Ultrasound guide peripheral IV insertion

Specialties Infusion

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I am a newly PICC line nurse and learned a lot from this website . Thank you everyone ,specially those who answered my questions.I appreciate all you help.

One day I started a peripheral IV for a hemodialysis patient with ultrasound. I saw my needle at center of the vein and also I got blood return.I could not get any blood return after advancing the catheter. I pulled back the catheter, felt almost out, suddenly blood return very good , flush very good . no infiltration, no pain but I donot feel comfortable left that much long catheter outside the vein. any idea what should I do ? keeping IV or Pull out? Why this happened?How long (cm) catheter should left outside the vein ? I read the article said it has to be 2 cm. I can not figure out why?My coworker said it is more difficult starting IV on hemodialysis patient .why?How can start a peripheral IV with ultrasound on a hemodialysis patient?any input greatly appreciated.Thanks a lot!!

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when you inserted the IV to the hub did it still flush w/o complication? Not all PIV will have blood return. You could be against a valve. If the IV flushes easily but doesn't have a blood return I would leave it in, especially if the patient is a difficult access. I work in the infusion center and I had this issue just a few days ago, I was going in for the 6th attempt to start an IV on this poor patient, I got in, horrible blood return but flushed without difficulty, she got her infusion and the IV lasted the full 4 hours.

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Specializes in Vascular Access.
when you inserted the IV to the hub did it still flush w/o complication? Not all PIV will have blood return. You could be against a valve. If the IV flushes easily but doesn't have a blood return I would leave it in, especially if the patient is a difficult access. I work in the infusion center and I had this issue just a few days ago, I was going in for the 6th attempt to start an IV on this poor patient, I got in, horrible blood return but flushed without difficulty, she got her infusion and the IV lasted the full 4 hours.

Why oh, why would anyone attempt 6 times on a patient????... Not only is this against standards, but your frustration, and that of the patient's were probably through the roof... TWO attempts is all one nurse should attempt, before getting someone else. Also, I wouldn't base my assessment to use that short term peripheral IV catheter on whether or not it flushed, since it would not yeild a blood return. I would only use it if the drug I was giving was a isotonic and therefore would NOT cause tissue damage if it infiltrated/extravasated.

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Thank you everyone for your input. It still flush w/o complication when I inserted IV to the hub,but my previous preceptor ,now my coworker told me that is not good because It will be infiltrated soon.I would take IVRUS 's suggestion depend on what kind medications have to give. Which drugs belong to isotonic category? Thank you so much!!

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Specializes in Vascular Access.
Thank you everyone for your input. It still flush w/o complication when I inserted IV to the hub,but my previous preceptor ,now my coworker told me that is not good because It will be infiltrated soon.I would take IVRUS 's suggestion depend on what kind medications have to give. Which drugs belong to isotonic category? Thank you so much!!

Forgive me, But you say you're a PICC nurse and you don't know which medications are safe to go peripherally? A prerequisite to being "PICC certified" is having the knowledge base which will result in the best patient outcomes. This includes knowing A&P and a broad knowledge of medications/solutions and their effect on the vascular system.

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Why oh, why would anyone attempt 6 times on a patient????... Not only is this against standards, but your frustration, and that of the patient's were probably through the roof... TWO attempts is all one nurse should attempt, before getting someone else. Also, I wouldn't base my assessment to use that short term peripheral IV catheter on whether or not it flushed, since it would not yeild a blood return. I would only use it if the drug I was giving was a isotonic and therefore would NOT cause tissue damage if it infiltrated/extravasated.

My apologies, I did not word that properly. I did not poke the patient 6 times, when I stuck them I was making the 6th attempt. Obviously I wouldn't stick a patient 6 times myself. i have had Iv's that flushed beautifully, and yielded no blood return but the patient said they could "taste" the saline. Should I be pulling those lines? There are other assessments to make before pulling a peripheral with no blood return. Most of them lose blood return within a few hours.

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Sorry making your misunderstanding.I know which medications are safe to go peripherally.

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