Should I Aspirate a Peripheral Cannula Prior to Using it?

The Infusion Nurses Society Infusion Therapy Standards of Practice states to assess and document patency for all types of venous access devices prior to intermittent infusions and regularly for continuous infusions. Patency is assessed by aspirating for blood return.

Yes. All vascular access devices require assessment of line patency prior to use. The process is the same for central venous access devices and peripheral intravenous catheters (PIVC).

NOTE: Use aseptic technique for the steps below.

1. Use the correct connection sequence based on add-ons (i.e. extension set with/without clamp, positive/negative displacement needleless connector). Refer to manufacturer for best practice.

2. Use a syringe with a 10 mL barrel (e.g. 10 mL syringe or 5 mL prefilled syringe in a 10 mL barrel) filled with 0.9% sodium chloride. This provides a safe injection pressure to reduce risk of vessel damage. If available, use a prefilled saline syringe as it reduces risk of infection and device failure. NOTE: Smaller barrel syringes exert higher injection pressures and are linked to vessel damage and premature device failure.

3. Aspirate slowly to confirm blood. Avoid letting blood enter the needleless connector if possible.

   • If blood return is sluggish, absent, or contraindicated due to patient condition, assess device using alternative methods such as slow push of 0.9% sodium chloride observing for signs of infiltration, resistance or patient reported complications.

4. Flush the PIVC using gentle pulsatile motions to increase debris clearance from the catheter. Use enough volume to flush the PIVC and any add-ons.

5. Do not bottom out the syringe plunger as this results in blood reflux into the catheter.

6. Use the correct disconnection sequence based on add-ons (i.e. extension set with/without clamp, positive/negative displacement needleless connector). Refer to manufacturer for best practice.

7. Administer medication using a syringe no smaller than a 10 mL barrel.

8. Repeat steps 1, 3, 4 and 5 immediately after medication administration. If medication is incompatible with 0.9% sodium chloride, use 5% dextrose in water followed by 0.9% sodium chloride.

Troubleshooting

• Never forcefully flush a PIVC. 

• If unable to aspirate or flush, check for external cause (e.g. kinked catheter at insertion site, closed clamps, kinked extension sets).

• If any complications are observed or reported by the patient, consider replacing the PIVC (vesicant medications or high volume) or increasing observation frequency (irritant medications).

References

Australian Commission on Safety and Quality in Health Care. (2021). Management of Peripheral Intravenous Catheters Clinical Care Standard. 

Cancer Nurses Society of Australia. (2024). CNSA Vascular Access Devices: Evidence-Based Clinical Practice Guidelines. https://www.cnsa.org.au/practiceresources/vascular-access-resources

Nickel, B., Gorski, L., Kleidon, T., Kyes, A., DeVries, M., Keogh, S., Meyer, B., Sarver, M. J., Crickman, R., & Ong, J. (2024). Infusion therapy standards of practice. Journal of Infusion Nursing, 47(1S), S1-S285. 

Pittiruti, M., Van Boxtel, T., Scoppettuolo, G., Carr, P., Konstantinou, E., Ortiz Miluy, G., Lamperti, M., Goossens, G. A., Simcock, L., Dupont, C., Inwood, S., Bertoglio, S., Nicholson, J., Pinelli, F., & Pepe, G. (2023). European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project. The Journal of Vascular Access, 24(1), 165-182. https://doi.org/10.1177/11297298211023274 

World Health Organization. (2024). Guidelines for the prevention of bloodstream infections and other infections associated with the use of intravascular catheters. Part I: peripheral catheters. World Health Organization. 

Last Updated on: 10/09/2024