Pushing flush too slow?

[Birdy2]

So the other night I was trying to flush a patients iv that had NS @75. I was giving morphine. So I flushed a little, gave the morphine slowly, then went to flush and was push/pausing it but it stopped flushing. It was fine and then all the sudden wouldn't push. I didn't move the iv, pushed the morphine slow like you're supposed to, and it just wouldn't flush. Then it started swelling up. It had infiltrated but I'm just wondering what I did wrong. The iv was obviously in before I gave the morphine but then it blew after I gave it. Some nurse told me I could have pushed it too slow. She said u can push it too fast and too slow but I don't understand. Can anyone explain this and what I did wrong?

[Lev, MSN, RN, NP]

I don't think you did anything wrong. Sometimes things happen.

[Birdy2]

Well ok. Do u have any idea what she was talking about when she said sometimes you can push it too slow? She was referring to the morphine. How could that make the iv blow?

[Esme12, ASN, BSN, RN]

I have not heard of pushing too slow can cause an infiltration.

[klone, MSN, RN]

Well ok. Do u have any idea what she was talking about when she said sometimes you can push it too slow? She was referring to the morphine. How could that make the iv blow?

No idea what she meant by that. I have never heard of that happening and I don't see how what she said is logical.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

Not knowing the specifics about your patient, I'll just say that, in my experience, patients who receive IV narcotics frequently tend to need several re-establishments before they are discharged. Some of these folks average restarts twice a day.. This is common for frequent flyers (not saying that this is the case for your patient) because trust and believe that when you don't see them, they are not just sitting around at home doing the best they can. Some of them are actually frequent flyers at other locations until the list recycles. After a while, venous access or maintenance is nearly impossible. Your administration may have just been the limit on that particular site.

But pushing to slowly leading to infiltration? I've never heard of that. However, if a patient has clotting issues involving really thick blood, it is possible that an occlusion could occur and your attempt to 'unstop' the catheter at its tip could have blown the vein. I would suggest, moving forward, if the medication to be pushed is compatible with the maintenance fluids, use one of the other access ports on the infusion line below the filter. That way, there is no need to pause the IV fluids, and the medication is delivered at a steady pace.

[Birdy2]

This patient had to have 3 started one day. We just couldn't keep them in and she was most impossible to stick. I think 6 people tried one day. This last time it blew we had almost run out of places and that one was like right below her pinky. I think what I might have done is push the lass flush a little too hard and it just came out. As far as I know she didn't have any clotting issues but maybe that's what that nurse meant, that if its clotted u can push it too slow.

[Loo17]

What gauge IV were you using? I have found that those with delicate veins (someone on long term prednisone) does better with a smaller gauge IV (22g or 24g) even if the vein appears larger enough to handle a bigger size. When starting an IV on someone with delicate veins I also try not to use a tourniquet. When pushing meds when fluids are running I go very slow and usually use a port farther away if I know the patient has fragile veins. If the patient does not have fluids and I know they have bad veins I make sure there are orders to flush Q8H to maintain the line and try to prevent a clot and I flush slow. Sometimes the veins blow regardless though.

I am not sure what the nurse meant about going too slow, maybe they were just trying to say sometimes it happens no matter what you do. It does not sound like you did anything wrong.

[Birdy2]

Pretty sure it was 22. Like I said maybe I just pushed a little too hard with the after flush, since it was in such a small vein. I'm used to push pausing like that to prevent clots. I will take your advice and use port farthest away next time I'm dealing with fragile veins and try to push slow for the flush. Thanks for all the advice!

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

This patient had to have 3 started one day. We just couldn't keep them in and she was most impossible to stick. I think 6 people tried one day. This last time it blew we had almost run out of places and that one was like right below her pinky. I think what I might have done is push the lass flush a little too hard and it just came out. As far as I know she didn't have any clotting issues but maybe that's what that nurse meant, that if its clotted u can push it too slow.

Pinkys, thumbs, feet.....sure signs of 'it's-just-a-matter-of-time' before its a done deal.

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

One other thing that is helpful with those delicate sites is using a smaller syringe to flush with. For example, if you have a size 24g on a thumb or pinky, sometimes the pressure from the 10cc flush syringe is too much. I don't know if your hospital uses them or not, but there is a smaller prefilled saline syringe (3 & 5cc), or simply extract the saline into a smaller syringe from the larger one.

[FlyingScot, RN]

One other thing that is helpful with those delicate sites is using a smaller syringe to flush with. For example, if you have a size 24g on a thumb or pinky, sometimes the pressure from the 10cc flush syringe is too much. I don't know if your hospital uses them or not, but there is a smaller prefilled saline syringe (3 & 5cc), or simply extract the saline into a smaller syringe from the larger one.

You might want to check your facts about this.