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Anne Marie Frey
blood return verification....

We are going around with this topic again...some of the units in my hospital draw back to check for blood return from central lines either daily or once per shift, some do not.  The INS standards say to "...aspirate for a postiive blood return....prior to administration of parenteral medications and solutions."


What are people doing out there and does anyone know of evidence.

Do you aspirate for blood with each dose of intermittent med?

Do you aspirate a line for blood return that is infusing a continuous infusion? In which case do you aspirate daily, once per shift??

And what do you do if there is not a blood return?  Stop the infusion, unocclude with some agent that is appropriate? 

My population is neonates and pediatrics, so lines are small and many don't have a brisk blood return. We do not infuse a vesicant unless we get a blood return, so oncology kids, for example, do get a larger line, if they are able.  Most placed by IR so tip placement verified at insertion.  Blood return does not necessarily mean line is in proper place, only that it is intravascular unless recent tip location verified.

Would value your opinions...


Anne Marie Frey


The evidence for this

The evidence for this standard from INS and guideline from ONS comes from many reports of serious extravasation injuries when a blood return was either not assessed or was absent. ONS guidelines has much stricter language than INS by guiding the nurse in how to educate the patient about the risk and reasons for holding any drug infusion. There are no studies to quantify a required amount of blood. I would recommend aspiration before each intermittent med. The line is being flushed anyway to assess for line patency. Checking for blood return is a part of that patency assessment. Continuous infusion is the scenario not addressed by any studies that I know of. So no recommendations about this. Certainly if you have reason to believe there is a problem - pump occlusion alarms, sluggish gravity flow, positional irregularities, etc - this check is indicated. If no blood return, the catheter should be considered nonfunctioning until you have either diagnosed the problem with a dye study in rad or treated and reversed the situaiton with a solution to clear the line. The choice of agents depends upon the nurses assessment of the entire situation, catheter performance history, etc. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

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