From the Research
To minimize the incidence of blood clots related to Peripheral Intravenous (PIV) lines, healthcare providers should follow a clinically indicated replacement strategy rather than routine replacement, as this approach has been shown to have no clear difference in rates of catheter-related bloodstream infection, thrombophlebitis, and all-cause bloodstream infection, while also reducing device-related costs. This strategy involves removing the PIVC when clinically indicated, such as when there are signs of infection, blockage, or infiltration, or when the catheter is no longer needed for therapy 1. Proper insertion techniques and maintenance protocols are also crucial, including selecting an appropriate vein and catheter size, using the smallest gauge catheter that will accommodate the prescribed therapy, and securing the PIV with either sterile tape or a transparent semipermeable dressing to prevent movement that can irritate the vein wall and trigger clot formation. Regular flushing with 0.9% sodium chloride (normal saline) using a pulsatile push-pause technique helps maintain patency, and daily assessment of the insertion site using a standardized tool like the Phlebitis Scale helps identify early complications.
Some key points to consider when implementing this strategy include:
- Inspecting the insertion site at each shift change and removing the catheter if signs of inflammation, infiltration, occlusion, infection, or blockage are present, or if the catheter is no longer needed for therapy 1
- Using the smallest gauge catheter that will accommodate the prescribed therapy to minimize endothelial damage and prevent stasis of blood 2
- Maintaining adequate hydration to prevent blood hypercoagulability, one of the components of Virchow's triad that contribute to thrombosis formation 3
- Considering the use of a heparin flush (10-100 units/mL) according to facility protocol for intermittent infusions, though evidence supporting heparin over saline is mixed 4
By following these guidelines and adopting a clinically indicated replacement strategy, healthcare providers can minimize the incidence of blood clots related to PIV lines and improve patient outcomes.