I was wondering if in real time, how many staff are always aspirating all cental access lines to check blood return prior to all infusions, even non-vessicant.
My guess is that the number is actually very low, but that is probably related to the lack of education about the need for this step. I would not infer that a low compliance with this step means that it is unnecessary. It is a major question that is always asked in any legal case involving catheter complications especially infiltration and extravasation. This is the most frequent cause of infusion-related lawsuits. National standards and guidelines would be used to measure the individual nurse's performance in a legal case and that would include both INS and ONS with both emphasizing the need for assessing for blood return. Lynn
INS Standards do not provide information about a quantity of blood that must be aspirated. There is no evidence to support any specific amount. See Standard 45 and 61. Both state "positive blood return" but do not give any requirements for a specific quantity. The same syringe used to flush the catheter with saline can be used to aspirate for a blood return. There is no need to disconnect this syringe to accomplish both of these tasks. You must connect the saline filled syringe anyway, so there should be no additional hub manipulation to assess for a blood return. The saline will flush the whole blood back into the vein and not allow it to reside inside the lumen, therefore there should be no impact on lumen occlusion. Flushing and locking procedures have no impact - positive or negative - on the occurance of vein thrombosis or what is happening inside the vein around the catheter. The risk for NOT checking for a positive blood return is much greater than the risk for catheter complications. This is a critical component of your assessment of the catheter's functionality and must be done before each medication administration. Lynn
My guess is that the number is actually very low, but that is probably related to the lack of education about the need for this step. I would not infer that a low compliance with this step means that it is unnecessary. It is a major question that is always asked in any legal case involving catheter complications especially infiltration and extravasation. This is the most frequent cause of infusion-related lawsuits. National standards and guidelines would be used to measure the individual nurse's performance in a legal case and that would include both INS and ONS with both emphasizing the need for assessing for blood return. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Is there an INS standard that defines the quantity and quality of the concept of "Blood of Return"?
Last evening at our local AVA meeting it was defined for legal purposes as a documented 3 mL brisk blood return and I asked several questions
(1) What is done with the blood?
(2) How frequently is the 3 mL check done and documented?
(3) How would this process effect our thrombus and infection prevention efforts?
I would add that there was a previous post on IV-therapy.net that stated a hospital system had written a policy discouraging lab draws from all CVCs
(4) How does checking for blood return in this manner differ from actually drawing a blood sample from a CVC--You are still manipulating the catheter?
Robbin George RN VA-BC Vascular Access Resource Department Alexandria Hospital Virginia
Robbin George RN VA-BC
INS Standards do not provide information about a quantity of blood that must be aspirated. There is no evidence to support any specific amount. See Standard 45 and 61. Both state "positive blood return" but do not give any requirements for a specific quantity. The same syringe used to flush the catheter with saline can be used to aspirate for a blood return. There is no need to disconnect this syringe to accomplish both of these tasks. You must connect the saline filled syringe anyway, so there should be no additional hub manipulation to assess for a blood return. The saline will flush the whole blood back into the vein and not allow it to reside inside the lumen, therefore there should be no impact on lumen occlusion. Flushing and locking procedures have no impact - positive or negative - on the occurance of vein thrombosis or what is happening inside the vein around the catheter. The risk for NOT checking for a positive blood return is much greater than the risk for catheter complications. This is a critical component of your assessment of the catheter's functionality and must be done before each medication administration. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861