Question about flushing lines

luv2b_a_nurs · Jun 1, 2011

If I can't flush it easily at first I'll reposition the catheter. Sometimes the tip gets bent, especially in the AC. I had two of these this week! If I can't flush it, I pull the IV out. No way would I take a chance and push too hard as to dislodge a clot.

AgentBeast, MSN, RN · Jun 1, 2011

Odd/possibly dumb question:
Why is it that it's OK to flush an IV line when it's clotted and not running? I know we do this all the time, but I cringe every time I do it because I am literally shooting a clot into the person's vein. Am I missing something???

It is never okay to just flush a clotted line. As the previous poster stated you can try and reposition it as sometimes the tip of the cath can get a "kink" in it, but usually it's best to just remove it.

JustEnuff2BDangerous, BSN, RN · Jun 1, 2011

It depends, really, on how long the IV has just been sitting there with nothing running through it. Most hospitals have a "flush IVs not in use every ____ hours" but nobody really abides by it. If the IV has only been sitting a few hours and has a "clot", chances are the "clot" is not big enough to do any damage to the patient (usually its just a teeny tiny "clot" on the very end of the catheter, only big enough to clog the hole).

demylenated, BSN, RN · Jun 1, 2011

It depends, really, on how long the IV has just been sitting there with nothing running through it. Most hospitals have a "flush IVs not in use every ____ hours" but nobody really abides by it. If the IV has only been sitting a few hours and has a "clot", chances are the "clot" is not big enough to do any damage to the patient (usually its just a teeny tiny "clot" on the very end of the catheter, only big enough to clog the hole).

^^^^ What they said, plus we use heplock solution to help dissolve any blood (clot). I always pull back to see "what" it is I may be dislodging... that submerses it into the heparin solution...

Plus as everyone else said, reposition... It could be up against the vein wall or a valve... If you can't flush it easily, and you have to apply too much pressure (which is relative), the D/C for sure!!! Most of the time, it is sluggish, and just needs cleaned out with some hep-lock solution.

getoverit, BSN, RN, EMT-P · Jun 1, 2011

...(usually its just a teeny tiny "clot" on the very end of the catheter, only big enough to clog the hole).

Remember, the diameter inside an IV catheter is bigger than some capillaries/collaterals. A dislodged clot from there could easily occlude a coronary or pulmonary vessel.

cabanaboy · Jun 1, 2011

Has anyone actually heard of this being a problem, or know of any research regarding this issue?

Flo., BSN, RN · Jun 1, 2011

Has anyone actually heard of this being a problem, or know of any research regarding this issue?

I was thinking the same thing. It reminds me of the old "you got to get every tiny air bubble out of the syringe" thinking.

MunoRN, RN · Jun 1, 2011

It's important to remember that in the venous system are not the same as when they are on the arterial side. Not all clots are the same either, some are full of fibrin and hard, some are more like room temperature red jello. Next time you D/C an IV, make sure you don't flush it prior to D/C'ing, then after you take it out flush some saline through it into a specimen cup. Often times you'll notice a small cylindrical soft clot comes out, this is what get's "dislodged" when you flush, not all clots occlude the lumen so you may not notice when you flush one out of the IV and into the vein.

I once found a large clot in a Cordis introducer that wasn't occluding the lumen, but would clog the cap when aspirating. I took the cap off and pulled it out and it was about an inch long and the diameter of the cordis lumen which is almost 3mm. Ever since then I've noticed that if I aspirate first I can find these "IJ worms" about half the time. I saved one and showed to the surgeons on rounds and none of them seemed at all concerned, so I gave one to our CNS's who supposedly did some investigating and found that it was no big deal. I agree that a clot that size seems like something that shouldn't be in their vein, but if that supposedly isn't something to worry about than a 22 gauge clot certainly isn't.

The concern with aggressively trying to flush when a catheter is occluded is more with damaging the catheter itself, or the vein, and having a piece of the catheter break off, since it will never dissolve like a clot will.

ICUenthusiast · Jun 1, 2011

Since a central line and clots got brought up, what do you guys do for clotted centrals?

In our ICUs, the RN's can order TPA x2 (it's like 3 cc)for each clotted line per protocol.. out on the floor, a MD has to order, and I think a ICU RN has to come give it.. doesn't happen enough for me to know though!

ZippyGBR, BSN, RN · Jun 2, 2011

Remember, the diameter inside an IV catheter is bigger than some capillaries/collaterals. A dislodged clot from there could easily occlude a coronary or pulmonary vessel.

i'd love to know how a clot in a vien got into coronary vessel unless there's a structural abnormality in the heart ... what's actually going to happen if there is a clot is potentially a micro or pico-PE

blondy2061h, MSN, RN · Jun 2, 2011

Since a central line and clots got brought up, what do you guys do for clotted centrals?
In our ICUs, the RN's can order TPA x2 (it's like 3 cc)for each clotted line per protocol.. out on the floor, a MD has to order, and I think a ICU RN has to come give it.. doesn't happen enough for me to know though!

We use tPA 2mg/2ml. We shoot it in, let it dwell for 30 minutes, then draw it back out. If 30 minutes doesn't do the trick, we'll leave it an hour.