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Old 10-31-2009, 12:19 PM   #1
82-Alpha599
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IV occlusion


When I was doing my paramedic clinicals in hospital and an IV became occluded the nurse would just ram 10-20mL NS through the line. I would always refuse to do it and let them.

Out on the road I can not count how many times I've picked up a pt for a interfacility txp and enrout noticed the line was occluded.

If the pt did not necessarily need fluids I have always just locked off the line and advised the receiving facility of the problem, what they did after that I don't know. Last night for the first time, I had a subarachnoid bleed s/p assault. pt had a 22g IV in the bicep flowing just over TKO. I guess from the ride on the cot with our low IV pole the IVoccluded (no blood backed up into line). Enrout ptBP slowly dropped down to 100/60 from 145/95ish. Pthad very poor IV access and I couldn't establish another line so I did like the RN's I've seen in the past and didn't like it at all. I felt a little resistance and a small pop and then the line flowed as a 22g should.

I figured that it was arelatively fresh clot and the body would be able to break it up before itbecame a major problem.



What do you guys do for an occluded IV??


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Old 10-31-2009, 12:31 PM   #2
Linuss
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Freak out, assume I did something wrong, and have the charge nurse fix it.



But that's just me :p
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Old 10-31-2009, 12:51 PM   #3
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1. Ensure access is adequate and secure with the RN while taking report, securing IV site and lines before moving patient to transport stretcher. Recheck after moving and before departure from hospital.

2. Check IV site and catheter for infiltration and dislodgement.

3. Follow the tubing for a mechanical kink and/or equipment failure.

4. Attempt to flush.

5. Check IV site and catheter for infiltration and dislodgement.

Quote:
If the pt did not necessarily need fluids I have always just locked off the line and advised the receiving facility of the problem, what they did after that I don't know.
One should not do assignments such as ALS/CCT IFTs if they are not comfortable with all aspects of care. You must be properly trained to manage an IV catheter, the IV pumps and all the medications your are transporting on that patient.

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I would always refuse to do it and let them.
If you demonstrated you were not comfortable with IVs, we would be forced by the attending/ED or ICU doctor to send one of our RNs with you.
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Old 10-31-2009, 12:54 PM   #4
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Don't know why all those censord symbols popped up. Just ignor them
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Old 10-31-2009, 01:17 PM   #5
82-Alpha599
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Ventmedic... I think you need to reread my original post. Never said I'm uncomfortable or untrained with IVs.
What I'm really asking us what is the standard care for an occluded IV. Around hear it is to give a forceful 20ml saline flush. However I am uncomfortable doing that because now I just released an embolism into my patients blood steam.

is the body able to break up this embolism before it causes a CVA, DVT,...
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Old 10-31-2009, 02:19 PM   #6
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Quote:
Originally Posted by 82-Alpha599 View Post
Ventmedic... I think you need to reread my original post. Never said I'm uncomfortable or untrained with IVs.
What I'm really asking us what is the standard care for an occluded IV. Around hear it is to give a forceful 20ml saline flush. However I am uncomfortable doing that because now I just released an embolism into my patients blood steam.

is the body able to break up this embolism before it causes a CVA, DVT,...

But in your post you state:

Quote:
Originally Posted by 82-Alpha599 View Post
I would always refuse to do it and let them.

*******************************

Out on the road I can not count how many times I've picked up a pt for a interfacility txp and enrout noticed the line was occluded.

If the pt did not necessarily need fluids I have always just locked off the line and advised the receiving facility of the problem, what they did after that I don't know.
That does not speak well of someone who says they are comfortable with IVs. The word "always" appears alot and it seems you haven't put forth the effort to learn the proper way of clearing an occlusion while continuing to accept transports involving IVs. It would only take some one time to know they should seek out some additional training and it probably shouldn't be advice from an anonymous forum. This is too important to just blow off. You may be transporting a patient some day that will have serious consequences from you just locking off the line.

New Paramedics and Paramedic students (Linuss),
Do they no longer teach how to flush a line in school?
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Old 10-31-2009, 03:28 PM   #7
82-Alpha599
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I know the propper way to clear an occlusion:
Per AAOS sixth edition use [U][/gentalU] 10ml flush if that does not work discontinue IV and reestablish in opposite extremity. And that is what I did.
If the patient was being tensfred to another hospital 4 miles away for a tooth ach and happens to have a bag of NS TKO that occludes. Then I am not going to start another line, ill let the nurses at the new facility try to flush it there way.
Now ill ask again. Could the occlusion from this senario cause a CVA?

I did find multiple nursing references online that said to never flush an occluded IV line. I did it the way I was tought, now I'm wondering if there are any other ways that I do not know of.
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Old 10-31-2009, 03:29 PM   #8
82-Alpha599
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I know the propper way to clear an occlusion:
Per AAOS sixth edition use [U][/gentalU] 10ml flush if that does not work discontinue IV and reestablish in opposite extremity. And that is what I did.
If the patient was being tensfred to another hospital 4 miles away for a tooth ach and happens to have a bag of NS TKO that occludes. Then I am not going to start another line, ill let the nurses at the new facility try to flush it there way.
Now ill ask again. Could the occlusion from this senario cause a CVA?

I did find multiple nursing references online that said to never flush an occluded IV line. I did it the way I was tought, now I'm wondering if there are any other ways that I do not know of.
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Old 10-31-2009, 03:32 PM   #9
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Pretty easy to aspirate the line thus drawing up the occlusion and some blood to verify patency as well as clear the occlusion
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Old 10-31-2009, 03:44 PM   #10
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Originally Posted by 82-Alpha599 View Post
Around hear it is to give a forceful 20ml saline flush. However I am uncomfortable doing that because now I just released an embolism into my patients blood steam.
20 ml is not required to flush a line. What if you transport a baby or a child? As Kaisu stated aspirate and flush enough to feel the fluid start to flow while watching for blanching and infiltrates.

Be mindful of what you have running for medication in that line. Flushing from a point high in the tubing can give the patient a serious bolus and that can have dire consequences.

Instead of surfing the internet, tell your supervisor you need additional training and get some formal instruction in a hospital from a nurse. You may be working with central lines such as PICCs, IJs and subclavians with multiple lumens. You may also have Port-a-caths or Broviacs that you must be familiar with as a Paramedic doing IFTs. You will need to know when a heparin flush is required.

Last edited by VentMedic; 10-31-2009 at 03:47 PM.
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