Tool For Un-Occluding IV's?

[blondy2061h, MSN, RN]

On another forum a member was discussing a time in the hospital when her IV occluded and her nurse shoved some sort of tool down it and wiggled it around to remove the occlusion. I've never heard of such a thing and I certainly can't imagine doing it. She didn't specify the type of line, but it sounded like a PIV. She did say it was in her arm. My only possible idea is that it was a PICC and this was a guide wire in IR, but she also definitely made it sound immediately bedside. Any thoughts?

[Asystole RN]

"Run away" is my thought.

There is no clinical excuse to physically manipulate an occlusion with an instrument at the bedside. I agree that this was probably a PICC and the nurse most likely used a guide wire but if I ever had that nurse in court I would eat. her. alive. I have seen this practice done and have see it pop up every once in awhile.

If the occlusion was a thrombus then there are drugs like Cathflo that are indicated for that, if it was a precipitate there are drugs for that, if it was a lipid occlusion there are drugs for that. If the cause was unknown or not resolved with drugs then the catheter needs to be looked at, as in fluoro or other means to assess.

Sticking things into the catheter and poking around at the bedside is never acceptable practice in any circumstance.

Asystole RN, BSN, CRNI, VA-BC

Vascular Access Specialist, Clinical Consultant

[IVRUS, BSN, RN]

I agree with Asystole...

Cathflo (Alteplase) will clear an occluded line if it is occluded due to fibrin buildup. It will NOT clear it if the line is occluded because of a precipitate. And the cost of this is prohibitive if we are talking about a peripheral IV catheter.. just resite the peripheral.

Now there is such a thing as an endothelial "brush" which in theory was suppose to clear occlusions, but I never really saw the point of it as the complication in its use outweighed its benefits.

Hope it helps..

IVRUS RN, CRNI, BA

Vascular Access Specialist, Clinical Infusion Educator

[kidzcare]

That sounds like an infection waiting to happen. No no no.

[blondy2061h, MSN, RN]

Thanks everyone. This is all pretty much what my response was in the thread there.

[AnnieOaklyRN, BSN, RN, EMT-P]

I hope no one stuck something through a PIV!! You could easily shear a peripheral catheter and it becomes an embolus, never stick any object down a line, unless it is a guide wire and is meant to be there!

As others have said we use Cathflo which is medication to clear clots from central lines...

Annie

[FlyingScot, RN]

I'm willing to bet it was before the age of safety needles and she pulled a stylet out of a new angiocath. I've seen idiot nurses do that. So many things wrong with that scenario.

[nynursey_]

We have occlusion protocols in place that specify which medication is to be used for de-clotting and in sequential order. As for a peripheral line, if I can't get a flush through in spite of positioning, I assume that it's infiltrated and discontinue the site. It's simple enough to put another IV in as opposed to placing the patient in danger by trying to force anything through a line that is occluded.

[IVRUS, BSN, RN]

Well for a peripheral IV catheter which doesn't flush despite all clamps being open, one should try gentle aspiration first (using a 3 cc syringe) Gently aspirating for two to three minutes will usually bring a fibrin strand into your IV catheter and then syringe which you can promptly discard and then flush the line thoroughly with NSS that is in a secondary syringe. This works well, for all types of IV catheters.