Checking for a blood return is a significant component of a complete catheter patency assessment. Two standards of practice from the Infusion Nurses Society address this important step – Standard 61, Parenteral Medication and Solution Administration and Standard 45 Flushing and Locking. These statements do not limit the need to check for a blood return to a certain type of catheter or medication, making it important to obtain a blood return from both peripheral and central catheters prior to giving all medications. The reason for these standards is to prevent unnecessary complications such as infiltration or extravasation.
The blood return should look like whole blood with the same color and consistency, however there are no requirements that you be able to aspirate a specific amount of blood before using the catheter.
Many times, it seems impossible to obtain a blood return, leaving you to think that the catheter may not be functioning properly. Frequently the technique used for aspiration is the cause of the problem. Here are a few technique tips to ensure a blood return.
Failure of these step to produce a blood return means that the catheter is not functioning properly. Other steps in assessment include looking at the site to check for color changes (redness or blanching), fluid leakage from the puncture site, or swelling. Sometimes you will have to compare both extremities to see that swelling is present with a peripheral catheter. This is because fluid is accumulating in compartments of the arm and it is not appearing as a raised swollen area at the catheter tip.
Flush the catheter with normal saline to check for resistance. Palpate the site before and during the flush. Did the patient complain of any discomfort when palpated? Did you feel any temperature change at the site? Did you feel the flush solution moving through the vein or feel fluid accumulating at the catheter tip?
Finally, listen to everything the patient tells you about how the entire area feels. Flushing a central venous catheter whose tip has migrated to the jugular vein will cause the patient to hear a gurgling sound or running stream. Complaints of pain or discomfort in strange locations of the chest, neck, or upper abdomen could be related to the catheter.
Before any medication is given through the catheter, you need to ensure that the site is free from all signs and symptoms of complications, that the patient has no complaints about the site, and that a blood return can be easily obtained. Many may think that a blood return will not provide useful information from a short peripheral catheter, but it is an important part of your assessment. A peripheral vein may have an additional puncture that allows fluid to leak into the tissue but you still get a blood return. That is why it is important to perform a complete assessment looking for all signs and symptoms.
To download a poster that might be useful in teaching other nurses about this process, go to our website – hadawayassociates.com and scroll down to the Free Poster download.
Author: Lynn Hadaway
Lynn Hadaway has more than 35 years experience in infusion nursing and adult education. Her experience comes from multiple acute care settings, healthcare manufacturing, continuing professional education.