Intravenous (IV) lines deliver fluids, medications, and nutrients directly into the bloodstream. Flushing an IV line with saline keeps it open and functional, preventing blockages and ensuring effective medication delivery. Encountering resistance during a flush indicates a potential issue with the catheter or the patient’s vein.
Common Causes of Resistance
Resistance during IV flushing signals a partial or complete blockage within the catheter or an issue with its placement. A common cause is a blood clot inside the catheter, which can occur if blood flows back or flushing is irregular. Certain medications or incompatible drug mixtures can also create precipitates, forming a blockage. Mechanical problems, such as a kink in the tubing or a clamp not fully open, can obstruct fluid flow.
The catheter tip’s position within the vein can also lead to resistance if it rests against a vein wall. Patient movement can cause the catheter to shift, leading to malpositioning. In some instances, the vein itself may constrict, a venospasm, triggered by cold or irritating substances.
Immediate Impact of Resistance
When resistance occurs during an IV flush, it indicates fluid is not flowing freely into the vein. This impacts medication delivery, as drugs may not reach the bloodstream as intended. Forcing a flush against resistance can damage the vein or IV line, potentially causing rupture or dislodgement.
Patients may experience pain or discomfort at the IV site, such as tenderness or a stinging sensation. A painful flush often suggests complications like fluid leaking into surrounding tissues.
Steps to Take When Resistance Occurs
The first action when resistance is felt during an IV flush is to stop applying pressure to the syringe. Forcing the flush can damage the patient’s vein or catheter. Next, assess the IV site and tubing for kinks, open clamps, and signs of swelling or redness around the insertion site.
Gently repositioning the patient’s limb may resolve positional issues by shifting the catheter tip away from a vein wall, allowing fluid to flow. Do not force the flush if resistance persists, as this risks dislodging a clot or damaging the vein. If resistance cannot be resolved, or if pain, swelling, or other symptoms occur, contact a healthcare provider.
Risks of Unaddressed Resistance
If resistance in an IV line is not addressed, several complications can arise. Infiltration occurs when fluid leaks out of the vein into surrounding tissue, causing swelling, pain, and blanching. Extravasation, a more severe form of infiltration, occurs when irritating medications leak into the tissue, potentially leading to blistering, tissue damage, or nerve damage.
Phlebitis, or vein inflammation, can cause redness, warmth, tenderness, and a hard, cord-like feeling along the vein. This can be caused by mechanical irritation, chemical irritation from medications, or infection. Unresolved resistance also increases infection risk at the IV site, characterized by redness, swelling, pus, or fever, potentially spreading to the bloodstream. If resistance cannot be cleared, the IV line may become unusable, requiring removal and reinsertion elsewhere.