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

[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!

[IVRUS, BSN, RN]

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??

So as one progresses in life, and new research emerges, one's opinion can't change or one is being hypocritical? Geessshhh... So those who realized that the earth isn't flat, but actually, round, shouldn't voice their new understanding, or they'll be called out??????? I guess I need to tell EVERYONE to STOP DOING RESEARCH, cuz' if your opinion changes, you're going to be called out by this poster who doesn't believe in new research!!

[~Mi Vida Loca~RN, ASN, RN]

So as one progresses in life, and new research emerges, one's opinion can't change or one is being hypocritical? Geessshhh... So those who realized that the earth isn't flat, but actually, round, shouldn't voice their new understanding, or they'll be called out??????? I guess I need to tell EVERYONE to STOP DOING RESEARCH, cuz' if your opinion changes, you're going to be called out by this poster who doesn't believe in new research!!

Oh I never said I don't believe in new research, that would be absurd. I know that you CAN have a patent PIV without the presence of free flowing blood. I know this is a FACT!

You have evaded just about every direct question asked of you. As pointed out there are some flaws in the research you presented. Look how often research will go in circles. The whole "how should a baby sleep" is a good example of this. You knew from your own practice that you CAN have a patent line WITHOUT the presence of free flowing blood when you pull back on a PIV. When directly asked this question multiple times you just kept posting in circles around it.

I stand by my previous post. You can continue to post in circles.

[Joanie49]

On central, PICC, and Midlines I always use a 10ml flush on the line and flush 5ml into the line, draw back and check for blood return, if there is no positive blood return I do not continue or put meds though it. Normal IV's (int's) I flush and if there is no issue (pain, obvious infiltration) I go ahead and give meds. So basically I never check for blood return on normal INT's but ALWAYS for advanced lines. Hope this helps!

[MunoRN, RN]

So as one progresses in life, and new research emerges, one's opinion can't change or one is being hypocritical? Geessshhh... So those who realized that the earth isn't flat, but actually, round, shouldn't voice their new understanding, or they'll be called out??????? I guess I need to tell EVERYONE to STOP DOING RESEARCH, cuz' if your opinion changes, you're going to be called out by this poster who doesn't believe in new research!!

You are wildly misrepresenting the status of research on this subject, there is absolutely no "new research" that has supported this position, it appears to be based on a poor understanding of the basic functional principles of peripheral IVs.

Lack of blood return is an extremely non-specific indicator of a catheter that is unsafe to use. The vast majority of PIVs that are still safe to use will not return blood, and it's still possible for infiltrated/extravasated/infected catheters to return blood, so as an assessment parameter it serves little purpose.

You still haven't answered how you've deemed the frequent PIV site changes that would result, and the resulting delays in medications and use of sites that are known to be at higher risk of complications would produce a net benefit.