IV doesn't back blood?

[bfx]

I am a new grad and just put my first IV into the real pt. I careful use the #22 cath into th forearm vein. the vein was distended very well. However when I tried to draw the blood back to confirm that I am in. there was nothing.

I only tried to pull the syringe a little bit. Do I need pull a little bit harder?

Does the length of the cath inside the vein matters?

very confused and thanks for any input!

[IVRUS, BSN, RN]

Dear bfx,

It is good practice to assess for the presence or absence of a blood return and usually you will have one especially post placement however, in this case you may be encountering one of the following:

1. Depending on the patient's venous access, you may have placed it near an area of bifurcation, or it may be up against a valve in the vein, or the vein wall itself.

2. In addition, since you are using a small guage catheter & if the vein was small a good flashback may not be as evident as using a large gauge in a larger vessel.

3. You didn't say what the brand name of the IV cathter was ( so the material of the IV catheter could be assessed ) but some catheter materials are softer than others and thus can collapse especially if too much negative pressure is placed on the syringe barrel when withdrawing.

Therefore, the absence of a blood return doesn't meant that you aren't in the vein, but a greater attention needs to be placed on the site when flushing to assess for s/s of infiltration.

[bobnurse]

typically a blood return is absent due to

1. The catheter size is to large in relation to the vessel lumen, i.e. blood cannot flow adequately around the catheter, thus you cannot aspirate blood flow.

2. The catheter is against the vessel wall and sucking into it when your aspirating

3. a fibrin clot is on the outside of the catheter, like a door.....When you aspirate, it will occlude the catheter, but open when you flush.......

But many times, a lack of blood flow is a result of the catheter size in relationship to the vessel size.....Especially in geriatric patients with a poor tunica media, causing the vein to collapse around the catheter.....This poses problems during infusions because there is no blood flow to dilute your medication, greatly increasing your risks of phelbitis and thrombus formation........Many nurses only look to access the vein.....They arent looking to see if its a suitable vein to properly flow around the catheter and dilute the medication........This is the reason for venous intimal destruction and poor peripheral veins in the older adults.........this is why PICC and Midline catheters have become so popular, to preserve the peripheral veins.