Recently we encountered a patient with a scalp PIV with the tip going upward versus downward toward the heart. The nurse caring for the patient the day of discovery, told us that she stopped all fluids on this patient and ordered a PIV be placed in another location prior to reinitiating fluids.
We confirmed her decision and thoughts regarding tip location, however other than just saying "the tip needs to go toward the heart/flow of blood" we were unable to provide additional education as to why and what complications arise from using a PIV with the tip upward against the natural flow of blood.
Could you please provide us with more specific rationale so we can better educate when this question comes up? It is crazy, but this happened twice in the past week!
Thank you
Tammy
I have thought of a couple of concerns with just a few minutes of thinking about this. I have never actually looked for any information about this. Fluid flowing in the opposite direction of blood flow would create turbulence in the vein. This could disrupt the tunica intima and that creates the risk of thrombophlebitis. Flow by gravity might not infuse easily against the blood flow and if it is on a pump, there could be alarms of downstream occlusion. I am not aware of any studies on this and I have not read the peds chapter in any infusion textbook for any information about this, but those would be a good place to start. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I just did a Google search using a couple of phrases. "Retrograde IV infusion" pulls up the medication administration technique where the small quantity of drug is injected retrograde or backwards up the IV set and allowed to slowly infuse at the rate of regular fluid flow. I could not pull up anything about placement of the actual catheter against blood flow. But I did think of another reason to avoid this. Veins have valves that close and open to keep blood moving toward the heart. If you infuse against blood flow, these valves could close below the infusion site. Depending upon the flow rate and size of vein, fluid could accummulate in the vein and overflow from the puncture site producing an infiltration/extravasation injury. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
This could be one of those practices based on anatomy and fluid dynamics that will not be studied due to the probable adverse consequences to the trial group. I don't know if this apples to scalp veins since a tourniquet is not used, but when a tourniquet is placed the vein fills with back pressure and the valves close. A venipuncture against the flow would have to pierce any valve encountered rather than push through valve closure. Damage to the valve and bending of the catheter are both likely outcomes. A catheter directed with the blood flow would be subject to laminar flow forces pulling it toward the center. Pointed oppositely, flow dynamics would push it against the wall until it bends or kinks around. Meanwhile, the turbulence would attract components of the clotting cascade and immune mediators which would likely increase the drag on the catheter until the main flow can channel around it leaving the vascular equivalent of a stick in a sandbar in the vessel. I don't think anyone is going to sign up for the trials to verify that but you could demonstrate the physics pretty easily. It might make a good science fair project for your mid-schooler.
Daniel Juckette RN, CCRN, VA-BC