Q in re Preventing Angiocath Clot

[solneeshka, BSN, RN]

Hello, all! Nursing student here getting ready to graduate and start working on an acute medicine floor in June. I have an angiocath question that I have to get cleared up. If you have a bag of fluids running and the bag runs out, does that create a risk that the angiocath will clot off? I had an instructor tell me that once and she was always on us to be sure to watch the clock and not let a bag run all the way out. We were either to disconnect it before the bag was finished (if there were no more fluids ordered) or else change out the bag before it was empty. But in clinicals, I see it happen all the time. So what's the scoop? Do I need to be worried about this or not?

[CraigB-RN, MSN, RN]

Yes.

Just because it happens all the time doesn't mean it isn't a problem. If it's missed long enough, you run the risk of you angiocath clotting off, making it unusable. that's why saline locks are flushed routinly.

[solneeshka, BSN, RN]

I definitely get that just because I see other nurses do something, that doesn't mean it's the best way to handle it, and I know that SL's get flushed once a shift to confirm that they are patent and help keep them that way. But that's just once every many hours; my instructor was very adamant that a line shouldn't be connected to a patient for even a moment unless there was something actively running through it. I'm not talking about not leaving an empty bag hanging for two hours, I'm talking about making sure we disconnect the bag before it's empty at all. That was the reason she emphasized for always using a flush bag; yes, it can help you get more of the IVPB med out of that line and into the patient where it belongs, but the bigger reason was to give you more time to get into the room when the IVPB was finished, because even though that fluid wasn't running anymore, the primary bag would be and since the line was still infusing that meant it wouldn't clot off.

My point with observing that other nurses don't seem to worry about this is that their patients will have empty bags connected for at least a little while, but it doesn't seem to be an issue that their patients' SLs are clotting off and having to be replaced. Are they just lucky? How do you handle it? Do you just get in as soon as you can when you know a bag is due to be finished, but maybe you'll be there a little afterwards? Or do you make a specific point to be in the room before the bag is finished, so that you can disconnect it without a moment of having an empty bag connected? (This was how we were supposed to handle it.) I'm not averse to doing it, I just want to know if I really need to be before I go to the effort!

[PAERRN20]

Why aren't these fluids on pumps? If it's a medical floor they really ought to use pumps so they know not only when the bag is empty but also an accurate input.

I wouldn't worry if the bag was dry for say a half hour or hour, but really you should get the bag down as soon as it's empty. Then flush the line. Saline locks are usually flushed q shift. But again, fluids really should be on the pump.

[solneeshka, BSN, RN]

I'm a little confused about bringing up pumps...the fluids are on pumps. And they do beep when the bag is empty. But they beep in the patient's room, and at that moment, I probably will not be in the patient's room, chances are I will be in another patient's room taking care of something else and not hear the beep. I know the SL's need to be flushed, but my question is, do angiocaths clot off if you leave them connected to a bag that's run empty for a brief amount of time? Not a couple of hours, just maybe a minute. For example, my instructor freaked out once when I connected the line to the patient and *then* set the volume and rate on the pump. And it wasn't for a pump safety issue, her concern was that connecting the patient to the line without fluids actively running could lead the angiocath to clot. I mean, she *leapt* to disconnect it!

I don't know if my question is confusing or something, so let me try asking this way: In general, if your patients' bags run out before you get to the room, do you find that the angiocath tends to clot off?

[PAERRN20]

It won't hurt it to leave an empty bag connected for a few minutes. It's basically like a saline lock at that point.t won't clot off. The reason I mentioned flushing q shift is because the locks are only flushed q8 hrs and they don't normally clot off in that time frame. The pump will switch over to a KVO rate usually so that gives you some time to get there. Also keep the clip on the extension set clamped. That'll help prevent blood backflow. Not sure why your instructor acted the way s/he did. Hope that helps.

[solneeshka, BSN, RN]

It won't hurt it to leave an empty bag connected for a few minutes. It's basically like a saline lock at that point.t won't clot off. The reason I mentioned flushing q shift is because the locks are only flushed q8 hrs and they don't normally clot off in that time frame. The pump will switch over to a KVO rate usually so that gives you some time to get there. Also keep the clip on the extension set clamped. That'll help prevent blood backflow. Not sure why your instructor acted the way s/he did. Hope that helps.

Thank you! Another question: How do I keep the extension set clamped, since it needs to be open for the med to flow out of it...there's a step in here that I'm missing...

[PAERRN20]

Thank you! Another question: How do I keep the extension set clamped, since it needs to be open for the med to flow out of it...there's a step in here that I'm missing...

The extension set clamp will only be closed if there are no fluids running. That will keep blood from following up into the extension set tubing. Blood sitting in the tube can make a line clot off faster, so that's the rational to keep the clamp closed when fluids aren't running.