Fixing occluded peripheral IVs

Hello everyone,

I would like to know if it is OK to fix an occluded peripheral IV by using a 3 cc syringe instead of a larger syringe. I know that smaller syringes exert more pressure into the lumen and are not OK to use with PICCs, but I am unclear as to whether or not this is OK for plain old peripheral IVs.

My facility does not have any rules against it (and, no, we don't need a doctor's order lol!) and my Google searches only turn up results for PICCs.

Also, I'd like to hear your tips and tricks on fixing IV locks that have occluded despite regular flushing and all the usual standard care.

Thanks guys! Last edit by Cuddleswithpuddles on Mar 24, '12
I've been out of bedside practice for only a couple of years, but never heard of declotting a peripheral IV or saline lock. When a PIV/SL clots off, you either change the site or get the doc to D/C it.

On second thought, declotting is probably not the best word for it.I am talking about fixing an IV that does not flush or aspirate. Sometimes it is difficult to put a new one in and I want to "save" it before having to start a new one.

What system or brand of cannula / tubing do you use?

I have only "fixed" one, on a guy that the off-going nurse warned me that it took a handful of nurses to stick him and to guard the site with my very life! She told me that the site was sensitive to hand positioning and the pump was constantly going off, but a hand reposition fixed it.It was fixable beyond repositioning. I could see through the tegaderm that somehow the catheter had kinked outside the entry point. I would suspect it had happened as the successful nurse put on the tegaderm. I VERY carefully removed the tegaderm, straightened out the catheter, and reapplied a new tegaderm. Voila! Fixed. Sometimes blood return isn't the best way to assess patency. Valves could close, the vein could be small and sensitive to aspiration pressure, etc. However, if it doesn't flush, and there are no catheter kinks (admittedly, I think that's a rather rare occurrence), you need a new site. The only things I could think of that would prevent a flush are clots. Sluggish flushing could be that the catheter has migrated out of the vein, and you'll see leaking or a small bump form upon flushing.

Quote from VivaLasViejasI've been out of bedside practice for only a couple of years, but never heard of declotting a peripheral IV or saline lock. When a PIV/SL clots off, you either change the site or get the doc to D/C it.

I was trained to start a new IV whenever a saline lock became occluded because of the risk of forcing fibrin clumps into the circulation, or damaging the vein by pushing against resistance. Like I said, I've been out of bedside nursing for a while....things change.

Quote from NoviceRN10Considering the fact that small clots are usually what occlude a peripheral IV, I think it's odd that you would just change the IV site instead of flushing it to get the clot to move. I am constantly flushing clotted lines to get them to run again (usually thanks to other nurses leaving my patients high and dry when they don't replace the bags before the end of their shift). I use either a 3cc or a 10cc, whatever is in my pocket. I use the 10cc for piccs, of course.

Smaller syringes exert less pressure not more.

The smaller syringe exerts more pressure than the larger syringe. It's fine to use a 3cc on a PIV. Remember to visualize the PIV itself -- it's only about 1-1/4" long give or take, depending on brand and gauge size.

Quote from NO50FRANNYWhat system or brand of cannula / tubing do you use?

Quote from ScottESmaller syringes exert less pressure not more.

Quote from AltraThe smaller syringe exerts more pressure than the larger syringe. It's fine to use a 3cc on a PIV. Remember to visualize the PIV itself -- it's only about 1-1/4" long give or take, depending on brand and gauge size.