IV lines

[Elena88]

Question for experienced nurses...do you have tips and tricks for stopping backflow of blood into the line or the bag of fluids when the fluids don't need to be run under pressure?

Especially if the line has to be disconnected for patient to get up or for administering something else in between. I did this and the blood in the IV line made its way back to the bag so we had to change the whole bag of fluids. Also is it correct to change the bag if there's some blood in it from the patient's own cannula?

[Wuzzie]

If you're talking about fluids infusing via gravity just raise the bag.

[Rocknurse, MSN, APRN, NP]

Why can't you simply clamp the line?

[Elena88]

The line was clamped higher near the bag but there was a small amount of backflow of blood near the cannula when disconnecting from the patient. Then one of the healthcare assistants told me there was some blood in the bag so she'd changed the whole thing to a new bag. Which now thinking about it, the blood shouldn't have back flown into the bag past the clamp...So then is there a need to change the whole bag for a small amount of back flow in the IV line itself or can that just be reconnected?

[Double-Helix, BSN, RN]

Unless you clamp the line while you are flushing, you can get a small amount of backflow into the catheter hub or tubing. No, there is no need to change a bag or tubing due to a small amount of back flow in the tubing of a general IV fluid. You would simply flush the tubing into the catheter. If there is a significant amount of back flow and your fluids cannot be flushed/bloused (if you're running vasopressors, for example), you would change the bag.

In no situation should blood back up past a clamp. If the line is clamped anywhere, there should be minimal backflow at any point in the tubing/system.

[Wuzzie]

If it's just a small amount of blood in the line you just flush it but if it's in the bag you need to change it. Please tell me though what a health care assistant was doing changing an IV bag? They shouldn't be touching them.

[JKL33]

There is usually a clamp of one kind of another on the cathether set itself (i.e. closer to the point of insertion) that can also be utilized.

[Guest219794]

1- Blood in the bag is a problem. Unless you put the bag lower than the patient, this should not be possible. In order for blood to travel up a line, the pressure in the blood vessel would have to be higher than the pressure in the line. Veins have low pressure, but arteries have high pressure.

2- PT care assistant changing a bag of fluids? What environment?

3- To clamp or not to clamp? It depends on what kind of caps. There are positive displacement caps. I believe when these are clamped in the wrong sequence, it actually negates the abilities of the cap, and is more likely to cause back flow. With these caps, the correct technique is to flush, remove syringe, then clamp- if you clamp at all. I thinkhttps://www.youtube.com/watch?v=i_8TB17uEmM

Read this thread.

[Guest219794]

1- Blood in the bag is a problem. Unless you put the bag lower than the patient, this should not be possible. In order for blood to travel up a line, the pressure in the blood vessel would have to be higher than the pressure in the line. Veins have low pressure, but arteries have high pressure.

2- PT care assistant changing a bag of fluids? What environment?

3- To clamp or not to clamp? It depends on what kind of caps. There are positive displacement caps. I believe when these are clamped in the wrong sequence, it actually negates the abilities of the cap, and is more likely to cause back flow. With these caps, the correct technique is to flush, remove syringe, then clamp- if you clamp at all. I think

[Guest219794]

[video=youtube_share;i_8TB17uEmM]

[psu_213, BSN, RN]

The line was clamped higher near the bag but there was a small amount of backflow of blood near the cannula when disconnecting from the patient. Then one of the healthcare assistants told me there was some blood in the bag so she'd changed the whole thing to a new bag. Which now thinking about it, the blood shouldn't have back flown into the bag past the clamp...So then is there a need to change the whole bag for a small amount of back flow in the IV line itself or can that just be reconnected?

I'm a bit confused here. The line was clamped and then disconnected from the patient? Even if it wasn't clamped, there would not be any blood into the bag (just whatever fluid was left in the line/bag all over the floor). If the lock tubing is not clamped, some blood can back up into the lock tubing when the bag of fluids is disconnected from the lock--still confused about the bag though.

Also, I too would like clarity on who the "heathcare assistants" are and why they are touching a bag of IV fluid. Is this the US?

[Elena88]

This is the UK, some of our HCAs (healthcare assistants) can have training for cannulation although they don't normally put up IV fluids or flush lines so I'm not sure if this HCA did that with supervision from someone else.

The line was clamped and disconnected from the cannula so the patient could go to the toilet (young fit person with stable vitals). This is in the emergency department. I clamped the line, disconnected with a small backflow from the cannula into the line. Then before I had the chance to see the patient after he returned from the toilet to reconnect his fluids, I was told the bag had blood in it so she changed the whole thing. I just can't understand how the blood could have gone past the fully shut clamp to get into the bag.

On a separate note, maybe in this case it would have been better to flush the line via the line flush port, then clamp then disconnect?

The bag was not lower than the patient, it was on the IV hanger attachment behind and above his bed and his cannula was antecubital fossa

this is the giving set used: Baxter IV Fluid Giving Set - Supplied singly or in boxes of 1