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

Nurses Medications

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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 Emergency/Cath Lab.

So this line that I have ripping a wo fluid bolus into that I can't draw off of is not adequate to give meds.

You have management written all over you.

Specializes in NICU, PICU, PACU.

It isn't in our policy either. Best thing to do is follow your hospital protocol.

Specializes in Pediatrics, Urgent care, ER, BMT.

It is not in the policy of any of the hospitals I have worked at, for a PIV (unless it is a vesicant or irritant). It would cause more harm, as others have mentioned, to keep placing IVs every time we did not draw blood back. Just because you do not draw blood back on a PIV does not indicate it is improperly placed.

Yes, We all know that short term peripheral IV catheters have fibrin building up quickly, frequently leading to withdraw occlusions, BUT todays standards of practice say that if one cannot get a free-flowing blood return from ALL IV catheters, you have a non-functioning IV catheter. Resite it in that case. More and more research is done and that research is where STANDARDS OF PRACTICE are from. Check Infusion Nurses Society: www.ins1.org for they are the organization which publishes these standards. This organization is cited in courts of law whenever a case involving IVT is seen.

Home infusion pharmacy protocols do not instruct aspiration of blood prior to IVP of vesicants through a PICC, Vanco being very commonly administered IVP by lay persons. Are there changed policies for home infusion that I'm not aware of?

Just anecdotedly, with every infiltration or extravation injury I've seen in home health (fortunately only a few), the patient claimed that they complained of pain but there was a delay in assessment while the infusion continued, far more obvious symptoms and reflection on care than a line that didn't aspirate.

The main thing is to make sure the IV is working...that is flush. Blood return is irrelevant as many IVs don't give good return. Yes, you can re-cap a saline syringe, but not sure why you would as you're going to use the whole syringe to flush when giving a med (unless you're just recapping to set aside while you're administering the med). But don't recap it and carry it around for 5 hours then re-use it. It is only saline no reason to save those extra few milliliters.

I've never blown an IV while checking for blood return, and I haven't noticed that doing so occludes them.

I do agree that a good IV doesn't always have blood return. I, like some others, watch and feel for cool fluid going into the vein above the site as I push saline/med.

I prefer to see blood return on a peripheral IV before pushing Phenergan.

Specializes in NICU, Infection Control.

If you pull back on a 24g IV in NICU, you will likely blow that vein every time. Flush gently w/NSS, assess for ease of flow, blanching, edema, and other signs of infiltration.

*extravasation

I should not post before coffee..

Specializes in Transitional Nursing.
Have you ever been called in as an expert in Infusion Therapy, Muno... Obviously not, because you would then know what the Courts look to for proper standards of care with infusion.

Expert witnesses simply testify to what they see and do in their daily practice, they do not make laws and simply being an expert witness means nothing. Both the defense and the plaintiff must have an expert witness in med mal cases but that doesn't mean their word is gospel. Especially since each on is essentially saying the opposite of the other.

Specializes in Med/Surg, StepDown, Tele, ICU.

I've seen and used plenty of good PIVs that you can't draw blood back through. Even with tensioning the hub, proximal tourniquet, etc. I've even utilized an ultrasound to visualize these catheters in the vein and you can see them perfectly in place and can often visualize the pulsatile distention, flow, and bubbling of a flush going into the vein. These can be perfectly good IVs despite no blood return. Don't discount and pull a perfectly good peripheral with the absence of blood return being your only assessment discrepancy.

You need to find out what your employer's policy is. You need to use your assessment skills to assess beyond whether you get easy blood return. Most importantly you need to think about what you are about to put into that vein and how imperative it is that you know that it is in place, patent, and that the vein isn't toast. Additionally maybe ask if you should be trying to run it through a peripheral to begin with...

This is truly frightening to me!!

I find it frightening that you rely only on blood return to determine an IV Is "good" I.e. Temperate, edema, color , etc. that's why we learn nursing assesment skills ������

I didn't read all pages of the post but in my experience PIV lines will not always give blood return even if they are patent. I didn't read all the research either, but my thoughts on this are that the valves in the vein are often contributing factors with PIV lines. The valves can create issues with placing the line and can sometimes be in the way. One can "float" the catheter through a valve, or push through, it feels like to me and then if the line is directly "up against" or just past a valve this could cause a problem with blood return. Sometimes these sites are "positional" and moving the catheter a few mm in or out will result in better flow.

The other issue that I am aware of from PIV catheters is that often the vein might appear to be large but the lumen of the vein is small. This is especially seen in smokers, in my experience, or people with peripheral vascular disease. So that when one is starting the PIV the chosen catheter may not be especially good fit for the vein because it was chosen based upon the appearance of the vein but the lumen of the vein is smaller than one thought. These sites can be a challenge as well and I sometimes think about what possible long term complications can occur with these types of patients when they require hospitalization and have these tiny veins.

If an IV flushes well or has infusing fluids I really don't understand what the problem would be to infuse the medication even without blood return. Not every patient has ideal veins and not every catheter is not hampered by valves or properly sized. Sometimes even a 24 gauge catheter is too large for some patient's veins but they still need the medication and somehow we make it work.

Is this best practice? No, best practice might mean in this situation a perfect vein with a perfect catheter size. This is an excellent Evidence Based Practice question and if one were curious, one might go to the journals and see what information is available. In the real world it is realistic to not require blood return, in my experience.

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