Random question

[Vanclemons]

My friends and I have a question,

When you go to flush an IV line on your patient and you see some old blood that has back flowed into the line, do you flush it through or pull it back before flushing it? We are worried about pushing clots into the patient but seasoned nurses are telling us it's ok on our floor.

[NotReady4PrimeTime, RN]

How will it clot in the IV fluid? In the same way the IV fluid mixes with the blood in the vein, blood mixes with fluid in the catheter/tubing. Without you see a visible clot, there's no issue here. Unless your patient is in a hypercoagulable state such as disseminated intravascular coagulation (DIC) - who should probably be in the ICU - their blood will take some time to clot. Think about coagulation labs. Normal activated partial thromboplastin time is 30 - 40 seconds, but is hastened by the addition of the "activator". Partial thromboplastin time is 60-70 seconds for WHOLE blood not blood mixed with saline/dextrose. Tiny clots in the VENOUS circulation go through the lungs first and are trapped in the capillaries there. It takes a significant clot in the venous circulation to cause symptomatic pulmonary embolus. Tiny clots in the ARTERIAL circulation will obstruct blood flow distal to the clot. The only time I'm seriously worried about air or clots in my IVs is if the patient has an unrepaired cyanotic heart defect, because their circulation mixes arterial and venous blood together and could cause that air or clot to reach the brain.