peripheral IVs

I know sometimes with a peripheral, the IV catheter can be against a wall of the vein.... If you attempt to aspirate blood and don't get any, should you try to flush and way and asess the insertion site for pain, swelling, coolness? or do you pull the IV?

Thanks!

I usually wait until I get a flash of blood, and then advance it just 1/2 a centimeter more and then try to flush it. If they are a difficult stick I dont advance the catheter until I have the saline flush on the end. I use the saline to float the cath into place.!

i should have added: i meant with say, a peripheral heplock? ie-patient has IV push med due, you aspriate for blood return prior to giving and get no return. Do you still flush annd if no pain, puffiness, coolness or resistance, go ahead and give med?

thanks!

If I have a hep lock that flushes easily & there is no pain or sign of infiltration I use it.

Unless you have like an 18 gauge in, I have never seen an IV after an hour or twos insertion able to draw blood back, since we dont maintain our PIV's with help just saline flushes.

sometimes with a heplock you may not be able to aspirate blood but will still flush and work well. but if you meet any resistance while attempting to flush then i would pull the IV b/c it might have clotted.

I agree that you may not always get blood return from a PIV. As long as the IV flushes with ease and no signs of infilitration or phlebitis, I still use the IV.

If I had a flash when I started the IV, but don't have one after I connected the IVF, I have not problem using it. The IV cannula could be up against the side or even up against the valve. Just make sure you watch for the area immediately proximal to the IV for infiltrating.

Blessings

For an existing PIV, I never expect to see a flash when I aspirate. you wil see it in a new IV, but rarely with a small bore (22g or smaller). If I can easily flush with saline, and there is no swelling or resistance I feel confident that it is patent to use. You will occasionally get a patient who is very sensitive, and feels a little sting when you first flush an IV that is only used intermittently. I carefully assess the site for leaking, swelling and position, and then try to flush at a slower rate. Most times it was just the initial sensation, and the IV is still patent. I will start the drip, but stay in the room for the first few minutes to reassess, then instruct them to call if it feels uncomfortable. Exceptions to this are some IV narcs which can sting really bad going in even when diluted, and IV potassium, which just plain hurts to get IV (Y-site it with some saline to decrease the pain), but I warn my patient that it can be uncomfortable before giving it.

Hope this helps.

Amy

For an existing PIV, I never expect to see a flash when I aspirate. you wil see it in a new IV, but rarely with a small bore (22g or smaller). If I can easily flush with saline, and there is no swelling or resistance I feel confident that it is patent to use. You will occasionally get a patient who is very sensitive, and feels a little sting when you first flush an IV that is only used intermittently. I carefully assess the site for leaking, swelling and position, and then try to flush at a slower rate. Most times it was just the initial sensation, and the IV is still patent. I will start the drip, but stay in the room for the first few minutes to reassess, then instruct them to call if it feels uncomfortable. Exceptions to this are some IV narcs which can sting really bad going in even when diluted, and IV potassium, which just plain hurts to get IV (Y-site it with some saline to decrease the pain), but I warn my patient that it can be uncomfortable before giving it.

Hope this helps.

Amy

That is such a great idea. You can still Y site the potassium with a pump right?

Just remember to look at the whole picture. assessing an IV site is not only looking for one thing. These are some things to assess for:

1 how long as the catheter been in place

2. Where is it located. HALF of all IV-related complications occur at an area of flexion and that includes the ACF.

3 Is there any redness,swelling or pain at above or below the site

4. Is the site cool to the touch

5. Is the line patent and does it flush easily

6. Does it have a blood return. as stated you are not always able to get a blood return on a PIV. It is OK to use as long as there are no other s/sx of complications.Conversely, a blood return is not a guarantee that you are in a vein. You can often get a blood return while a cannula is partially in the vein and partially out,or in other words beginning to infiltrate.