Blood return prior to using PICC or CVC?

Nurses General Nursing

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Specializes in Infusion, Med/Surg/Tele, Outpatient.

Is it okay to use a PICC line that flushes but does not provide blood return? The more senior nurses on my unit make it a big deal when I get a cath flow/activase order because a PICC will not return blood. I am the PICC Statlock superuser on the unit, and chemo cert. According to the PICC rep, if you cannot get 3 ml blood return, the PICC should not be used, and the ONS class stressed that CVCs should always provide blood return prior to using. Our CVC policy doesn't actually spell out blood return prior to using any central cath.

Thanks!

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Specializes in Oncology.

When I went to ONS class the rule was "brisk blood return" or placement verified by x-ray before use. Our policy is based on this.

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Specializes in Vascular Access.

NOOOOOO... :-)

It is NOT okay to use a centrally placed IV catheter if a blood return can't be obtained with gentle aspiration or with nursing interventions such as repositioning the pt, or coughing/deep breathing. Remember that after placement of all IV catheters, fibrin builds up. This fibrin is a mixture of immunoglobulins, formed blood elements etc. and usually what happens is that a fibrin tail develops, allowing you to infuse, but negative aspiration on the syringe causes the fibrin to cover the opening of the lumen, or cover the valved opening and therefore, a blood return is not able to be obtained. This fibrin is a precurser to bacterial contamination and thrombus. One must restore patency to the line.... So, YES, you are correct and the ones who are alarmed at your actions are the ones who need further education!

Good for U !!!

Hopefully you can educate and your policies and procedures can reflect approriate standards of care.

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Specializes in acute rehab, med surg, LTC, peds, home c.
When I went to ONS class the rule was "brisk blood return" or placement verified by x-ray before use. Our policy is based on this.

The placement is always verified by xray initially. Do you mean if the pic is being used and then one day you cant get a blood return you have to check placement again?

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Specializes in Infusion, Med/Surg/Tele, Outpatient.

Yes, say it was placed & verified a few shifts ago, now has no blood return.

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Specializes in Oncology.
The placement is always verified by xray initially. Do you mean if the pic is being used and then one day you cant get a blood return you have to check placement again?

Exactly, after trying TPA and all of the blood return "tricks" previously mentioned.

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