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

  1. 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!
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  2. 75 Comments

  3. by   IVRUS
    If you DON'T pull back to obtain a blood return, you aren't following best practices. EVERY IV catheter should yeild a brisk, free-flowing blood return which is the color and consistancy of whole blood. This assessment is crucial in determining line patency. If you do NOT get a free-flowing blood return, do NOT push the medication into the IV catheter.
    In addition, saline syringes are single use only, meaning you cannot save a portion of the syringe to use at a later time.
  4. by   missjune
    Quote from IVRUS
    If you DON'T pull back to obtain a blood return, you aren't following best practices. EVERY IV catheter should yeild a brisk, free-flowing blood return which is the color and consistancy of whole blood. This assessment is crucial in determining line patency. If you do NOT get a free-flowing blood return, do NOT push the medication into the IV catheter.
    In addition, saline syringes are single use only, meaning you cannot save a portion of the syringe to use at a later time.
    Thanks for your response!! Just to make sure, do we pull back using saline syringe or medication syringe?
  5. by   IVRUS
    Your assessment for a brisk, freeflowing blood return is done with the Normal Saline syringe. Then, once you determine that you have line patency, give the IVP medication over the time frame needed.
  6. by   ~Mi Vida Loca~RN
    Quote from IVRUS
    If you DON'T pull back to obtain a blood return, you aren't following best practices. EVERY IV catheter should yeild a brisk, free-flowing blood return which is the color and consistancy of whole blood. This assessment is crucial in determining line patency. If you do NOT get a free-flowing blood return, do NOT push the medication into the IV catheter.
    In addition, saline syringes are single use only, meaning you cannot save a portion of the syringe to use at a later time.
    Have you never encountered lines that are good working lines but that you can't get blood return on?
  7. by   ~Mi Vida Loca~RN
    To the OP, your hospital should have a policy on this I would imagine. I don't agree with the previous poster that every line should have free flowing blood return to be a patent line and to use it. (I don't remember their exact wording and can't check it now without closing this out)

    I have encountered numerous lines that were good lines, worked great but didn't draw blood. It also wasn't the policy of the hospitals I have been at that you had to draw back blood before pushing meds. It was policy we had to flush the line to check that it was patent, give the med and then flush again. (yes with new syringe).

    It's very rare in my experience, but I have even started many good IV's that didn't draw. They worked great to put stuff in, just now take anything out.
  8. by   IVRUS
    Quote from ~Mi Vida Loca~RN
    To the OP, your hospital should have a policy on this I would imagine. I don't agree with the previous poster that every line should have free flowing blood return to be a patent line and to use it. (I don't remember their exact wording and can't check it now without closing this out)

    I have encountered numerous lines that were good lines, worked great but didn't draw blood. It also wasn't the policy of the hospitals I have been at that you had to draw back blood before pushing meds. It was policy we had to flush the line to check that it was patent, give the med and then flush again. (yes with new syringe).

    It's very rare in my experience, but I have even started many good IV's that didn't draw. They worked great to put stuff in, just now take anything out.
    BUT... part of assessing if any line is patent is checking for that blood return, AND making sure that the line flushes without resistance. You are seriously risking infiltration, if you're pushing a non-vesicant and risking extravasation if you're pushing a vesicant. If you do not have a blood return in your IV catheter, you have a non-functioning IV catheter. It is frightening to think that your hospitals didn't have appropriate policies in place which dealt with giving IVP medications and CONFIRMING a brisk, free flowing blood return. Extravasation of a vesicant is an event that can easily, and frequently does, land you in a court of law to defend your actions. Patients have needed skin grafts when a vesicant extravasates. Cathflo should be used when you have a persistent withdrawal occlusion in all central catheters.
  9. by   ~Mi Vida Loca~RN
    Quote from IVRUS
    BUT... part of assessing if any line is patent is checking for that blood return, AND making sure that the line flushes without resistance. You are seriously risking infiltration, if you're pushing a non-vesicant and risking extravasation if you're pushing a vesicant. If you do not have a blood return in your IV catheter, you have a non-functioning IV catheter. It is frightening to think that your hospitals didn't have appropriate policies in place which dealt with giving IVP medications and CONFIRMING a brisk, free flowing blood return. Extravasation of a vesicant is an event that can easily, and frequently does, land you in a court of law to defend your actions. Patients have needed skin grafts when a vesicant extravasates. Cathflo should be used when you have a persistent withdrawal occlusion in all central catheters.

    So back to my question, is it of your opinion that if there is not free flowing blood flow when you draw back that it's not a patent line??

    I am well aware about resistance when flushing and all of that. I have had problems when people come in with their PICC line and had to get a cathflo order from the doc.

    But I know for a FACT you can have a patent line without free flowing blood return. I have seen it often on already established IV's (of a few hrs because I work in an ER setting) and rarely on a newly inserted IV's. Flushes great. Bolus goes in great. No infiltration. No pain. Can even visualize the flush going in under U/S. But no blood return. Not getting free flowing blood when drawing back does not automatically mean it's not a patent line.
  10. by   ~Mi Vida Loca~RN
    Quote from IVRUS
    If you DON'T pull back to obtain a blood return, you aren't following best practices. EVERY IV catheter should yeild a brisk, free-flowing blood return which is the color and consistancy of whole blood. This assessment is crucial in determining line patency. If you do NOT get a free-flowing blood return, do NOT push the medication into the IV catheter.
    In addition, saline syringes are single use only, meaning you cannot save a portion of the syringe to use at a later time.
    Ok so I am a little confused. You say this here. But in another post you have said this

    Oct 21, '10 by IVRUS
    Are we talking about a short term peripheral IV catheter?
    Usually, these peripheral short term IV catheters won't yield a blood return.


    Which is the same thing I have said. The poster didn't mention a central line or a PICC line or midline so I am assuming we are talking about a regular short term peripheral IV which is what you would most commonly see in an acute care setting.
  11. by   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.
  12. by   ThePsychWhisperer
    Quote from 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!
    Central lines such as PICC lines and mid-lines should usually yield good blood return, and if they don't, I don't try to flush anything through them. That being said, I have seen many peripheral lines that I could flush through rapidly with the equivalent of two tons of pressure but they just. will. not. draw, with or without a tourniquet applied, and often times this has nothing to do with clotting. I usually flush some plain NS through a peripheral to ensure patency of a line because, even if it is "blown", a small amount of NS is usually easily reabsorbed into the system with no lasting effects. As for vesicants as noted by a PP, one would be silly to use one of these medications without first testing for a properly working IV, right? Right.
    I have yet to see a policy in my facility that states that, even though fluids flow freely through a line and people are receiving therapeutic effect from medications, that because it will not draw, we have to restart the line. This would be just cruel to some populations with very few workable veins of which to speak (ex-IV drug addicts, little old grammas).
    As for recapping and reusing flushes at a later time, this is bad practice. The flushes are sterile, meaning once you have broken the package and the seal, you have compromised sterility, meaning bacteria can begin to build. Use a new flush every time.
  13. by   ThePsychWhisperer
    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.
    Do you have a link to these Standards of Practice that we can view without paying $75? I'd like to research this, but not that desperately.
  14. by   BSN16
    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.
    Went to this website, could not access anything. Also checked up to date to find anything about how lack of blood aspiration in PIV means an not functional PIV, still nothing. If i were to take your word for this, this would be completely absurd to have to pull/restart IVs on all patients who have lines that do not aspirate back blood.

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