IV start question.

Nurses General Nursing

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I am an LPN, and few weeks ago I observed an RN starting an IV, ( we don't get to many where I work -(IV's) the nurse had a hard time finding the vein, then found one - advanced the cath needle, but got no blood return , and said something like "that is weird, it's in but no return..." then pushed some fluid in, and said someting like "well it's in, its going in fine"... and started the IV bag, 20 minutes or so later the arm was swollen and fluid filled, and the IV was stopped and restarted on another arm , by another nurse. . can you start an IV with-out getting a blood return? Thanks for the answers in advance.

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Easy answer...no.

If you don't get flash, you aren't in the vein. Many people can "feel" when they enter the vein which is all well and good, but if there is no flash, you are not where you should be.

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Specializes in A myriad of specialties.

I don't know what the heck that nurse was thinking. You always need a blood return to verify you're in!

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Specializes in SRNA.

Let that nurse know IVs need to be placed in a vein, not just in an arm...sheesh!

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Specializes in ER, ICU, Medsurg.

I have to disagree. I have started many a 22g that I didn't get blood return. Flashed when I entered but not return blood. Flushed well and the IV maintained its patency. It was explained to me that sometimes the 22g cannula is too small to bring back blood, idk, but I do know that it is possible

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Specializes in acute care med/surg, LTC, orthopedics.

And so it went interstitial. D'uh. I guess we saw that coming.

Please tell this nurse she needs to review her venipuncture techniques.

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I have to disagree. I have started many a 22g that I didn't get blood return. Flashed when I entered but not return blood. Flushed well and the IV maintained its patency. It was explained to me that sometimes the 22g cannula is too small to bring back blood, idk, but I do know that it is possible

I guess I was thinking flash as opposed to blood return (which is what the OP stated). I've started IVs without blood return (sometimes they just suck to the side of the wall too and you can't get anything back), but never without flash.

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Specializes in ICU.

I've seen fellow nurses get a flash, but once cath is introduced and flushed, no blood return. The IV still worked fine. I've been told that the cath could be against the vein wall.

By the way, I'm a three year old ICU nurse and stink at starting IVs. The patients usually come up with an IV in from ER before being admitted to my unit. I try every time, but frequently don't get it. Then one of my fellow nurses start a 20 gauge with their eyes closed.

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If the nurse wasn't in the vein, when she flushed it, she should have seen the skin blow up with saline. I've seen it done ONCE where there was no flashback on a #24. Patient had tiny veins. no problems after wards. Even when there is a flashback on a #24, usually don't see blood return after the catheter is properly placed within the vein. just my experience.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

I have had successful IV starts without a flash or blood return. Definitely not often, but it does happen.

Even if you DO get blood return, it's not a guarantee that you're still in the vein. ALWAYS ALWAYS ALWAYS observe the site as the fluid is running in. If you're not in the vein, the skin around the site will start to puff up almost immediately after you flush the IV.

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Specializes in ER.

yes you can start with no blood return, sometimes the blood is too slow coming out, but it's still a good line.

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Specializes in ICU-CCRN, CVICU, SRNA.

Frequently, yes. Especially on dehydrated or severely hypotensive patients. I always have a flash, but many times no blood return and IV runs fine.

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