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

[missjune]

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 return).

Also, is it ok to recap a saline syringe? Or do we have to use a new one for flushing afterwards?

Thanks so much for reading!

[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.

[Here.I.Stand, BSN, RN]

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.

[KKEGS, MSN, RN]

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.

[IVRUS, BSN, RN]

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.

[IVRUS, BSN, RN]

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.

[~Mi Vida Loca~RN, ASN, RN]

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.

[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.

[NotAllWhoWandeRN, ASN, RN]

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?

[IVRUS, BSN, RN]

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.

[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.

[~Mi Vida Loca~RN, ASN, RN]

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.

[NotAllWhoWandeRN, ASN, RN]

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.