IV Push med– do you always have to pull back for blood return? - page 4

I'm really confused. Some resources say to pull back on plunger for blood return before pushing med, while others say flush with saline and then push med (without mentioning a need to check for blood... Read More

  1. by   Libby1987
    Quote from IVRUS
    Yes, We all know that short term peripheral IV catheters have fibrin building up quickly, frequently leading to withdraw occlusions, BUT todays standards of practice say that if one cannot get a free-flowing blood return from ALL IV catheters, you have a non-functioning IV catheter. Resite it in that case. More and more research is done and that research is where STANDARDS OF PRACTICE are from. Check Infusion Nurses Society: www.ins1.org for they are the organization which publishes these standards. This organization is cited in courts of law whenever a case involving IVT is seen.
    Home infusion pharmacy protocols do not instruct aspiration of blood prior to IVP of vesicants through a PICC, Vanco being very commonly administered IVP by lay persons. Are there changed policies for home infusion that I'm not aware of?

    Just anecdotedly, with every infiltration or extravation injury I've seen in home health (fortunately only a few), the patient claimed that they complained of pain but there was a delay in assessment while the infusion continued, far more obvious symptoms and reflection on care than a line that didn't aspirate.
  2. by   foggnm
    The main thing is to make sure the IV is working...that is flush. Blood return is irrelevant as many IVs don't give good return. Yes, you can re-cap a saline syringe, but not sure why you would as you're going to use the whole syringe to flush when giving a med (unless you're just recapping to set aside while you're administering the med). But don't recap it and carry it around for 5 hours then re-use it. It is only saline no reason to save those extra few milliliters.
  3. by   RNfaster
    I've never blown an IV while checking for blood return, and I haven't noticed that doing so occludes them.

    I do agree that a good IV doesn't always have blood return. I, like some others, watch and feel for cool fluid going into the vein above the site as I push saline/med.

    I prefer to see blood return on a peripheral IV before pushing Phenergan.
  4. by   prmenrs
    If you pull back on a 24g IV in NICU, you will likely blow that vein every time. Flush gently w/NSS, assess for ease of flow, blanching, edema, and other signs of infiltration.
  5. by   Libby1987
    *extravasation

    I should not post before coffee..
  6. by   Glycerine82
    Quote from IVRUS
    Have you ever been called in as an expert in Infusion Therapy, Muno... Obviously not, because you would then know what the Courts look to for proper standards of care with infusion.
    Expert witnesses simply testify to what they see and do in their daily practice, they do not make laws and simply being an expert witness means nothing. Both the defense and the plaintiff must have an expert witness in med mal cases but that doesn't mean their word is gospel. Especially since each on is essentially saying the opposite of the other.
  7. by   InArduisFidelis
    I've seen and used plenty of good PIVs that you can't draw blood back through. Even with tensioning the hub, proximal tourniquet, etc. I've even utilized an ultrasound to visualize these catheters in the vein and you can see them perfectly in place and can often visualize the pulsatile distention, flow, and bubbling of a flush going into the vein. These can be perfectly good IVs despite no blood return. Don't discount and pull a perfectly good peripheral with the absence of blood return being your only assessment discrepancy.

    You need to find out what your employer's policy is. You need to use your assessment skills to assess beyond whether you get easy blood return. Most importantly you need to think about what you are about to put into that vein and how imperative it is that you know that it is in place, patent, and that the vein isn't toast. Additionally maybe ask if you should be trying to run it through a peripheral to begin with...
  8. by   DextersDisciple
    Quote from IVRUS
    This is truly frightening to me!!
    I find it frightening that you rely only on blood return to determine an IV Is "good" I.e. Temperate, edema, color , etc. that's why we learn nursing assesment skills ������
  9. by   Gypsy Moon
    I didn't read all pages of the post but in my experience PIV lines will not always give blood return even if they are patent. I didn't read all the research either, but my thoughts on this are that the valves in the vein are often contributing factors with PIV lines. The valves can create issues with placing the line and can sometimes be in the way. One can "float" the catheter through a valve, or push through, it feels like to me and then if the line is directly "up against" or just past a valve this could cause a problem with blood return. Sometimes these sites are "positional" and moving the catheter a few mm in or out will result in better flow.
    The other issue that I am aware of from PIV catheters is that often the vein might appear to be large but the lumen of the vein is small. This is especially seen in smokers, in my experience, or people with peripheral vascular disease. So that when one is starting the PIV the chosen catheter may not be especially good fit for the vein because it was chosen based upon the appearance of the vein but the lumen of the vein is smaller than one thought. These sites can be a challenge as well and I sometimes think about what possible long term complications can occur with these types of patients when they require hospitalization and have these tiny veins.
    If an IV flushes well or has infusing fluids I really don't understand what the problem would be to infuse the medication even without blood return. Not every patient has ideal veins and not every catheter is not hampered by valves or properly sized. Sometimes even a 24 gauge catheter is too large for some patient's veins but they still need the medication and somehow we make it work.
    Is this best practice? No, best practice might mean in this situation a perfect vein with a perfect catheter size. This is an excellent Evidence Based Practice question and if one were curious, one might go to the journals and see what information is available. In the real world it is realistic to not require blood return, in my experience.
    Last edit by Gypsy Moon on Apr 19 : Reason: grammar & additional thoughts
  10. by   TitaniumPlates
    Not just management, but someone who is on a "committee" that likes to pull the "but you could get called into court" and the "best practices" cards to claim authority.

    So sticking Grandma 17 times because I removed one cath after another (and risking nerve damage as well as infection) bc of no "adequate" blood return is best practice? Seriously? Please don't come near me or mine with your IV set up, IVRUS.

    I like being a member of the ENA, but they do not govern my nursing. My hospital's policy governs my nursing practice. Some IV team member doesn't come into my ED and tell us during a code that I can't use that IV because there's no return. They'd get laughed off my unit. And deservedly so. It doesn't take a genius to assess a site for patency without blood return. Valves. Narrow lumen. PVD.

    really. Sheesh.
  11. by   Here.I.Stand
    I'm a bit late to this thread, and there are hundreds of things I can better spend $75 on than source material... But in my anecdotal experience, it is very rare that I do see blood return in a PIV hours/days after insertion. Obviously if there is pain, leaking, or any of those signs of infiltration I immediately stop any administration. But to delay treatment in the critically ill or injured -- many of whom do not have central lines, to avoid any CLABSI risk -- over a PIV that actually is patent? That is extremely frightening to me.
  12. by   kschenz
    On my unit we do not use blood return as a way to check for patency. We flush with saline to determine if a line is patent. Of course I work in NICU where we do not routinely push meds anyway. We almost always use an IV pump even for tiny doses but still check for patency if a baby has a saline locked PIV. The only time we push is during a code when we are administering meds prior to intubation.
  13. by   IVRUS
    Quote from DextersDisciple
    I find it frightening that you rely only on blood return to determine an IV Is "good" I.e. Temperate, edema, color , etc. that's why we learn nursing assesment skills ������
    Who said that a blood return is the ONLY thing that should be assessed? I never did. A blood return is one part of ones assessment in checking patency of ALL IV catheters.

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