IV Push med– do you always have to pull back for blood return? - page 5

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   IVRUS
    Quote from Libby1987
    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.
    Who gives VANCO IV push? That is insane. Before the administration of ALL medications, especially vesicants, you MUST get a free-flowing blood return from the IV catheter.
  2. by   ~Mi Vida Loca~RN
    Quote from IVRUS
    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.
    So now you feel it is only ONE part of the assessment, YET you have stated if you do not get free flowing blood then the IV is deemed not patent and a new IV needs to be placed.

    So why bother checking any other methods if getting blood return, or not getting blood return, is going to be the determining factor on a patent IV?? That doesn't make any sense.

    I just find your statements constantly contradictory.

    I mean at one point you stated that you will RARELY get blood return in a PIV, then later go on to say you should ALWAYS get free flowing blood return or it's a useless IV. To the point that you're telling people *some who might be naive enough to just go off your word* that they need to taking out any IV that doesn't draw blood to place a new one.
  3. by   QuackPack
    What the first response said.

    While every situation can be a little different and different IV lines as well.
    I assumed when reading the original post she was speaking of a standard IV .

    With that in mind, while not the only protocol for assessing , blood return is something you want to see.

    I personally am going to want to see that before I push a med. It is just the best practice.
    Last edit by QuackPack on Apr 20
  4. by   NotAllWhoWandeRN
    Quote from IVRUS
    Who gives VANCO IV push? That is insane. Before the administration of ALL medications, especially vesicants, you MUST get a free-flowing blood return from the IV catheter.
    I'm sure in context that IVP means IV piggyback.

    What's your work situation? I have a hard time picturing you on an inpatient unit implementing this practice, especially since I've never seen any facility policy that supports requiring blood return for all meds. I'd like to know how your patients react to being stuck every few hours.

    Same question for others who have said you must have blood return to do ANYTHING with a PIV. How's that working in real life?
  5. by   IVRUS
    Many times it is 'operator error' as to the reason why clinicians aren't able to get a blood return from a catheter. First try using a 3ml syringe. Also, gently withdraw not vigorous suctioning helps. Putting a tourniquet 6 inches above the VP site of a short term peripheral also helps. Your organization can set their own Policies, but since Infiltration/Extravasation is in the top two reasons why nurses performing IV therapy are sued, the lack of a blood return, which is a vital part of a catheter's assessment, must be paid attn too.
  6. by   QuackPack
    Wow...

    Maybe it is because I am not used to this site , but following this thread has been difficult.

    For me personally while not the only method to use to assess , I use blood return as one of those criteria. There are many factors to consider.

    I have had obese patients infiltrate with no outward signs of this initially and no complaints of discomfort etc..

    Certain meds are bigger risk as well, like Dilantin , Phenergan , Toradol etc.
  7. by   ~Mi Vida Loca~RN
    Quote from IVRUS
    Many times it is 'operator error' as to the reason why clinicians aren't able to get a blood return from a catheter. First try using a 3ml syringe. Also, gently withdraw not vigorous suctioning helps. Putting a tourniquet 6 inches above the VP site of a short term peripheral also helps. Your organization can set their own Policies, but since Infiltration/Extravasation is in the top two reasons why nurses performing IV therapy are sued, the lack of a blood return, which is a vital part of a catheter's assessment, must be paid attn too.
    A lot of us are well aware of methods of how to get blood from an IV. I have used a 1mL syringe before when I knew they were a pt that was very difficult to get blood from and an even harder stick to try and straight stick them.

    You seem to avoid a lot of direct questions and just keep circling back around to the same thing. I supposed back when you stated MOST PIV's won't have blood return, it was error on your part and not the fact that it is not uncommon for regular PIV's to not draw blood.
  8. by   NotAllWhoWandeRN
    Quote from IVRUS
    Many times it is 'operator error' as to the reason why clinicians aren't able to get a blood return from a catheter. First try using a 3ml syringe. Also, gently withdraw not vigorous suctioning helps. Putting a tourniquet 6 inches above the VP site of a short term peripheral also helps. Your organization can set their own Policies, but since Infiltration/Extravasation is in the top two reasons why nurses performing IV therapy are sued, the lack of a blood return, which is a vital part of a catheter's assessment, must be paid attn too.
    You've said all of that before. I asked a direct question about how this applies to your personal nursing practice.
  9. by   IVRUS
    Quote from NotAllWhoWandeRN
    You've said all of that before. I asked a direct question about how this applies to your personal nursing practice.
    How does this apply? I do not give any medication into an IV catheter without a brisk, freeflowing blood return. Knowing the reasons why it won't yield a blood return should make everyone pause if they don't get one. Has a fibrin tail built up? Is it thrombosed? Has the endothelial layer (Tunica Intima) been damaged and has edema, which is preventing the blood return? All of these conditions can easily lead to more vessel damage... still want to use it?
  10. by   Daisy4RN
    Quote from IVRUS
    How does this apply? I do not give any medication into an IV catheter without a brisk, freeflowing blood return. Knowing the reasons why it won't yield a blood return should make everyone pause if they don't get one. Has a fibrin tail built up? Is it thrombosed? Has the endothelial layer (Tunica Intima) been damaged and has edema, which is preventing the blood return? All of these conditions can easily lead to more vessel damage... still want to use it?
    I believe that NotAllWho Wander is asking what type of a environment you work in, (ie do you work in an acute care facility??). I also would like to know because I, and others, know that it is not possible, or necessary, to start a new PIV just because of no blood return. I also would like to know where you work that this not only is the practice, but also that nurses have enough time to do this, and patients aren't complaining like crazy about being stuck so many times.
  11. by   PsychNP2Be2017
    Quote from IVRUS
    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.

    Quote from IVRUS
    How does this apply? I do not give any medication into an IV catheter without a brisk, freeflowing blood return. Knowing the reasons why it won't yield a blood return should make everyone pause if they don't get one. Has a fibrin tail built up? Is it thrombosed? Has the endothelial layer (Tunica Intima) been damaged and has edema, which is preventing the blood return? All of these conditions can easily lead to more vessel damage... still want to use it?
    Which is it exactly? Either the brisk flow of blood is only one part of the assessment, or it is the end all, be all before the administration of meds. And what is the point of having a patent IV if you're not going to administer meds through it? It just seems like a bit of double talk coming from your end of the world.
  12. by   ~Mi Vida Loca~RN
    Quote from PsychNP2Be2017
    Which is it exactly? Either the brisk flow of blood is only one part of the assessment, or it is the end all, be all before the administration of meds. And what is the point of having a patent IV if you're not going to administer meds through it? It just seems like a bit of double talk coming from your end of the world.
    I think what happened was in the start of this thread you had a confused newbie and this poster gave what appeared to be a educated factual answer speaking more about specialized lines. Then I came in and challenged that knowing better and in doing a little search to find out this posters background in nursing *because I suspected as a vascular access specialist they worked primarily with PICC, Central Lines and Midlines where their comments would absolutely make sense* I then uncovered a post where they said the complete opposite of what they told the OP. Now they have constantly contradicted what they have said multiple times and ran circles around answering exact questions ever since.

    I could also be wrong, but I would be willing to bet at this persons hospital there is NOT a policy that states before giving any IV medication you must be able to withdraw free flowing blood from the PIV. Or that if a PIV does not draw back free flowing blood that IV is to be discontinued and a new IV inserted.

    Furthermore I would also be willing to gander that this poster is aware that in regular PIV's you can have a patent IV that does not draw back blood and can be used and that they have used these very IV's because they were smart enough to know there are other ways to assess patency and that getting blood is not the end all. (especially since this WAS their practice years ago when they made that other post)

    However it would be hard to just admit all that with all the circles and contradictions, and to just admit that maybe the initial post was in regards more specifically to specialized lines and NOT your run of the mill PIV's


    But hey, what do I know??
  13. by   PsychNP2Be2017
    Quote from ~Mi Vida Loca~RN
    I think what happened was in the start of this thread you had a confused newbie and this poster gave what appeared to be a educated factual answer speaking more about specialized lines. Then I came in and challenged that knowing better and in doing a little search to find out this posters background in nursing *because I suspected as a vascular access specialist they worked primarily with PICC, Central Lines and Midlines where their comments would absolutely make sense* I then uncovered a post where they said the complete opposite of what they told the OP. Now they have constantly contradicted what they have said multiple times and ran circles around answering exact questions ever since.

    I could also be wrong, but I would be willing to bet at this persons hospital there is NOT a policy that states before giving any IV medication you must be able to withdraw free flowing blood from the PIV. Or that if a PIV does not draw back free flowing blood that IV is to be discontinued and a new IV inserted.

    Furthermore I would also be willing to gander that this poster is aware that in regular PIV's you can have a patent IV that does not draw back blood and can be used and that they have used these very IV's because they were smart enough to know there are other ways to assess patency and that getting blood is not the end all. (especially since this WAS their practice years ago when they made that other post)

    However it would be hard to just admit all that with all the circles and contradictions, and to just admit that maybe the initial post was in regards more specifically to specialized lines and NOT your run of the mill PIV's


    But hey, what do I know??
    Shenanigans, Mi Vida! Pure shenanigans from you!

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