IV Push med– do you always have to pull back for blood return? - page 6

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   ~Mi Vida Loca~RN
    Quote from PsychNP2Be2017
    Shenanigans, Mi Vida! Pure shenanigans from you!
    I was tired and finally decided to call a spade a spade. I really did try to be diplomatic.
  2. by   JasonBuzestes
    Best practice is to pull back on the flush to check for blood return. Don't use the medication syringe because if you don't get good return, then you may need to waste that med.

    That said, check your hospital's policy on this. Also, this practice is for pushing through IV lines. Aspirating when giving an injection is a different story and can vary based on the med.
  3. by   NicuGal
    I just had a lengthy surgery and not one nurse checked for a blood return on any of the three PIVs I had. And guess what, they were all fine, until they burned when they flushed them. I am an extremely hard stick, and yes I had an IJ for a few days, but Inwould have personally smacked any nurse who tries to pull my IVs for no blood return, especially my hand ones. The 22 I had in my forearm did have a blood return when unlocked. There are other ways to assess an IV as I have well learned in the neonate world.
  4. by   Jickson001
    Have you never encountered lines that are good working lines but that you can't get blood return on?
  5. by   jackbeninja
    This is just a smidge unrealistic. Not every situation permits for best practice. I agree with you, that's the way it "should" be, but nothing is so simple. Small gauge IVs will rarely draw back even immediately after insertion and will still flush just fine. Ive had the IV team place peripherals and confirm with ultrasonography and the IV still won't draw back.

    I find that much of nursing is a compromise between best practice in the textbooks and reality on the floor. What care environment do you work in?
  6. by   whatdayisit11to7Nrse
    Yes yes yes always check blood return or you may introduce a micro clot into the circulatory system. And yes yes yesss always use a NEW. STERILE. FLUSH.
  7. by   Libby1987
    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 completely misspoke re the method (again with pre coffee posting), Vanco is commonly supplied in an elastomeric device via PICC but nonetheless administered by laypersons who do not nor are instructed by any pharmacy protocol to assess for blood return prior to administration.
  8. by   IVRUS
    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??
    So as one progresses in life, and new research emerges, one's opinion can't change or one is being hypocritical? Geessshhh... So those who realized that the earth isn't flat, but actually, round, shouldn't voice their new understanding, or they'll be called out??????? I guess I need to tell EVERYONE to STOP DOING RESEARCH, cuz' if your opinion changes, you're going to be called out by this poster who doesn't believe in new research!!
  9. by   ~Mi Vida Loca~RN
    Quote from IVRUS
    So as one progresses in life, and new research emerges, one's opinion can't change or one is being hypocritical? Geessshhh... So those who realized that the earth isn't flat, but actually, round, shouldn't voice their new understanding, or they'll be called out??????? I guess I need to tell EVERYONE to STOP DOING RESEARCH, cuz' if your opinion changes, you're going to be called out by this poster who doesn't believe in new research!!
    Oh I never said I don't believe in new research, that would be absurd. I know that you CAN have a patent PIV without the presence of free flowing blood. I know this is a FACT!

    You have evaded just about every direct question asked of you. As pointed out there are some flaws in the research you presented. Look how often research will go in circles. The whole "how should a baby sleep" is a good example of this. You knew from your own practice that you CAN have a patent line WITHOUT the presence of free flowing blood when you pull back on a PIV. When directly asked this question multiple times you just kept posting in circles around it.

    I stand by my previous post. You can continue to post in circles.
  10. by   Joanie49
    On central, PICC, and Midlines I always use a 10ml flush on the line and flush 5ml into the line, draw back and check for blood return, if there is no positive blood return I do not continue or put meds though it. Normal IV's (int's) I flush and if there is no issue (pain, obvious infiltration) I go ahead and give meds. So basically I never check for blood return on normal INT's but ALWAYS for advanced lines. Hope this helps!
  11. by   MunoRN
    Quote from IVRUS
    So as one progresses in life, and new research emerges, one's opinion can't change or one is being hypocritical? Geessshhh... So those who realized that the earth isn't flat, but actually, round, shouldn't voice their new understanding, or they'll be called out??????? I guess I need to tell EVERYONE to STOP DOING RESEARCH, cuz' if your opinion changes, you're going to be called out by this poster who doesn't believe in new research!!
    You are wildly misrepresenting the status of research on this subject, there is absolutely no "new research" that has supported this position, it appears to be based on a poor understanding of the basic functional principles of peripheral IVs.

    Lack of blood return is an extremely non-specific indicator of a catheter that is unsafe to use. The vast majority of PIVs that are still safe to use will not return blood, and it's still possible for infiltrated/extravasated/infected catheters to return blood, so as an assessment parameter it serves little purpose.

    You still haven't answered how you've deemed the frequent PIV site changes that would result, and the resulting delays in medications and use of sites that are known to be at higher risk of complications would produce a net benefit.

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