One of the first tasks infusion nurses must perform when taking care of their patients is assessing the patency of the line. As any nurse will attest to, the inability to access a line can be very frustrating and, depending on the line, may require special interventions.

The inability to access a peripheral IV line is probably the easiest to deal with. Most nurses can pop a new peripheral IV in fairly quickly, especially infusion nurses who perform IV starts frequently throughout their shift and are therefore extremely skilled at finding veins on some of the most challenging IV starts. Some infusion nurses even have specialized equipment to help find deep or tiny veins. For example, a doppler can be used.

PICC lines are a bit more challenging. There can be a few reasons why a PICC cannot be accessed; it may be clotted, or the line may be dislodged. Infusion nurses must first determine the cause as to why it cannot be used. A clotted line won't flush or is "sluggish" when flushing. Infusion nurses can try a few techniques to try to get the line flushed, such as gentle flushing using a push-pause method, having the patient turn their head, or repositioning the arm. If those methods fail, tissue plasminogen activator (tPA) may be required.

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A PICC line may also be dislodged, which may be discovered when external catheter length is measured. An X-Ray may be required to find out where the end terminates and whether or not it can still be used (depending on the infusion needed). If it cannot be used, a new PICC line must be inserted by a specially trained nurse.

Central venous ports are also a little more complicated if infusion nurses are unable to access. They are surgically implanted, so the inability to access a port can make even the most seasoned infusion nurse worry. The port may be clotted, and also may require a de-clotting agent. It may also help to reposition patients to see if that is the reason why it is occluded. Sometimes the access needle needs to be repositioned as well.

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There are many troubleshooting tips infusion nurses have adopted with experience, but they should always be sure to follow their facility's policies and procedures and involve the physician and radiology as needed. They should also be up-to-date on current standards of care and practice with regards to the types of lines they manage in their day-to-day work.