Q&A: PIV insertion

Q: I know I’m in the vein but get no blood return and when I flush with saline to check it blows. Can it be pt is dehydrated.

A: The presence of a blood return during the insertion of a peripheral IV catheter is an indication that the tip of the catheter has entered the vein. If you do not get a blood return at all, the tip of the catheter may have not entered the vein or punctured through the vein. Dehydrated patients are always a challenge when assessing for a suitable vein for venipuncture. As a general rule, it is best to select veins that feel soft , resilient and bouncy as you palpate over and across the vein. After applying the tourniquet, give the veins time to fill (venous distention) which will help in assessing for veins to puncture. After you have punctured the vein, wait for the blood return before advancing the rest of catheter. In dehydrated patients, blood return may be slow and advancing the catheter too quickly before you see the blood return might end up puncturing through the vessel.


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