… bloody, as in blood return… which, to an infusion nurse is truly exhilarating!

When I am challenged to insert a 24g peripheral IV catheter in a tiny, invisible vein of a dehydrated infant, 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. YES!! YES!!! YES!!!

When I aspirate for blood return from central venous catheters (CVC), it gives me the feeling of victory, knowing that the CVC is properly functioning and ready to use.  Positive blood return means a free flowing blood return easily obtained on aspiration, and the color of whole blood. In other words, bloody RED, not pink-tinged.

Seeing blood 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, bloody may also indicate a serious problem.

• Seeing blood at the peripheral IV site and/or CVC insertion/exit site can mean complications. Redness or blood 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 able to obtain a 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. 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 (inability to obtain blood return), we will be told to go ahead and use the CVC for infusion. It is a dilemma but don’t forget… 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.

Today is Halloween and this is where my love affair with all things bloody ends. Honestly, I love Halloween but I’m a wimp. I’m  not in love with scary movies, nor care for people’s costumes with blood, guts, and gore. No offense to anyone, it’s just not for me… probably because  I’ve seen enough in real life!!

Happy Halloween!!