What Should I Do If My Tube Is Blocked by an Indwelling Needle?

"The indwelling needle was inserted yesterday, why is it blocked today? "This is a problem that almost every caregiver has encountered.

 

"The benefits of high-pressure water jets was inserted yesterday, why is it blocked today? "This is a problem that almost every caregiver has encountered. Pull the needle and re-puncture? It increases the financial burden of the patient and the workload of the nursing staff. Forcibly flush the tube with saline? If not handled properly, blood clots or insoluble particles can enter the blood circulation and cause blockage of tiny blood vessels or insufficient blood supply, which can eventually cause tissue hypoxia. How should I handle this situation? Please continue to read on.

 

 

Causes

1. Thrombotic blockage

The following conditions can lead to blood reflux in the lumen of the infusion tube to form clot or thrombus.

â‘ The liquid in the infusion bottle is not replaced in time after infusion.

(2) Increased intravenous pressure caused by crying of children, change of patient's position, resulting in pressure on the infusion site, etc.

â‘¢ infusion bottle hanging too low.

â‘£ pressure or blockage of the exhaust tube 

⑤ twisting or folding of the infusion tube.

â‘¥Improper sealing method of intravenous indwelling needle, no regular flushing or too long retention time.

2. Non-thrombotic blockage

â‘ The infused drug has crystallization (such as mannitol temperature is too low), precipitation or turbid particles.

â‘¡The drug concentration and viscosity are too high (such as 20% fatty milk).

â‘¢ multiple drugs mixed without attention to drug compatibility contraindications, resulting in insoluble particles.

â‘£increased particle contamination during the IV infusion configuration process, such as multiple punctures of rubber plugs resulting in debris dislodging and entering the liquid directly as insoluble particles.

⑤ The environment of IV infusion configuration is not air disinfected and purified.

 

 

Handling skills

1. Judging the type and nature of blockage

Judge the type and nature of the blockage according to the possible causes of the indwelling needle blockage.

For example, if the obstruction occurs when the patient is feeding 20% fat milk, it can be considered as a non-thrombotic obstruction due to high viscosity of fluid after excluding thrombotic obstruction.

2. Treat according to the type and nature of blockage

â‘ The blockage is insoluble particles: remove the needle immediately, remove the causative agent and re-puncture. Do not forcibly flush the tube with a syringe containing 0.9% sodium chloride syringe to prevent the particles from causing long-term harm to the patient.

â‘¡The blockage is a newly formed clot: Use an empty 10 ml syringe to gently pull back and extract the clot from the tube as much as possible. If the patient's condition allows, 10ml of 0.9% sodium chloride injection containing sodium heparin (25u/ml) or urokinase (100,000U/ml) diluted in a clamped tube for 5 minutes can also be used, then pump back with an empty syringe and repeat again if there is no return blood; if there is no return blood again, the needle should be removed immediately.

3. Timely communication with patients to avoid disputes

Communication with the patient should be made in time when the obstruction of the indwelling needle occurs, informing the patient of the possible causes of the obstruction of the indwelling needle and the next treatment measures of the nursing staff. Such communication can not only get the patient's understanding and cooperation, but also effectively avoid disputes.

4. In the face of patients prone to obstruction, the patrol should be strengthened

For patients with high blood viscosity who are prone to obstruction (such as patients in shock), rounds should be strengthened. Especially when such patients input fatty milk type of highly viscous drugs, they should pay attention to the infusion and make key handover.

 

 

Preventive measures

1. Before infusion, you should be familiar with the nature of the injected drug and configure it in strict accordance with the drug instructions

Avoid precipitation, turbidity and crystalline particles due to changes in solubility and PH value of the drug caused by changes in the solvent. When mixing multiple drugs, attention should be paid to the contraindications of drug compatibility.

2. When using powder drugs, it must be completely dissolved.

For difficult-to-dissolve powder drugs (e.g. cyclophosphamide, piperacillin sodium tazobactam for injection powder), a shaker can be used to promote their dissolution so as to reduce the production of insoluble particles. 

3. When dispensing or infusion, should minimize the number of punctures to the infusion bottle stopper, the needle should not be too thick, in order to reduce the gel plug particles off.

4. Strengthen infection monitoring in treatment rooms, dispensing rooms, patient rooms and injection sites.

In the condition of the hospital infusion to add drugs should be in line with the requirements of the dispensing center, in order to effectively reduce the damage of particles on the blood vessels, to avoid their accumulation and the formation of thrombosis.

5. The use of intravenous indwelling needle, infusion finished timely pressure sealing tube, regular flushing and replacement of heparin cap are the key to prevent blockage.

The retention time generally depends on the condition, there is no uniform standard in China, generally recommended for 3~5 days, but most scholars believe that no more than 7 days is appropriate. For patients with high blood viscosity, 2~5 days is appropriate.

6. At present, certain disposable infusion sets are prone to uncontrolled drip rate regulators, so nursing staff must make diligent inspections and observations. When making rounds, they must not only observe the drip of the infusion set Murphy's small pot, but also focus on observing whether the skin of the patient's indwelling needle site is red and swollen, whether the dressing is clean and dry, and at the same time pay attention to the patient's chief complaint.

 

Nursing staff experience sharing

The following is a summary of relevant experience from senior clinical nursing staff.

1. For patients with indwelling needles before infusion, you can use 5ml empty needle back to draw, to determine the return of blood before connecting the infusion, not directly infusion on and then determine whether the patency, so as to avoid clot input. 

2. The small switch of the indwelling needle to close the position must be close to the beginning of the cannula needle extension tube, to avoid the backflow of blood in the tube to the cannula needle, the formation of blood clots cause obstruction.

3. Be sure to do a good job of patient education, instruct patients to avoid collision or hand rubbing the local placement, avoid strenuous movement and excessive force on the arm of the puncture side, pay attention to keep the puncture site dry and clean, prevent the occurrence of hematoma, blockage, fluid leakage, etc.