bright red blood from IV

[gman33]

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Every once in a while, I'll put in an IV and the blood looks more red than I expect.
Pretty much always an U/S line.

I've noticed this happens more on people on Coumadin.
The blood came count out a little faster as well.

This always has me worried that I somehow stuck an artery.
I'll usually confirm my position by flushing the line and watching it under U/S.
These aren't pulsatile or anything obvious like that.

Anyone have any thoughts on the U/S line that is confirmed venous, but the blood looks bright red?

 

[deleted547339]

Happens a lot on pt's with high FiO2

 

[gman33]

Happens a lot on pt's with high FiO2

My brain was too tired to think of this.
That was the case with the one last night.
thanks.

 

[Arcan57]

Happens a lot on pt's with high FiO2

Especially the really septic ones who've stopped using oxygen in the periphery (the about to die abnormally high ScVO2 group).

 

[Bostonredsox]

Especially the really septic ones who've stopped using oxygen in the periphery (the about to die abnormally high ScVO2 group).

/nod. This happens on TLCs too. Septic pts with hyperdynamic LV function who are on 100% NIPPV can have some pretty bright blood come back from that IJ stick. I used to almost reflexively restick those. Now I just confirm wire is in jugular with long and short axis views. Happens quite commonly. Same deal with peripheral veins. Bright red blood just infers there is a high oxygen content, certainly does not mean it's necessarily arterial.

Note if it's pulsating id restick 😉

 

[deleted547339]

/nod. This happens on TLCs too. Septic pts with hyperdynamic LV function who are on 100% NIPPV can have some pretty bright blood come back from that IJ stick. I used to almost reflexively restick those. Now I just confirm wire is in jugular with long and short axis views. Happens quite commonly. Same deal with peripheral veins. Bright red blood just infers there is a high oxygen content, certainly does not mean it's necessarily arterial.

Note if it's pulsating id restick 😉

I had a pt with an INR of like 8 that absolutely had to have central access. PO2 was crazy high. Had super high intra-abdominal pressure. Don't remember why, but couldn't go IJ.

I stuck the fem vein, but it was spurting out and bright red. I had watched it go in on ultrasound, but it still made a bit nervous, lol.

 

[Bostonredsox]

I had a pt with an INR of like 8 that absolutely had to have central access. PO2 was crazy high. Had super high intra-abdominal pressure. Don't remember why, but couldn't go IJ.

I stuck the fem vein, but it was spurting out and bright red. I had watched it go in on ultrasound, but it still made a bit nervous, lol.

Yeah that happens. I've had jugular blood literally shoot over my shoulder with Severe severe PAH and RV failure, volume overload and massive JVD. Had been on the vent for about 20 min, still on 100% so blood was pretty red too. It wasn't pulsatile but more like a wide open garden hose. Scared the **** out of me. US showed a nice wire snug in the vein though.

 

[pratik7]

Yeah that happens. I've had jugular blood literally shoot over my shoulder with Severe severe PAH and RV failure, volume overload and massive JVD. Had been on the vent for about 20 min, still on 100% so blood was pretty red too. It wasn't pulsatile but more like a wide open garden hose. Scared the **** out of me. US showed a nice wire snug in the vein though.

I had a similar episode once. I was so paranoid, I got a quick portable cxr to confirm guidewire was in RA before i dilated.

 

[docB]

Good discussion. Learning to do the procedure is one thing. Learning what to do with these odd ball scenarios and where your comfort level is takes experience.

I have had actual pulsatile return on good lines (dark red usually) in patients with high CVP. I recall one patient with severe pulmonary hypertension who really made me worried. But it was in the vein.

As for the bright red blood issue remember that your CO patients will have this. It sounds obvious but If you're dropping a line on a burn patient it's usually a pretty stressful situation and that bright cherry red return can make you act on reflex before you remember the hemoglobin physiology. I yanked what was probably a good line on a 12 yo burn victim because of this once. Like I said, experience.

 

[alpinism]

Great stuff. We were just talking about this in conference last week. Same thing with anaphylactic and neurogenic shock (any form of distributive shock). I believe some pts w/ acute adrenal insufficiency, liver failure, and hyperthyroidism can also have high SvO2/MVO2 levels leading to brighter venous blood.

LITFL: http://lifeinthefastlane.com/education/ccc/svo2/

 

[logos]

I have stuck the artery several times while trying to place deep brachial US guided PIVs. The veins are right near the artery. No big deal, just hold pressure for a min or two.

 

[dotcb]

learning point - ultrasound visualization in the correct vessel (specific) trumps color of blood, pulsatile pattern, etc. (nonspecific)