Thomas A. Sharon, R.N., M.P.H.

When it comes to foreign body emboli, it seems that few nurses and doctors remain aware of this risk because so many violate the prime directive in the standards of care: Once you pull the needle out of the catheter never reinsert it. The intravenous insertion needles come contained within a flexible catheter with the beveled point protruding from the distal end. This allows for penetration into the vein and withdrawal of the needle with the catheter remaining in place. The proper technique is to insert, pull the needle back and check for flash back (a spurt of blood flowing back into the chamber within the hub of the needle. What happens all too often is when the workers realize that they missed the vein because there is no flash back, or the catheter seemed to have slipped out of the vein during the threading process, they reinsert the needle in order to access the vein without having to withdraw and start again. However, this is completely contrary to the standard of care because if the catheter tube is kinked upon reinsertion of the needle the needle could sever a portion of the catheter and it then becomes a foreign body. If it happened inside the vein it becomes an embolus free floating toward the heart and results in a pulmonary embolus, which is a life-threatening condition.The proper technique is to thread the catheter into the vein and if unsuccessful they must withdraw the entire needle followed by the catheter and start again. The reinsertion of the needle into the catheter is a gross departure from the standards of care.