Do you use an IV with no blood return??

[RN-ing, BSN, MSN, NP]

If an IV flushes well, the vein does not blow, there is no infiltration and is not painful to flush, but you do not get blood return....do you use the IV?

Just looking for opinions...personally, I use the IV based on the fact that I see expected physiological results when I push meds, but this has been debated on my floor since I started there 3 years ago.

Opinons? Facts?

[IVRUS, BSN, RN]

Are we talking about a short term peripheral IV catheter?

Usually, these peripheral short term IV catheters won't yield a blood return. especially if it's a small catheter, like a 24 gauge and your looking at a time lapse of greater than 24 hours of dwell. You see, fibrin will build up at the catheter's tip and this may occur in short order after placement. This fibrin will often create a tail, which when the line is flushed, pushes out allowing you to infuse, but negative aspiration on the IV catheter causes the tail, or flap to cover the lumen's opening and will not give the blood return you're looking for.

Therefore, that is one reason why when a nurse is pushing Chemotherapy Agents in short term peripherals, the IV catheter should be fresh, or newly placed because Vesicants should never be put into an IV catheter which doesn't yield a brisk blood return. Remember too that Vancomycin is a vesicant as is IV phenergan. Neither one of these medications should go into a short term peripheral, but rather they should be infused into a catheter which terminates in the central vasculature. However... Do we infuse them peripherally, yes.. But careful and strict observation should be done when infusing to prevent serious complications.

[AlleeBooRN]

yes i have but it depends on the situation and what i am doing. if its a child, a chemo pt, or a patient that its an incredibly hard stick??? if there is no symptoms of not being patent and is infusing ok i have but monitor closely.

[sunnycalifRN]

As a previous poster has said, peripherals often will not draw back after a few days, even 18's. But, if it flushes easily and without pain, no signs of infiltration, it's okay to use.

[Suethestudent]

IVRUS that was a superb reply.

[RN-ing, BSN, MSN, NP]

Yes, IVRUS thank you for the info!

[OCNRN63, RN]

Never, ever in my dept., but we give chemo., so that's a different ball of wax.

[iluvivt, BSN, RN]

You must NOT use only one parameter to assess an IV site so if the site is without swelling or pain or other s/sx of infiltration/extravastion then YES you can use it. Conversely, a blood return form a PIV does not guarantee that the site is "good" b/c the tip of the catheter can be partially working its way out of the vein..so yes you still get a blood return.

[IVRUS, BSN, RN]

iluvivt said:

You must NOT use only one parameter to assess an IV site so if the site is without swelling or pain or other s/sx of infiltration/extravastion then YES you can use it. Conversely, a blood return form a PIV does not guarantee that the site is "good" b/c the tip of the catheter can be partially working its way out of the vein..so yes you still get a blood return.

Right on ILUVIVT... Are we twins??? My brain seems to be mimicking yours..LOL. There are rare occasions when a blood return is had, but the vessel and SQ are both being exposed to the solution/medication. So, yes, it is important to assess all parameters associated with the IV catheter/Site assessment.

[iluvivt, BSN, RN]

IVRUS...your advice is always right on and I am glad to see it so I do not have to write a long explanation all the time....I just get to say "I agree". I just add in any extra info or opinions I have. I know some nurses have a difficult time with this concept and I always have to draw a picture when I explain to them. I can tell that you have a done a lot of reading and stay on top of your chosen expertise! I know I have as I always have believed that knowledge is power..the power to make the best decision you can for a patient. I will never practice nursing any other way!

[regularRN]

Usually I will ask for the IV team RN to evaluate the access, because I do not want to pump Vanco into the surrounding tissues - and yes, we all know Vanco should be administered via a central line, but in reality... However, if I assess a PIV, it flushes fine but there's no blood return and the pt.'s in pain and needs morphine... then I would give that because morphine is regularly administered subcut and IM without tissue damage. I would still ask for the IV RN to assess the PIV, but it entirely depends on what you are pushing.