# IV occlusion



## 82-Alpha599 (Oct 31, 2009)

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.:censored: 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.

:censored: 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.:censored: 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.:censored: I guess from the ride on the cot with our low IV pole the IV:censoredccluded (no blood backed up into line).:censored: Enrout pt:censored:BP slowly dropped down to 100/60 from 145/95ish.:censored: Pt:censored:had 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.:censored: I felt a little resistance and a small pop and then the line flowed as a 22g should.

I figured that it was a:censored:relatively fresh clot and the body would be able to break it up before it:censored:became a major problem.

:censored:

What do you guys do for an occluded IV??


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## Shishkabob (Oct 31, 2009)

Freak out, assume I did something wrong, and have the charge nurse fix it. 



But that's just me


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## VentMedic (Oct 31, 2009)

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. 



> 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. 



> 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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## 82-Alpha599 (Oct 31, 2009)

Don't know why all those censord symbols popped up. Just ignor them


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## 82-Alpha599 (Oct 31, 2009)

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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## VentMedic (Oct 31, 2009)

82-Alpha599 said:


> 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:



82-Alpha599 said:


> I would *always refuse* to do it and let them.
> 
> *******************************
> 
> ...


 
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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## 82-Alpha599 (Oct 31, 2009)

I know the propper way to clear an occlusion: 
Per AAOS sixth edition use [/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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## 82-Alpha599 (Oct 31, 2009)

I know the propper way to clear an occlusion: 
Per AAOS sixth edition use [/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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## Onceamedic (Oct 31, 2009)

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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## VentMedic (Oct 31, 2009)

82-Alpha599 said:


> 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.


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## VentMedic (Oct 31, 2009)

This thread is good to illustrate the devices I mentioned in my post.

http://www.emtlife.com/showthread.php?t=13623&highlight=broviacs


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## 82-Alpha599 (Oct 31, 2009)

As ridryder mentioned in that thread. I'm in one of the areas that are under no circumstances allowed to use any form of central line even in a code and we are unable to gain access. We are not trained on them at all unfortunatly. 
Too bad. Seems like they would be a great tool of we had the propper training.


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## VentMedic (Oct 31, 2009)

82-Alpha599 said:


> As ridryder mentioned in that thread. I'm in one of the areas that are under no circumstances allowed to use any form of central line even in a code and we are unable to gain access. We are not trained on them at all unfortunatly.
> Too bad. Seems like they would be a great tool of we had the propper training.


 
What do you do it someone has one on an IFT?

I hope you have RNs that work for your ambulance service.


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## mycrofft (Nov 1, 2009)

*ANd those RN"s are trained in field and out of hospital experiences.*

Clots aren't usually a loosely stationed lump waiting to slide down the blood vessels. They are sticky fiberous things.

Also, your ideal villain of a clot is in a vein right?

Vein goes to heart to lungs...and a clot does what in those teeny tiny lung vessels? (For that matter, that television show death-dealing venous air bolus when it hits the heart is likely to fragment, pass to the lungs and be absorbed unless it is a dooooozey).

Fat embolus in vein...different from a blood clot, but still likely to wind up in lung before it hits brain, or heart. Clots from left atrium in A-fib etc...again, different case.

Pulmo embolus will do for you just fine, though.


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## Shishkabob (Nov 1, 2009)

VentMedic said:


> *New Paramedics and Paramedic students (Linuss),*
> Do they no longer teach how to flush a line in school?



They most certainly taught me how to, it was more of a joke 


Though if something happens to an IV line I hooked up, I do assume it was me.  Just last week a nurse sent me in to flush a line of a pt whos line wouldn't flow.  I spent 15 minutes trying to get the darn thing to flow, checking for bubbles, making sure it was all hooked up, flushing the cath with some saline, and finally checking the dial-a-flow the hospital uses.  I left to get a nurses help, came back and found out I HAD fixed it, it just took a bit for it to flow.

It's more of a confidence in my knowledge thing.


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## DV_EMT (Nov 1, 2009)

If its a PICC - TPA (Cathflo) will declot it

if its a peripheral IV... try flushing with NS... if no results, remove and try another IV access 



and for PEG/NG tubes (I know it not the subeject... but I thought i'd add it) - Pancrease (sp*) and sodium bicarb mix will de-clog that


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## mycrofft (Nov 1, 2009)

*Two freakish ambulance IV malfunctions*

1. BP cuff on same arm as a dorsal hand IV.
2. When ambulance litter was lowered to load into Caddy, the little posts on the top frame pinched down on the tubing against the bottom frame.

Hey, it was dark and one peson did the IV while another was doing the EMT stuff! :blush:


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## redcrossemt (Nov 2, 2009)

82-Alpha599 said:


> As ridryder mentioned in that thread. I'm in one of the areas that are under no circumstances allowed to use any form of central line even in a code and we are unable to gain access. We are not trained on them at all unfortunatly.
> Too bad. Seems like they would be a great tool of we had the propper training.



If you're talking about IFT patients, get permission (i.e. orders) from a doctor before leaving the sending facility, as well as instructions for use if you are unfamiliar with the line from nursing staff. Depending on the line, you may need to draw first, or flush first, or flush after with either 0.9NS or Heparin in different concentrations. If you don't carry Heparin, get some from the hospital. That's a drug we are approved to use when provided by the sending facility. The key here is to know what you have and get orders to use it (because we don't have standing orders for such) before you need it.

Your rescue patients are a different story, however. You have to be comfortable knowing what type of line it is and how to manage it, and then, technically, to get online orders from a physician. If you aren't familiar and comfortable with the device, you are stuck with peripheral IV or IO access...


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