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Kristin Walker
Checking for blood return every shift
Our current policy when drawing blood from Picc's is to flush after with 20 ml of NS.  We are currently having cathflo reps inservice our hospital on the use of their product and they are telling that part of their assessment on pt's is to make sure every central line including picc's should be tested to make sure there is a brisk blood return.  My point is this..... if you are bring blood into the lumen every 12 or 8 hrs to ensure patency, wouldn't you want to flush it with 20 ml as if you are drawing blood.  That is not our current practice.  The RN's only flush the lines with 10 ml NS on their assessment.  They are not checking for a brisk blood return unless they are drawing blood.  When they are flushing, they are making sure it flushes with ease---if not, they then investigate further to see if there is a blood return.  What do you all think?  Is it really necessary to aspirate blood up into the lumen of the catheter if you really don't have to draw blood.  I think it can cause more problems in the long run.  Any suggestions/comments are welcomed!
Timothy L. Creamer
According to INS

According to INS standards (#50, Flushing) practice criteria M and N address your question.

M. If resistance is met or an absent blood aspirate noted, the nurse should take further steps to assess patency of the catheter prior to administration of medications and solutions. The catheter should not be forcibly flushed.

N. The nurse should aspirate the catheter for positive blood return to confirm patency prior to administration of medications and solutions.

PWO (Persistent Withdrawl Occlusion)  treatment success outcomes improve with prompt intervention rather than when failed blood sampling occurs.

Hope this helps. 

Timothy L. Creamer, RN

Clinical Specialist, Bard Access Systems

Timothy L. Creamer RN, CRNI

Clinical Specialist, Bard Access Systems

Florida Division

In addition to the INS

In addition to the INS standards of practice, there are also statements from ONS about checking for a brisk blood return before each catheter use. So yes, you should include aspiration for a blood return as part of your total assessment of catheter function before it is used. There is no evidence to suggest that this blood aspiration and immediate flush creates a problem. There are numerous case studies and lawsuits where the absence of this blood return or the nurse's failure to check have caused serious problems with infiltration or extravasation injuries. Remember many drugs are vesicants, not just chemotherapy drugs. Vancomycin, KCl, promethazine, TPN are just a few. I think 10 mLs of saline flush is sufficient immediately after this aspiration. 

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

Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

You may want to read Sophie Harnage article "Achieving zero infection rate for central lines for 18 months" in JVAD.  They flush every shift as part of the MAR and check blood return.

Makes sense to me.  Blood on tip of catheter is very bacteria friendly for a home.  A catheter that does not aspirate means something is wrong and it is not a functioning device as defined by the ability to withdraw blood therefore you cannot infuse meds.

Do we really know if our catheters meet the definition of the INS Standards (ability to infuse and aspirate both)? I think we are lax as a entire industry on this policy.  Checking for blood return may in turn be equated to infection control in the future.



Kathy Kokotis

Bard Access Systems

Definitely check for blood

Definitely check for blood return before any use of any central line.  It should be in the policy, and staff RNs need to be practicing it.

I think whether to flush with 10 or 20 might also depend on how much flushing you'll be doing during the shift.  If I was giving a QD dose of Vanco and the patient had no other use of the PICC, I would flush with 20ml.  Minimum 10ml. 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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