Risks of Flushing IV Lines with Saline in Pediatric Patients

Q: Risks of Flushing IV Lines with Saline in Pediatric Patients

Dear Ms. QQ： 1. Since your child is hospitalized, your concerns should be directed to the nursing staff or the attending physician. 2. If I am not mistaken, you may be worried about blood clots obstructing veins or arteries. Embolism refers to the bloc

Intravenous therapy

When a child is hospitalized and receiving intravenous fluids, if the IV line becomes occluded, the nurse may flush it with saline solution.
Is there a significant risk of blood clots entering the bloodstream in this situation? What precautions should be taken?

QQ, 30~39 year old female. Ask Date: 2023/05/05

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
QQ:
1.
Since your child is hospitalized, your concerns should be directed to the nursing staff or the attending physician.

2.
If I am not mistaken, you may be worried about blood clots obstructing veins or arteries.
Embolism refers to the blockage of a blood vessel by an insoluble substance originating from elsewhere in the body.
These substances causing embolism can be solid, liquid, or gas, collectively referred to as an embolus.
Common types of embolism include thromboembolism, fat embolism, gas embolism, amniotic fluid embolism, and tumor embolism, among others.
In hospitals, many intravenous infusions are administered daily, and sometimes due to factors such as slow drip rates, kinks in the soft catheter, the position of the IV bag being too low, or the underlying condition of the patient, blood can coagulate within the infusion line due to backflow.
Nursing staff may first use sterile saline or distilled water to flush out the clot, or even administer heparin; ultimately, this can lead to the destruction of blood cells and hemolysis.
Typically, the precipitate from coagulation will be broken down and returned to the venous circulation.
The body's blood vessels and blood naturally contain plasminogen, which is activated to plasmin to dissolve clots.
This is why hospitals use this technique to maintain IV lines, aiming to minimize patient discomfort during injections; thus, serious embolism events are rarely reported.
(In fact, throughout a person's life, various organs and blood vessels continuously undergo coagulation and fibrinolysis processes.
When coagulation is too strong or fibrinolysis is too weak, it can lead to conditions such as cerebral infarction, myocardial infarction, peripheral artery occlusion, and mesenteric artery occlusion, among others.)
3.
Of course, if the clot is too large or cannot be cleared, a new IV line will need to be established.

Reply Date: 2023/05/05

More Info

Flushing intravenous (IV) lines with saline in pediatric patients is a common practice, especially when there is a concern about a blockage or occlusion in the IV line. However, it is essential to understand the risks and considerations involved in this procedure, particularly in children, who may have different physiological responses compared to adults.

Risks of Flushing IV Lines with Saline
1. Air Embolism: One of the primary risks associated with flushing an IV line is the potential for air to enter the bloodstream. If air is introduced during the flushing process, it can lead to an air embolism, which can be life-threatening. This risk is particularly concerning in pediatric patients due to their smaller blood volume.

2. Dislodging Clots: If there is a clot present in the IV line, flushing with saline can dislodge it. This dislodgement can lead to the clot traveling through the bloodstream, potentially causing a blockage in smaller blood vessels, which can result in complications such as pulmonary embolism or stroke.

3. Infection: Flushing an IV line can introduce bacteria if proper aseptic techniques are not followed. This is particularly critical in pediatric patients, who may have immature immune systems. An infection can lead to serious complications, including sepsis.

4. Fluid Overload: Pediatric patients are at a higher risk for fluid overload due to their smaller body size and limited ability to handle excess fluids. Flushing an IV line with saline can contribute to this risk, especially if the child is already receiving fluids.

5. Vascular Injury: Improper technique during flushing can cause damage to the blood vessels, leading to complications such as phlebitis (inflammation of the vein) or thrombosis (formation of a blood clot).

Considerations and Precautions
1. Assessment of the IV Line: Before flushing, healthcare providers should assess the IV line for any signs of blockage or complications. This includes checking for swelling, redness, or pain at the site of the IV.

2. Use of Appropriate Technique: Nurses and healthcare providers should use proper flushing techniques, including using a syringe with a Luer lock to prevent air from entering the line. The flush should be done slowly to minimize the risk of dislodging clots.

3. Monitoring: After flushing, the patient should be closely monitored for any adverse reactions, such as changes in vital signs, signs of respiratory distress, or any unusual symptoms that could indicate complications.

4. Education: Parents and caregivers should be educated about the signs of complications that may arise from IV therapy, including signs of infection (fever, increased redness or swelling at the IV site) and signs of embolism (chest pain, difficulty breathing).

5. Consultation with Specialists: If there are concerns about the integrity of the IV line or the presence of clots, it may be necessary to consult with a pediatric specialist or a vascular access team for further evaluation and management.

In conclusion, while flushing IV lines with saline is a routine procedure, it carries inherent risks, particularly in pediatric patients. Careful assessment, adherence to aseptic techniques, and vigilant monitoring can help mitigate these risks. If there are any concerns about the procedure or the child's condition, it is crucial to communicate with healthcare providers for appropriate management.

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