IV start question.

Nurses General Nursing

Published

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.

Specializes in pediatric critical care.

Working in peds means we rarely have a blood return, but always a flash. You can get a flash, the site flushes beautifully, the fluids are running well, but it can still infiltrate soon after you walk away. The key is frequent assessment of the site.

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Okay, I'm seeing people use "blood return" and "flash" as two separate things. What is the difference, for those of you who are not using the terms interchangeably?

Up Vote Up Vote ×
Okay, I'm seeing people use "blood return" and "flash" as two separate things. What is the difference, for those of you who are not using the terms interchangeably?

my use of the terms is: "flash" refers to seeing the blood fill the cath or hub (depending on type of IV) when inserting into the vein

"blood return" refers to, after attaching your flush syringe, flushing a couple of cc's, then gently pull back . . . you should see blood freely flow into the syringe.

Of course, with small gauge IV's, the blood return may not be as brisk . . . but with an 18 or 16, the "blood return" should be very brisk.

Up Vote Up Vote ×
Specializes in ER/Ortho.

I am great at starting IV's. I am a new nurse Dec 09, but darn it ..its my thing. I did a small stint in the ER, and now I work on the floor. I am the one the other nurses call when they can't get it. Being a new nurse, and feeling I still have so much to learn it makes me happy I can do something right.

Anyway, I would not assume I had a vein if I didn't get a flash EVER. I would continue took until I got a flash. I am not concerned with blood return. I usually get the flash, and flush if there is not pain or swelling then we are good to go.

Up Vote Up Vote ×
Specializes in CCT.

It's entirely possible to establish patent venous access without a flash or being able to draw. In dry/low perfusion state patients there may not be enough pressure in the venous system to cause a flash, especially with a small catheter. In addition it is not at all unusual to be unable to draw off an existing IV cath.

It's hugely important in these cases to establish patency by flushing the line, multiple times if need be.

Up Vote Up Vote ×
Specializes in ED, CTSurg, IVTeam, Oncology.

i've probably put in well over 100,000 iv's.

average 7000 per year x 14 years of iv team, and then not even counting the other 11 years doing ed, ct surg, and onc; so i think i've seen just about anything that one can see with iv's.

from my experience, yes you can successfully cannulate a vein, get flashback but no continued blood return (happened to me on multiple occasions), though it is generally unlikely, especially if the initial flashback was good and strongly positive. i mean, if the blood flashback was fast and quickly filled the flashback chamber; this usually means it's stuck in a fair sized vein with a good amount of pressure and an ample blood supply. if it stopped flowing so suddenly after advancement of the catheter, it could be one of several reasons:

1. the catheter punctured through the vein and is now sitting in the subcutaneous tissue beneath the vein, or during the advance the catheter tip pushed the vein away from the needle tip, and never made it into the lumen in the first place.

2. the catheter tip is stuck up against a valve, effectively sealing the catheter to back flow.

3. the catheter caliber closely approximates or exceeds the vein's lumen, such that no distal blood can flow around the catheter in a proximal direction; since the venous system is unidirectional because of it's valve structures, a finite amount of blood volume exists between each valve segment. if the initial flashback already sucked all the blood out, and no more blood can go into that vein segment because of the catheter size, then no more blood will come out.

an easy way to test to see if the iv solution is indeed in the vein or not, is to pull back the catheter about 2-3 mm (if sitting on a valve blood should flow once pulled back), or to allow the iv to run wide open for a few seconds. if the area swells immediately, then it's quite obvious that the catheter is not in the right spot. but sometimes, with patient's who have very loose subcutaneous tissue, fluid seems to get in but not cause significant or visible swelling right away.

you might try this: have the iv run wide open and visually note the character of the flow; then constantly observe the flow character while simultaneously applying a tourniquet well proximal to the site. if the flow rate slows down, then the iv is good (as venous pressure increased with tourniquet resistance, flow rate will decrease). if the flow continues unchanged, then venous pressure is not affecting flow, which leads one to believe that the catheter is not in the right place.

all said and done, frankly, if there is any doubt, you should always try for another site. on the other hand, subcutaneously injected iv fluid (ie hypodermoclysis aka s.c. infusion) remains a reasonable technology that may sound archaic to some, but still has positive clinical value for gentle rehydration. one can give up to 3 liters of fluids a day using s.c. infusion.

Up Vote Up Vote ×

Thanks everyone for the answers, I feel more educated on IV's now, and I never saw any flash at all. Thanks again for taking the time to answer. You guys are the best!

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
"blood return" refers to, after attaching your flush syringe, flushing a couple of cc's, then gently pull back . . . you should see blood freely flow into the syringe.

Interesting. I don't do that, ever.

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
All said and done, frankly, if there is any doubt, you should always try for another site. On the other hand, subcutaneously injected IV fluid (ie Hypodermoclysis aka s.c. infusion) remains a reasonable technology that may sound archaic to some, but still has positive clinical value for gentle rehydration. One can give up to 3 Liters of fluids a day using s.c. infusion.

That's how I used to give my renal-failure cat fluids when she was dehydrated.

As long as it's just maintenance fluid, it's not going to harm the person to have it subcutaneous, but I imagine it's probably a bit uncomfortable.

Up Vote Up Vote ×
Specializes in ER.
Interesting. I don't do that, ever.

why not??????

Up Vote Up Vote ×
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
why not??????

Why would I?

Up Vote Up Vote ×

For documentation and legal issues, blood return is a must, especially if given a viscious fluid/medication.

I'm a new nurse, but on my floor we do IV's daily so I've done over 50 already and finally have my rhythm and technique down, but that doesn't mean I get them everytime.

Up Vote Up Vote ×
+ Add a Comment