The 2016 Infusion Therapy Standards of Practice have already generated questions about one hot issue – should short peripheral catheters be routinely aspirated for a blood return to assess their patency? For the first time, this document includes a definition of “blood return” in the glossary, stating this is a component of VAD patency assessment and that the blood should be the color and consistency of whole blood. Blood return from peripheral catheters is included in standards on documentation, flushing and locking, VAD assessment, VAD removal, infiltration and extravasation, and antineoplastic agents. Many old nursing references state that reliance on blood return is not adequate to determine if the catheter is infiltrating fluid. The nurse can not rely exclusively on the presence of absence of a blood return before using the peripheral catheter. There could easily be a second puncture in the posterior vein wall and still get a blood return OR there could be a small catheter occluded by aspiration technique. For these reasons, the assessment must also include observing the appearance of the site, including comparison to the opposite extremity; palpating for change in temperature or induration; and patient complaints about the site. Other reasons for a lack of blood return could be damage to the endothelial vein lining producing edema or small thrombi that occlude the back flow of blood. Fluid may not be escaping from the vein – yet. But this damage can lead to infiltration or extravasation and continued use will only exacerbate the current complication. Complications are seen more frequently when venous sites in the hand, wrist, and antecubital fossa are used. The 2016 Standards now call for obtaining a blood sample from a peripheral catheter during the dwell time instead of during the insertion procedure. Studies are showing that this is a successful practice. If the peripheral catheter will yield a blood sample, it can easily produce a blood return for patency assessment. As I mentioned, technique can be the cause of failure to obtain a blood return. First and foremost, use a slow and gentle technique to aspirate from the catheter. Pulling hard and fast on the syringe plunger can pull the vein wall over the catheter lumen. Next, change to a smaller syringe as aspiration with a smaller syringe produces less pressure and better results. That is opposite from what happens with injection where a larger syringe is recommended. Finally, put a tourniquet on the arm above the catheter tip to see if there is a blood return. If all of these techniques fail to produce a blood return, do NOT use the catheter.
Liz Campbell
2/23/2016 02:49:01 am
Do you have any data or experience with the blood control devices used for piv? Our facility uses 4 catheters including the BD blood control. We find that a blood return can be difficult after a day of dwell time.
Lynn Hadaway
2/23/2016 04:30:07 am
I don’t think any studies have been published on these peripheral catheters with the blood control device inside the hub. But this device is only for the purpose of preventing blood contact for the inserter. This device is held open from the luer tip of the administration set or needleless connector and this should not be the cause of a lack of blood return. I would recommend looking at where these sites are located as the hand, wrist, and ACF are known to have greater rates of complications and this lack of blood return could easily be an early sign. Additionally, I would also look at what size catheters are being inserted. If the catheter diameter consumes the majority of the vein lumen, it occludes the blood flow around the catheter. This could easily be the cause of no blood return, but will also lead to early catheter complications and failure.
Yi Huey Wong
3/1/2016 07:55:20 am
May I find out what are the latest recommended steps if we do need to obtain blood sample from PIVC during insertion? What should be the recommended time we wait before we reapply the tourniquet to occlude the vein?
Lynn Hadaway
3/1/2016 11:12:04 pm
It is the tourniquet that is the problem, so do not re-apply the tourniquet before you obtain a blood sample from the peripheral catheter. If you are inserting the catheter, remove the tourniquet, attach the short extension set and needleless connector, complete the procedure with stabilization and dressing, then draw the sample. By that time, normal blood flow has returned and any electrolytes, cellular debris, etc from endothelial damage from the tourniquet has moved away from the site. If fluids are infusing, stop them and wait 2 minutes, draw 1-2 mL for discard, then draw the sample. There are many additional steps and much more information in the new 2016 Policy and Procedure Book from INS. 3/2/2016 01:13:03 am
Lynn-2 questions-Love the new site
Lynn Hadaway
3/2/2016 01:22:48 am
A systematic literature review revealed that extremes of pH does not produce the intravascular damage that was originally thought. Reference #7 on page S53. Yes, we can arrange for me to give a presentation to your chapter in July. Do you have a date yet? Sponsorship? Please send me an email with your details to lynn@hadawayassociates.com and I will check my calendar. Thanks
kathleen mohn
3/2/2016 01:13:44 am
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Author: Lynn HadawayLynn Hadaway is an international thought leader in infusion therapy and vascular access, having been in this practice for more than 40 years. Her experience comes from hospital-based infusion teams, device manufacturers, and continuing education services. Her journal and textbook publications are extensive. She also maintains board certification in infusion nursing (CRNI) and nursing professional development (RN-BC). Categories
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