Collaborative Intravenous Nursing Service (CINS) Guidelines

Algorithm persistent withdrawal occlusioni.e. fluids can be infused freely by gravity butblood cannot be withdrawn from17Blood return isabsentCheck equipment,Position, clamps, kinking.etcAsk patient to cough, deepbreathe, change position,stand up or lie with foot ofthe bed tipped up.Ascertain possible cause ofPWOBlood returnobtained - usecentral venouscatheter as usualFlush central venouscatheter with 0.9%Sodium chloride in10ml syringe using abrisk “push pause”technique. Check forflashback of bloodBlood return isstill absentPatient to receive highlyirritant/vesicant drugsor chemotherapyExclusionDormant lineIf unable to aspirate.Do not continue.Refer to Medic closeline and labelNo YesConsiderBlood return is stillabsentNoProceed if happy to doas long as there areno other complicationsor painAdapted from Standards for InfusionTherapy RCN (2005)SECONDARY CARE ONLYThe following steps should initially be done on admission or prior to drugadministration and documented in nursing care-plan so that all staff are awarethat patency has been verifiedStep 1Administer a 250ml normal saline “challenge” (unless serum sodium≤ 120 mmol/l) via an infusion pump over 15 minutes to test for patency –the infusion will probably not resolve the lack of blood return (unless thepatient has a high sodium or fluid restricted go to step 2)If there have been no problems, therapy can be administered as normal.If the patient experiences ANY discomfort or there is anyunexplained problems then stop and seek medical advice.It may be necessary to verify tip location by chest X Ray.ORStep 2 Instill Urokinase 5000iu in 2 mls and leave for 60 minutes. Afterthis time withdraw the urokinase and assess the catheter again.The CINs group hereby Repeat assert necessary. their moral If blood rights return to is still absent, it may bethe works herein in accordance necessary with the to Data verify Protection tip location by Act chest 1988. X Ray.Policy review date 01/10/10