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

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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!

Specializes in Vascular Access.
You've said all of that before. I asked a direct question about how this applies to your personal nursing practice.

How does this apply? I do not give any medication into an IV catheter without a brisk, freeflowing blood return. Knowing the reasons why it won't yield a blood return should make everyone pause if they don't get one. Has a fibrin tail built up? Is it thrombosed? Has the endothelial layer (Tunica Intima) been damaged and has edema, which is preventing the blood return? All of these conditions can easily lead to more vessel damage... still want to use it?

Specializes in Travel, Home Health, Med-Surg.
How does this apply? I do not give any medication into an IV catheter without a brisk, freeflowing blood return. Knowing the reasons why it won't yield a blood return should make everyone pause if they don't get one. Has a fibrin tail built up? Is it thrombosed? Has the endothelial layer (Tunica Intima) been damaged and has edema, which is preventing the blood return? All of these conditions can easily lead to more vessel damage... still want to use it?

I believe that NotAllWho Wander is asking what type of a environment you work in, (ie do you work in an acute care facility??). I also would like to know because I, and others, know that it is not possible, or necessary, to start a new PIV just because of no blood return. I also would like to know where you work that this not only is the practice, but also that nurses have enough time to do this, and patients aren't complaining like crazy about being stuck so many times.

Specializes in Psychiatric and emergency nursing.
Who said that a blood return is the ONLY thing that should be assessed? I never did. A blood return is one part of ones assessment in checking patency of ALL IV catheters.

How does this apply? I do not give any medication into an IV catheter without a brisk, freeflowing blood return. Knowing the reasons why it won't yield a blood return should make everyone pause if they don't get one. Has a fibrin tail built up? Is it thrombosed? Has the endothelial layer (Tunica Intima) been damaged and has edema, which is preventing the blood return? All of these conditions can easily lead to more vessel damage... still want to use it?

Which is it exactly? Either the brisk flow of blood is only one part of the assessment, or it is the end all, be all before the administration of meds. And what is the point of having a patent IV if you're not going to administer meds through it? It just seems like a bit of double talk coming from your end of the world.

Specializes in Emergency Dept. Trauma. Pediatrics.
Which is it exactly? Either the brisk flow of blood is only one part of the assessment, or it is the end all, be all before the administration of meds. And what is the point of having a patent IV if you're not going to administer meds through it? It just seems like a bit of double talk coming from your end of the world.

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??

Specializes in Psychiatric and emergency nursing.
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??

Shenanigans, Mi Vida! Pure shenanigans from you! :)

Specializes in Emergency Dept. Trauma. Pediatrics.
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. :p

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.

Specializes in NICU, PICU, PACU.

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.

Have you never encountered lines that are good working lines but that you can't get blood return on?

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?

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.

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.

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