I am asking for people's position on the infusing of vesicant via both PIV and central line . Knowing what research and the standards state, what is the reality of practice. Specifically, I am asking about the pediatric population whose venous access is limited and devices are small.
First: If there is no return of blood from a PIV prior to a vesicant infusion - do you replace the PIV?
Second: If giving an intermittent or continuous vesicant through a 1.9F PICC line - do you check for a blood return? - we do not routinely check 1.9F catheters for a blood return after placement due to risk of occlusion.
Third - When giving a continuous vesicant through a central line - do you stop it to assess for a blood return? - and how often.
Fourth - Knowing that a central line should be inserted for a continuous infusion of inotropes - and knowing that you can not check for a blood return due to risk of bolus - physician refuses to place central line due medical instability of patient - how does the bedside nurse/VAS manage.
Thank you everyone for your input. We are trying our best to match the standards with reality of practice and appreciate any response.