stripping an IV Vs. Establish IV

[NomadicMedic]

But think of all the time I save by using a monosyllabic word! That leaves me free to provide rapid, life-saving interventions.

I still call it "the bed". As in, "hey 72, can you guys bring the bed to the door...?"

Back in Washington, it was often called "the wheels", which I always found odd.

 

[18G]

We call it "run the IV through" around here.

 

[usalsfyre]

Wait, what? Do I actually know term that you guys don't? *enjoys this for a moment* :rofl:

Stripping means to pinch the tube with your fingers and push the contents down by sliding your fingers down the line.. It's done (or USED TO be done) when IVs are running slow or aren't running at all, or there's a suspected blockage in the patient's vein.

You're not supposed to do it.. Like, ever.. It creates a high pressure at the IV site, and you can push clots or anything else off the cannula site back up into the patients' vein, and you can rupture a vein..

So your telling me you can generate more pressure and cause more badness with this than a 10ml flush pushed into a port?

 

[Handsome Robb]

So your telling me you can generate more pressure and cause more badness with this than a 10ml flush pushed into a port?

Talk about raining on a parade. :lol:

So that means you could cause catheter whip by "stripping" a PICC line, right

I've never, ever seen someone do what you guys are talking about. If a line isn't flowing well I've always seen and been taught to "wipe it, pinch it, poke it, push it." If the line isn't flowing and repositioning doesn't help ad the tubing is clear I personally wouldn't be real thrilled about "forcing" the line open with a flush and risk pushing a clot into the vascular system. That's my own undereducated thought process though.

 

[Household6]

So your telling me you can generate more pressure and cause more badness with this than a 10ml flush pushed into a port?

Yup.. In the words of my medic ---"That's a bad thing."

 

[Veneficus]

Yup.. In the words of my medic ---"That's a bad thing."

I think your medic is mistaken...

I was once part of a "study" (aka fooling around at work) of discovering the best fluid to shoot out of a 10cc syringe.

Water can be launched >20 feet holding and pushing the plunger with 1 hand. (farther if you hold with one hand and push with the other)

Go ahead and try that moving your fingers down an IV tube full of water.

(for posterity, ultrasound gel is the best with a range >60 feet with 1 hand)

 

[usalsfyre]

Yup.. In the words of my medic ---"That's a bad thing."

I'm sorry, this just seems like an EMS myth. I could be wrong, have no data to back it up, but I'm highly skeptical.

 

[VFlutter]

I've never, ever seen someone do what you guys are talking about. If a line isn't flowing well I've always seen and been taught to "wipe it, pinch it, poke it, push it." If the line isn't flowing and repositioning doesn't help ad the tubing is clear I personally wouldn't be real thrilled about "forcing" the line open with a flush and risk pushing a clot into the vascular system. That's my own undereducated thought process though.

Are we talking about a Peripheral or PICC line? Personally I would not be too concerned about flushing a clot large enough to cause any problems.

Never heard of stripping IV lines but I would assume it is a similar concept to stripping chest tubes which we no longer do.

 

[Carlos Danger]

Stripping means to pinch the tube with your fingers and push the contents down by sliding your fingers down the line.. It's done (or USED TO be done) when IVs are running slow or aren't running at all, or there's a suspected blockage in the patient's vein.

You're not supposed to do it.. Like, ever.. It creates a high pressure at the IV site, and you can push clots or anything else off the cannula site back up into the patients' vein, and you can rupture a vein..

So your telling me you can generate more pressure and cause more badness with this than a 10ml flush pushed into a port?

Actually, I think he may be right.....at least in theory.

Pressure is inversely related to area. Pressure=Force/Area.

What this means is that applying the same amount of force to a smaller area generates more pressure over that area. That's why you can hit someone in the arm with a baseball bat and there's little risk of breaking the skin, but if you hit someone in the arm with a machete, using the same amount of force, it'll go right through their arm. The sharp edge of the machete means the force is applied over a much smaller surface area, meaning the pressure is much higher.

That's also why PICC lines are only supposed to be flushed with 10cc or larger syringes....using a 3cc syringe creates more pressure in the line than does a 10cc or 20cc syringe.

I can see how "stripping" the IV line (I've never heard of that) might result in a smaller surface area being exposed to force, and therefore higher pressures.

I have no idea if the difference in pressure is clinically important or not, but I can see why someone would postulate so.

 

[Handsome Robb]

Are we talking about a Peripheral or PICC line? Personally I would not be too concerned about flushing a clot large enough to cause any problems.

Never heard of stripping IV lines but I would assume it is a similar concept to stripping chest tubes which we no longer do.

The clot part was in reference to peripheral lines. I suspected that it wouldn't be a huge issue but what I've been taught completely contradicts that "don't do it or you'll make them have a stroke and die!!!!!!"

 

[Akulahawk]

I think your medic is mistaken...

I was once part of a "study" (aka fooling around at work) of discovering the best fluid to shoot out of a 10cc syringe.

Water can be launched >20 feet holding and pushing the plunger with 1 hand. (farther if you hold with one hand and push with the other)

Go ahead and try that moving your fingers down an IV tube full of water.

(for posterity, ultrasound gel is the best with a range >60 feet with 1 hand)

I think it might be similarly interesting (fun) to replicate the same "study" using 3 ml, 5 ml, and 20 ml syringes, all using the same methodology as the 10 ml tests. Something tells me that in the near future, there might end up being a further study regarding reaction times and avoidance of various liquid and gel substances.

 

[Veneficus]

I think it might be similarly interesting (fun) to replicate the same "study" using 3 ml, 5 ml, and 20 ml syringes, all using the same methodology as the 10 ml tests. Something tells me that in the near future, there might end up being a further study regarding reaction times and avoidance of various liquid and gel substances.

In the interest of science...You gotta do what you gotta do.

 

[Household6]

I think your medic is mistaken...

I was once part of a "study" (aka fooling around at work) of discovering the best fluid to shoot out of a 10cc syringe.

Water can be launched >20 feet holding and pushing the plunger with 1 hand. (farther if you hold with one hand and push with the other)

Go ahead and try that moving your fingers down an IV tube full of water.

(for posterity, ultrasound gel is the best with a range >60 feet with 1 hand)

Well, I'd never flush an IV that hard.. Would you? I mean when you use a 10cc syringe, you maintain control over the pressure. If there's a clot to be jettisoned off the IV, you're not going to force it off with all your might, right? If you use a reasonable and responsible amount of strength in your hand, and the little bugger doesn't move, the responsible thing to do is to disconnect the IV and start a new one..

When you squeeze and milk the IV line down, you have no idea how much force you're actually using. When you use a syringe, and you've done it a hundred times, you reach a point where you tell yourself, "That's too much pressure. This IV needs to come out."

 

[NomadicMedic]

I think you missed the point. Akula was joking about playing with syringes. I don't think any of us would one hand slam a flush to check the patency of an IV. (Unless of course we were flushing an IO... When I did a VidaCare in service, I was told, "The harder you push, the more effective the line.")