I was asked a question yesterday. On a PIV do you need a blood return before giving a medication. My answer was regardless of the type of VAD you need a blood return period. I was told that a PIV rarely gives a blood return so what are they supposed to do. Can someone help me out here with evidence and standards of care. I was told a central line only needed a blood return. This does not seem like safe practice to me as I have always believed that PIV's are no different than central lines for medication safety and you need a blood return. What would the courts say?
By the way the lecture attendee stated that they would be starting PIV's all day as they do not often get blood return from a PIV.
kathy kokotis RN BS MBA
Bard Access Systems
Checking for a blood return on a short peripheral catheter is just as important as doing this on a CVAD or a midline. Infusion Nursing Standards of Practice states this in several places. #45 Flushing and Locking, page S60 Practice Criteria E. #61 Parenteral Medication and Solution Administration, page S86, Practice Criteria B. Neither of these statements have any criteria eliminating or emphasizing one type of catheter over another. In all the legal casess I review, this is a major component I look for regardless of what type of catheter was used. Probably about 80-85% of my cases involve short peripheral catheters and I still emphasize this aspiration. There can be some issues with a peripheral catheter not found on a CVAD. Aspiration technique can pull the wall of a thin vein over the catheter lumen and occlude it. Dehydration and a rapid withdrawal on a small syringe can occlude the backflow. Also the catheter tip could have eroded through the vein wall and then moved back into the lumen, allowing for leakage yet a blood return is still present. So it is not a totally diagnostic tool, but it is a critical component of the total site assessment. Technique is important but some want to think that some will and some will not produce a blood return so why do it? That thinking will get you into legal trouble and your patient into a world of clinical issues from extravasation of medications. I now teach the OPAL method of site assessment and have created posters based on this acronym:
O for observe the site condition
P for palpate the site
A for aspirate from the catheter and flush
L for listen to any patient complaints
This process applies to all patients, all catheters, all infusions!
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
I like OPAL
did you publish this?
kathy Kokotis
Yes 1st in an ED nursing textbook and I have made it into a poster that I give at when I speak. 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