Thin Blood and Blown IV's

[BrittanyWynnRN]

Hi all! I have noticed that it is pretty common knowledge amongst my coworkers and the general medical community that when patients are on anticoagulants or they are known to have high clotting times that veins commonly blow on them. I was wondering if anyone knows the pathophysiology on this and if they could share their knowledge. The only thing that I could think of was to compare it to a cold milkshake and a warm milkshake where the straw would be the vein and if the milkshake was cold and more solid the straw would be stronger and more structurally stable and if it was warm and thinner then it would be weaker and thus more likely to drive through the other side or spring a leak, so to speak. I could be totally off, but if someone could fill me in I'd really appreciate it. Thank you!

[kanzi monkey]

I haven't heard this before. I would think it would be opposite--increased clotting time, less likely for the IV to clot off. I don't know how thinner blood would effect the vein stablity...

I'll look into it and see if I find anything else out. Anyone have any ideas?

[Lacie, BSN, RN]

Anticoagulants or clotting times have no bearing on a vessel "blowing" during an IV. If anything most pt's on these type medications have co-morbities that are related to cardiovascular disease or other issues that would make the vessel wall weakened. Poor elasticity for instance, bad stick, or just the vessel wall not strong enough to maintain a continued flow. I always utilized what I could feel rather than what was obvious by sight. Some pts have fragile veins and just tend to blow easily also particularly your elderly. If anything anticoagulants would result in increased eccymosis due to the blown IV as a secondary with the infiltration being the initial cause.

[leslie :-D]

w/o any supportive data at the moment, i am 99.9% certain there is not a causal relationship betw thin blood and blown iv's...

but does make sense that the primary and/or applicable comorbs should be the considerations here...

esp with elderly folk.

leslie

[miss81, BSN, RN]

Maybe we don't have any formal research to say that this is true. However, when i worked on the surgery unit and we were putting IV's in everyone going to the OR, everyone on TPN/Lipids, everyone bleeding post op, I certainly found that when a pt was on an anticoagulant their veins would "blow" the minute you touch the angio to it. I don't know why it happened, but my experience tells me there is some sort of correlation.

[CABG patch kid, BSN, RN]

I have nothing to back me on this, but I'm just thinking that as soon as the needle hits the vein, if the person is anticoagulated and you don't advance your cath good enough, that vessel will quickly begin to leak blood in the interstitial space, causing a hematoma or ecchymosis. Therefore it will appear that the vein has "blown" but really just showing your mistake sooner than if the person wasn't anticoaged. Not sure if this is correct, just an idea.