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 Nurse Leader specializing in Labor & Delivery.
For documentation and legal issues, blood return is a must, especially if given a viscious fluid/medication.
When you release the needle in order to screw in the hub, and blood comes pouring out of the catheter, I think that's a pretty good sign that you're in the right place.
Plus, almost every time we start an IV in my unit, we draw labs from the site prior to hanging the IV tubing. I think the two tubes of blood I got is proof positive that I'm in the right spot.
Specializes in Nurse Leader specializing in Labor & Delivery.
venous blood return verifies patency. Of course, not always, but you have NEVER attempted draw back for blood return on your IV starts?
No, I've never done that. Like I said above, having blood pouring out of the hub when you go to attach the tubing also verifies patency. I always go by the other signs that you're in a vein (flash, the feel of how well the catheter advances, seeing how well the fluid flows in, observing lack of swelling at the site).
When I'm attempting an IV start, if I see a good flashback after I insert the needle into the vein, I will then advance my catheter. After I pull the needle out, I'll attach my 10cc syringe to test/flush the vein, but first I'll try to see if I get a blood return using 10cc syringe, sometimes there will be a blood return and sometimes there won't. Even if I don't get a blood return, if it flushes well with no 'puffing' up of the skin, I know it's a good IV. I have seen many nurses do this, and is, in fact, how
I learned to start an IV.
You must monitor IV sites very often when fluid is running, because they can quickly become infiltrated which can cause a lot of damage if not seen right away.
Specializes in acute care med/surg, LTC, orthopedics.
All of our saline locks/hep locks have standing orders for qshift flushes. Very often I will pull back to check for patency mostly d/t force of habit but even if there is no blood return, I still flush while observing the site.
No, I've never done that. Like I said above, having blood pouring out of the hub when you go to attach the tubing also verifies patency. I always go by the other signs that you're in a vein (flash, the feel of how well the catheter advances, seeing how well the fluid flows in, observing lack of swelling at the site).
We use the Nexiva IV system, which is "bloodless" . . . so there is no dripping hub to confirm placement . . . hence, our protocol requires us to flush then draw back to get blood return. Sorry . . . it's just the way we do it.
klone, MSN, RN
14,857 Posts
When you release the needle in order to screw in the hub, and blood comes pouring out of the catheter, I think that's a pretty good sign that you're in the right place.
Plus, almost every time we start an IV in my unit, we draw labs from the site prior to hanging the IV tubing. I think the two tubes of blood I got is proof positive that I'm in the right spot.