IV start: no blood when withdrawing but still usable?

IVRUS, BSN, RN · Apr 1, 2015

First of all, what size IV catheter are you using? If you have a small 24 gauge into a small metacarpal vessel, blood return may be scant. You also need to pay attention to the size of your syringe with withdraw. A 10 cc syringe will generate much more suction and thereby collapse the catheter than a 3cc syringe will on aspiration. If I were giveing IV hydration fluids, and there were no s/s of ANY complications at the site, I would continue to use it... But If it were a vesicant that you were administering, I would NOT use it without a blood return.

TransportJockey, EMT-P · Apr 1, 2015

Tip could be against the valve, suction could be collapsing the vessel. Both are rather common depending on what size catheter you're using and where it is.

brownbook · Apr 1, 2015

I'm a little confused....do you attach a syringe and pull back every time you start an IV? There is no need to do this, and many reason not to! Or did you just do it for this IV because you didn't get a good blood return, only a flashback?

Even if you don't get a good blood return, attaching a syringe to check would NOT be my first choice to confirm the patency of an IV I had just started.

Most importantly why does spell check think patency is misspelled or not a valid word?

Anna Flaxis, BSN, RN · Apr 1, 2015

What IVRUS and TransportJockey said. So long as the catheter flushes briskly and there are no s/s of infiltration, you can use it for fluid administration and administration of non-vesicant medications. Advise the patient to let you know if they have any pain at or above the site, and frequently assess for any swelling, coolness to touch, pain, pressure alarms on your pump, or other s/s of infiltration.

To the question of attaching a syringe to check for blood return, 99% of the time I start an IV, I am also drawing labs (I work in the ER), so yes, I attach a 10mL syringe to my extension set, and once the catheter is placed, I attach my extension set, draw the blood, then flush with 0.9% NSS. Sometimes I'll get an 18g or a 20g that won't give me any blood. The first thing I do is I try withdrawing the catheter a teeny bit to pull it away from the valve or vein wall I suspect it is up against. This works the majority of the time.

IVRUS, BSN, RN · Apr 2, 2015

I'm a little confused....do you attach a syringe and pull back every time you start an IV? There is no need to do this, and many reason not to! Or did you just do it for this IV because you didn't get a good blood return, only a flashback?
Even if you don't get a good blood return, attaching a syringe to check would NOT be my first choice to confirm the patency of an IV I had just started.
Most importantly why does spell check think patency is misspelled or not a valid word?

Brownbook,

When placing an IV catheter, one needs to be cognizant of a blood return. As to the situation explained by the OP, this is a rarity. Most of the time, blood return is had with a successful catheter placement. And, one SHOULD be assessing for the return. Now, could an IV catheter be in place and yield a blood return, but still be infiltrating? Yes, but this too isn't the norm.

brownbook · Apr 2, 2015

IVRUS.....well......I'm still confused.......the original comment was "after I get a flashback, I attach a saline flush and pull on the syringe." I have never heard of this as being the standard for starting IV's, so I was, and am, confused? (Baring getting labs, which the original poster made mo mention of.)

Is this the standard of care for IV starts?

As I questioned in my post, was she using this technique only when she didn't get a good blood return or flashback, or for every IV start?

And even if she only used this technique when the IV start was "iffy" (and I have had many of those) there are several interventions I use before attaching a syringe to check for a good blood return. Honestly I can't remember the last time I attached a syringe to check for blood return on an "iffy" IV?

macawake, MSN · Apr 2, 2015

IVRUS.....well......I'm still confused.......the original comment was "after I get a flashback, I attach a saline flush and pull on the syringe." I have never heard of this as being the standard for starting IV's, so I was, and am, confused? (Baring getting labs, which the original poster made mo mention of.)
Is this the standard of care for IV starts?

It's definitely not standard in my neck of the woods. After getting flashback when placing the iv catheter, I use a saline flush to test the patency of my peripheral iv catheter (saline going in), I don't test it by trying to draw/aspirate blood. I hardly ever draw labs from a peripheral iv. It's not recommended in our guidelines.

I haven't done a proper database search, I just Googled "hemolysis blood draw peripheral intravenous catheters" and came up with this article:

http://ajcc.aacnjournals.org/content/18/5/474.full.pdf

(the article isn't brand new and I haven't checked the references, I just glanced at it).

The article mentions that the catheter material is often soft and stays open under positive pressure of intravenous delivery of fluids and medications but can collapse under negative pressure when blood samples are collected, causing turbulence and hemolysis.

Honestly I can't remember the last time I attached a syringe to check for blood return on an "iffy" IV?

Me neither. (On peripheral iv's that is).

IVRUS, BSN, RN · Apr 3, 2015

I think the problem here is that I'm meaning the OP to mean that he/she gets a flashback, hooks the female catheter hub to an ext set, or to a needleless connector THEN checks for a blood return. I did not get the feeling that she meant that she obtained a flashback and then hooked on her syringe to the stylet/needle. That would be out of the ordinary.

nowim clean · Apr 3, 2015

I start the IV attach a pigtail flush with saline pull back for blood return reflush tape it down start fluids if ordered. I do this every time on every IV.

brownbook · Apr 3, 2015

Yeah....that't the ticket....I kept visualizing her connecting a syringe to the stylet/needle....we had a failure to communicate!