just push harder and flush the IV. What I think in my head is (OMG, what about dislodging a clot!). I had another instructor tell me to push on the flush (and I pushed some but I didn't push THAT hard) so I told her I can't push anything through. So, she told me to pull back on the syringe a little and then try flushing. So, I pulled back on the syringe a little bit then was able to flush the ipid. What's everyone else's experience with flushing? Do you push harder on ones that seem "stuck." It scares me to do that, but my instructors don't seem as concerned as I do?!
If someone were to dislodge a clot from flushing a peripheral IV site, how quickly can someone die after dislodging the clot?

Maybe u should try removing some of the fluid in your flush initially (before you use it), like 1/2 a ml or so. The reason I say that is bc at our facility I've noticed that the flushes are hard to push initially, and sometimes it feels like the IV won't flush when in fact it's just the plunger on the syringe that is tight. Think of it kinda like priming a line. I always prime my flush first. Just a suggestion! ?

Ginnym1981 · Oct 14, 2012

Adri ? said:
Maybe u should try removing some of the fluid in your flush initially (before you use it), like 1/2 a ml or so. The reason I say that is bc at our facility I've noticed that the flushes are hard to push initially, and sometimes it feels like the IV won't flush when in fact it's just the plunger on the syringe that is tight. Think of it kinda like priming a line. I always prime my flush first. Just a suggestion! ?

I agree with this but I have a different way I do it!

A nurse taught me to remove the lid of the saline flush, pull BACK on the syringe a tiny bit to break the suction and then remove the air before flushing.

Then you don't have to remove any fluid, it's easier to push and you don't get saline on the floor, yourself or your pt :up: