RED is the color of fire and blood, so it is associated with energy, war, danger, strength, power, determination as well as passion, desire, and love. Today, many are wearing RED to celebrate Valentine’s day or some may be wearing RED to celebrate the Chinese Lunar New Year, the year of the Tiger. RED in the Chinese culture signify luck. On February 5, it was National RED Day when everyone was encouraged to wear RED to raise awareness of heart disease in women. Seeing RED may also indicate anger, or a warning as in RED flag, or losing money as in – in the RED. Many countries use the color RED in their flag to symbolize courage and sacrifice.

To an infusion nurse, seeing RED is always a good thing – truly exhilarating!

• When I am challenged to insert a 24g peripheral IV catheter in a tiny, invisible vein of a dehydrated infant, seeing RED is when I jump for joy as I watch anxiously for the blood return and pray that blood continues to backflow as I advance the catheter into the vein. SUCCESS!!!
• Seeing RED when I aspirate for blood return from central venous catheters (CVC) gives me the feeling of victory, knowing that the CVC is properly functioning and ready to use. By seeing RED as in positive blood return means a free flowing blood return easily obtained on aspiration, and the color of whole blood. In other words, RED, not pink-tinged.
• Seeing RED gives me the feeling of success as I watch the blood tubes fill up when I am drawing blood samples from a patient’s antecubital fossa.

Oh yes, it doesn’t take much to make an infusion nurse happy.

BUT in the world of infusion therapy, seeing RED maybe an indication of a serious problem.

• Seeing RED at the peripheral IV site and/or CVC insertion/exit site can mean complications. Redness at the site may indicate infiltration, phlebitis or infection.
• Seeing a patient turn RED during an infusion is not a good thing -it may a sign of an infusion reaction. Stop whatever is infusing and manage the patient accordingly.

NOT seeing red when aspirating for blood return from CVCs makes an infusion nurse unhappy…. as this indicates a problem.

• If the tip of the CVC is in the lower thirds of the superior vena cava at the junction of the SVC and RA, then you should get a blood return. If you can’t get a positive blood return, do not use and assess the cause.
• It is not an expectation for patients to do arm and shoulder movements or what most nurses refer to as “central line aerobics” while you aspirate for a blood return.
• If unable to obtain a positive blood return, then there is a problem with the central line and consider possibly drug precipitate, fibrin sheath, thrombus formation at tip of catheter, and mechanical problems such pinch-off syndrome, malpositioning of catheter tip, or catheter dislocation.

Ok, so you’re thinking, but in practice if we call the physician and report the problem, we will be told to go ahead and use the CVC for infusion. It is a dilemma. Assessing for blood return is one of the key indications of a properly functioning CVC and  without a blood return, the use of the CVC can put the patient at risk of serious complications.

Wishing everyone Happy Valentine’s day!