pt's arm turning white and red with IV?

[rehab nurse]

one of my patients had an iv started today, nurse had flashback, hooked up the primed IV tubing, then flushed. instantly, the anterior lower arm around the cannula turned white, then in a few seconds turned red, then back to regular color. this lady was skin and bones, there was no obvious infiltrate when flushing (and it was done several times with the same response). pt had no c/o pain. very odd. and when the iv was unclamped, it was very slow to infuse, like it was hitting resistance. however, the fluid was not infiltrating. it was very minimally pulsating up near the cannula and about half inch up the tubing.

does anyone know what this might have been? the site was d/c'd and another iv was inserted proximal to this site without problems. i have never seen anything like that in my life, just wondering if anyone else had and maybe knew what it could be.

thanks!

[unikuelady, RN]

could have been in the artery or possibly a veno-spasm.

[ARLadyRN]

I agree with unikuelady. always dc if you feel it isn't right, it probably isn't

[Medic/Nurse, BSN, RN]

Could have been

1-The IV catheter was in an artery. You must remove and choose another site. Even when necessary and done with a local, many patients complain loudly from arterial line placement. So...

2-The IV catheter was in a vein - BUT the vein lay in close proximity to an artery, so that when the line was flushed the artery was occluded. Hence, the transient nature of signs you described. (Most Likely situation)

3-Spasm of the vein in which the IV catheter was placed. Veins do not "pulsate". I think this is the least likely.

Anyway, when in doubt - just replace the site.

[Pedi-ER-RN, RN]

Sounds like it was in an artery. I know when an IV is placed in a scalp artery, the scalp will blanch when flushed.

[rehab nurse]

if it was entirely into an artery, would it have had a lot more blood pulsating out? this was very minimal, you could see it just past the catheter hub left from the angiocath and barely into the tubing. it flushed without resistance, the skin would turn white, then red. i just thought it was weird. it was my pt, but i didn't start the iv since i'm not allowed in this state. my short lived career with iv's was only when i worked in l&d, it was there i learned to place iv's as it was one of my duties after hooking up moms to the monitors.

but in yesterdays situation, line was d/c'd and a new one started without problems.

thanks for your replies!

[Gompers, BSN, RN]

if it was entirely into an artery, would it have had a lot more blood pulsating out? this was very minimal, you could see it just past the catheter hub left from the angiocath and barely into the tubing. it flushed without resistance, the skin would turn white, then red. i just thought it was weird. it was my pt, but i didn't start the iv since i'm not allowed in this state. my short lived career with iv's was only when i worked in l&d, it was there i learned to place iv's as it was one of my duties after hooking up moms to the monitors.

but in yesterdays situation, line was d/c'd and a new one started without problems.

thanks for your replies!

How fast was the IV set to run? I know with peripheral arterial lines, we use the same IV rate to keep the artery open as we would if we were trying to keep a vein open. The pressure from the IV fluid is enough to keep the blood from backing up too much. Definitely sounds like it was in an artery to me. When we draw from and then flush to clear our arterial lines, we do see the skin turn white and then pink up again.

[rehab nurse]

How fast was the IV set to run? I know with peripheral arterial lines, we use the same IV rate to keep the artery open as we would if we were trying to keep a vein open. The pressure from the IV fluid is enough to keep the blood from backing up too much. Definitely sounds like it was in an artery to me. When we draw from and then flush to clear our arterial lines, we do see the skin turn white and then pink up again.

the rate was 70 cc/hr, normal saline. i just have never seen anything like it before. what's bizarre is that you could see the nice long vein, and that's what the nurse went for, stuck, got flashback, hooked her up and she flushed with no problem. it was only when we hooked her up to the iv line that it wouldn't go. no s/sx infiltration, which you would have seen on this lol in a second. she weighed only 80 pounds, looked more like 50 to me.

[Gompers, BSN, RN]

the rate was 70 cc/hr, normal saline. i just have never seen anything like it before. what's bizarre is that you could see the nice long vein, and that's what the nurse went for, stuck, got flashback, hooked her up and she flushed with no problem. it was only when we hooked her up to the iv line that it wouldn't go. no s/sx infiltration, which you would have seen on this lol in a second. she weighed only 80 pounds, looked more like 50 to me.

You can sometimes visualize arteries on people with very thin skin. Either that or an artery was running directly in line with the visible vein and the IV cannula threaded into the wrong vessel. I'm betting on the thin skin though. We see it all the time in the NICU with our tiny preemies - their skin is transluscent and sometimes what we assume is a vein actually turns out to be an artery.