IV tips posted on Twitter March 2010
Infiltration:
- Checking for blood return or back flow of blood is good for patency but not a reliable method for assessing infiltration at IV site.
- If infusion continues to run when you apply digital pressure 3 inches above peripheral IV site in front of catheter tip – suspect infiltration.
Flushing:
- Minimum volume of flush solution should be equal to at least 2x the volume capacity of catheter & add-on-devices.
- If you are wondering how much to flush an access device, use this formula to determine flush volume
- If using 0.9% Sodium Chloride for flush, preservative free is preferred.
- If using 0.9% Sodium Chloride with preservative for flush, volume should not exceed 30mL in a 24hr period for adults.
- If using heparin to flush lines, use the lowest concentration to maintain patency and not cause systemic anticoagulation.
Local Anesthetic:
- Bacteriostatic 0.9% Sodium Chloride can be used as intradermal anesthesia (numbing) prior to placement of peripheral IV lines.
- If you’re wondering how this works, read this blog entry.
Infection Control:
- Nurses shall not wear artificial nails or nail products when performing infusion therapy procedures.
- I got a lot of re-tweets about this. This is not wishful thinking, it is a standard of practice. Read this blog entry.
Acknowledgment: Thanks to my twitter and nurse colleague, @nursingpins for introducing me to xtranormal.
Infusion Nurse Blog 
Just curious: why is checking for blood return not a good method? Where else would it come from? Thanks for the article.
Checking for blood return or backflow of blood is not a reliable method for assessing for infiltration. If an IV device is in a small vein, you may not get a blood return because of the vein size, one might think the infusion has infiltrated when it has not. Also, veins that have been previously used or punctured or veins that are very fragile may seep fluid at a site above or below the vein catheter entry point. In this case, there could be a blood return yet infiltration is occurring. The movement of an IV inside the vein – like in-out-movement (perhaps due to improper securement) can cause the skin and vein entry point to enlarge, allowing fluid to seep at the vein entry point resulting in an infiltration.
A complete assessment of the patient, the infusion system, the area around the tip of the catheter and the extremity where the IV is may be necessary to determine the presence of infiltration. Check for blanching, stretched skin, firm tissues and coolness.
Thanks for your comment.