IV hub clotting up!

[UrgentLiving]

Why is blood backing up into the IV catheter colored hub ??

1. Patient A - at start of shift, I noticed there was blood back up to the level of the saline lock/tubing extension (tubing was clamped properly), I also noticed the IV catheter hub had a pool of blood. I thought this was due to the previous shift not flushing. I restarted an IV, and removed the old one.

2. Pt. B - early on the shift, I had restarted this patient's IV, I flushed and clamped it. When it was time to infuse, I noticed the new IV catheter hub had a bit of pooled blood even though it hadn't been more than 2 hours since the the catheter had been inserted and flushed! I had to restart as it could not flush or draw.... Upon removing the recently inserted catheter, I noticed the blood had also clotted up.

What's up with this? Any tips?

[ProgressiveActivist, BSN, RN]

Some possibilities :

tourniquet left on

NIBP cuff above the site

hypertensive

Pts who are anticoagulated will have a blood tinged back up into the jloop.

Did a lab tech draw from the PIV?

Clogged ports are a sign your patient is using it to shoot up.

[AgentBeast, MSN, RN]

Are these iv's in the AC or across a joint? Whenever the patient bends his or her elbow or moves the joint a little saline is shot out and when the elbow straightens blood gets sucked in. See it all the time.

[THELIVINGWORST, ASN, RN]

Why didn't you just change the hub instead of reinserting the IV?

[UrgentLiving]

Yes, pt. A had an AC IV. Patient B was back of hand, near her knuckle. Thanks for pointing this out.

[UrgentLiving]

well, the colored hub of which I was talking about was the actual hub that is part of the IV catheter, where the "push-off plate" sits. (I looked up these terms on google). So, essentially, it's the widest part of the catheter itself. But I see where you were going with the advice. Thanks.

[iluvivt, BSN, RN]

Do you know what kind and type of needleless connector (NC) you are using (brand name and type: neutral, negative or positive displacement). The reason I ask is that one main reason VADS back up and clot is due to inadequate flushing procedures. Yes, there are other reasons such as applying a BP cuff on the same side as a locked VAD, patients with excessive coughing or vomiting,a disconnection or pinpoint hole in tubing or catheter that creates an air source or site placed at an area of flexion and small catheters that tend to clot off more easily due to their size.

It's the body's natural tendency to want to form a clot on this foreign substance it encounters and thus the frequent flushes. Within minutes of placing any VAD the body also starts to add on a layer of fibrin on all VADs! If you tell me the brand name and type I can tell you the proper sequence of the flushing. Each type of NC requires a different type of flush and if done correctly can really make a huge difference in maintaining patency!

[IVRUS, BSN, RN]

ILUVIVT, you are so right ON.... again.... LOL...

Do make sure that the IV catheter has its extension tubing CLAMPED, and always use an extension set on your peripheral IV's. When an extension set is NOT used, there is so much manipulation at the site each time you go to flush or give a med/solution that you damage the inner lumen of the vessel and start the process of phlebitis/thrombus formation. And, know your needleless connector... as ILUVIVT "stated", how you flush, and the sequence of clamping to prevent blood reflux, is dependant on what type of needleless connector you are using (Negative, Neutral or a Positive Displacement Device).