Can anyone help me with this question: Since the INS standards state to obtain a blood return from IV catheters, what does your policy say in referrence to short term, less than 3 inch peripheral IV catheters?

I realize that shortly after placement a small 24 gauge in a tiny vein of an elderly woman may fail to yeild a blood return due to vessel size, catheter size and fibrin buildup, BUT, does your policy state to remove and replace this small catheter if it fails to yeild a blood return at ANY time during its dwell? If not, how does your policy read?  My concern is that each nurse doing this observation needs to be assessing for other s/s of complications since these catheters often end up without a blood return even in the first 24 hours.  If a policy simply reads: "If a short term catheter fails to yeild a blood return, remove and replace" this will lead to unnecessary VP for the patient and a decrease in vascular access sites.  Since it's a INS standard, and surveyors are citing these standards, how do you defend 'leaving a 24 gauge' peripheral IV catheter in if if fails to give a blood return shortly after insertion, but there is no patient complaints, swelling, coolness or any other obvious complications.

Thanks in advance for your time.

 

 Many thanks Sarah. You can

 Many thanks Sarah. You can now find this in the Resources tab, Forms section. Look for the file labeled Assessing the Catheter and Infusion System. Opals are my birthstone, guess that is why I thought of this! Lynn

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

 Yes, you may use this. It is

 Yes, you may use this. It is being published in a more complete format than what I quickly posting here. I will upload the table, if I can figure out how to do that on this site. Look for a file titled OPAL.docx It contains the legend at the bottom that must be included in order to use it. Thanks Lynn

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

Lynn--May I use your

Lynn--May I use your OPAL concept on a poster for education purposes? What is the correct way to acknowledge/credit you?

Thank You

Robbin George RN VA-BC

Robbin George RN VA-BC

As always, Thank You Lyn for

As always, Thank You Lyn for your concise and informative insights. 

 As with any type of VAD, a

 As with any type of VAD, a complete assessment of patency must be performed before each use. I have come up with this acronym - OPAL

O= observe for any visible signs

P = palpate to detect induration, and ellicit any discomfort

A = aspirate for a blood return and flush the catheter for resistance, etc

L = listen for any patient complaints

A blood return check is one component of this complete assessment. Standing alone, a blood return on a peripheral catheter is not diagnostic. But it is a critical component of a complete assessment and can not be omitted. If you have a peripheral catheter without a blood return, there are many other things the nurse should include in the assessment prior to immediate removal. First assess the therapy being infused. If the pH and osmolarity do not fall within the recommendations, this should raise concerns. If the med is an irritant or vesicant, this should also raise concerns. Many times the aspiration technique is the problem - smaller syringes create less pressure on aspiration so a 3 mL is better than a 10 mL. Pulling very slow and gently on the plunger also. Paying attention to the quality of the gravity drip - rapid means usually the site is patent, slowed or halting flow means there could be a problem. Finally a tourniquet test - tourniquet on several inches above the catheter, flow by gravity, stopped fluid flow means the site is patent, continued flow means leaking into the tissue. All of this information should be written in your practice guidelines section of a policy document. This is the part that requires nursing judgment and does not fit either a policy statement or a procedure list. But it is a critical component of what the nurse should do to arrive at their decision about the patency of each site. I continue to give deposition in severe cases of infiltration and extravasation where none of this is done, especially checking for a blood return on peripheral catheters. The prevailing thought seems to be that you may or may not have a blood return from a peripheral catheter therefore it is not necessary to do. I have serious differences with this thought as it puts patients at risk for compartment syndrome, complex regional pain syndrome and necrotic ulcers, the final outcomes of infiltration and extravasation. Even plain fluids are not exempt for producing these problems as a large volume into one of the numerous compartments in the hand, wrist and lower forearm puts the patient at risk for arm amputation if not detected and surgical intervention within 5 to 6 hours. Combine this with the fact that the flow is regulated by an infusion pump that just keeps going regardless of where the fluid is infusing. Lynn

 

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