Standard 45/Practice Criteria G. states: "If...no blood return noted, the nurse should take further steps to assess patency of the catheter prior to administration of medications and solutions". Are there additional statemnets/standards within the INS document or elsewhere that guide the nurse about catheter use in the absense of blood return. There have been many conversations over there years highlighting the complications of using a CVAD when blood return is absent but the Standard does not seem to emphasize this imperative.
Robbin George RN, VA-BC Vascular Access Resource Department Alexandria Hospital Virginia
There are several statements about a blood return within the SOP. I am confused about why you think the statement quoted is not sufficient. So I am not sure what you think is needed or missing. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
The only time a blood return seems to be important is when they can not get one for a lab draw
When I ask nurses if a catheter has a blood return their response is generally "I didn't check but it flushed OK"
If I say that technically a CVC should not be used without a blood return confirmation am I exaggerating a truth?
Robbin George RN VA-BC
You are **not** exaggerating at all. A blood return for all VADs is a critical component of the assessment of the catheter's functionality prior to using it. My question was what do you think is missing from the INS SOP? I would direct you to thoroughly read the standards on Flushing and Locking and the standard of Medication Administration. That is where you should find what you are looking for. I don't have the document with me at this moment but you should be able to find these statements. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I think I get what Robbin is saying. the SOP states that the nurse should investigate the patency of the catheter prior to use and often times, actually way too many times, the nurses "investigation" is merely "well it flushes OK, so I can use it" this is not an appropriate investigation. While I have not completely read throught the entire SOP book yet, is there anywhere in the standards that state that a CVC should NOT be used unless there IS blood return. Hope I worded this right, but I believe that is what she is asking. Sorry if I misinterpreted.
ooo, maybe I found something that may be beneficial: Standard 61. Parenteral Medication and Solution Administration/Practice Criteria B: the nurse should aspirate for a positive blood return from the VAD to CONFIRM device patency prior to administration of parenteral medications and solutions.
Maybe this is the exact wording we need to prove to staff that this along with ease of flushing is what is required to confirm correct patency of a catheter.
See SOP 45 Flushing and Locking PC E also. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you to both Karen (for your correct interuptation of my question) and Lynn (for following up with an answer)
As always I too am grateful for the resource that is iv-therapy.net
Robbin George RN VA-BC
Robbin George RN VA-BC