Forum topic

5 posts / 0 new
Last post
tmorgan
blood return on midlines and extended dwell piv

we are gettignpush back from the PA's placing midlines and extended dwell catheters that it is normal for these lines to have no blood return. They are saying that if it flushes easily it can be used and are telling the MD's that order homecare this is ok. I have done a literature search but have found nothing to support there theory only INS that states blood return is a must. They want more than INS statement if anyone knows of any other source either way.

lynncrni
My company offers an online

My company offers an online CE course on midline catheters that provides 4 lengthy evidence tables. The reasons for absence of blood return is catheter is too large for vein, placed where either end is impacted by joint motion, inadequate stablization, and incorrect selection of this type of catheter for the infusates prescribed. Assessment of blood return is a major component of a site assessment for all VADs. Think of this as a site assessment - what it looks like, dressing integrity, etc - and patency assessment or no resistance to flush and a blood return. Many drugs have statements, warnings, precautions about what can happen at the infusion site. A common phrase found in Gahart's Intravenous Medication book is "determine absolute patency of the vein" in many drug monographs. You simply cannot see what is happening at this tip location and there can be a lot going on - thrombus formation is the most common one, which produces leaking, pain, edema, redness, etc. Blood return or lack of it is the most critical sign that there is a problem. You can continue to use the site until you have a raging complication or remove it and place another catheter. BTW why are PAs placing these and not an infusion/VA team of nurses? 

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

nancymoureau
Blood return with Midlines

I wonder how much for the inability to achieve blood return is due to incompetent needleless connections and blood reflux. Based on some current research just submitted for publication, having an anti-reflux device on any peripheral catheter made a big difference in survival. So many NC companies say neutral, positive pressure, etc etc, but what is really needed is no reflux, hold the pressure, no back and forth movement. Blood touching the polyurethane builds up on, inside and around the catheter. Flushing helps, but our devices are working against us. I agree with Lynn it can be too large a catheter in too small a vein, but that conclusion is not the complete answer, especially when we know the vein is larger at the end of the catheter. More research needed, but also more discrimination with making sure our products are working correctly...or getting one that does. 

Nancy L. Moureau, PhD, RN, CRNI, CPUI, VA-BC
PICC Excellence, Inc.
[email protected]
www.piccexcellence.com

swilebski
Needless connector

Nancy you mentioned no reflux. What is a good brand of anti-reflux needless connector? 

lynncrni
To my knowledge there are

To my knowledge there are only 2 brands in this anti-reflux category. Nexus TKO by Nexus Medical and one by ICU Medical but I cannot remember the trade name of the device. 

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

Log in or register to post comments