Returning blood waste back into a PICC

Blee O'Myacin, BSN, RN · Apr 23, 2008

Another thread has me wondering....why cant we return the waste blood back into a PICC. If you cleanse the port with alcohol swab prior to accessing (just as if you were administering a drug) why cant you return the blood? I mean, it would be the same as infusing a med via IV push, except it would be their blood rather than a drug. So how would contamination be an issue? The syrings is sterile, and you flush afterward. Im just wondering because when we draw coags from a PICC, we have to waste 20 ml's...thats ALOT to waste everyday or q 12 hours, especially if they already have a low H&H. Your opinions? ICU here returns it, but they have a special line that they draw it with (Im not sure what its called)

I've never worked anywhere where the policy had us return the waste, but we use transfer devices on our PICC lines, and waste into a 10ml tube, drawing into a syringe and pushing it back would risk the return of lysed cells. :twocents: I don't have the time to look up any evidence based data, but would be interested in seeing some if anyone has any to post. Thanks!

Blee

rizzle · Apr 23, 2008

Because the blood can begin to form micro clots in the syringe.

RN1982 · Apr 23, 2008

I never return wasted blood. And what the previous posts said. I thought the whole point of wasting the first 5-10cc was to get accurate results on the blood that you draw after the waste. I've heard of people returning the blood but I wouldn't do it.

classicdame, MSN, EdD · Apr 23, 2008

The syringe is no longer sterile once you lay it down, even if you replace it with the originial cap. Also, the blood coagulates quickly. You could be setting up a clot in the line and lose the line.

NeosynephRN · Apr 23, 2008

We never retrun our wastes either. We are getting some new tubing, that sets up on a CVP or A line, that will be self contained, and your waste will be captured in a little chamber, and when you are done with the sample you can give back the waste. Never exposed to air. I have not used it, they just had them at our meeting on Monday, but then this will not be on every patient.

chenoaspirit, ASN, RN · Apr 23, 2008

Yeah, maybe it was A-line tubing used.

Kerrigan 06 · Apr 23, 2008

The A-line tubing in reference - the SafeSet - is actually very handy to have around. It's basically a 12-or-so mL syringe built into the tubing. This only applies to arterial lines as far as I've seen so far, but I suppose it could be used for a CVP as well.

Seeing how quickly blood starts looking icky inside of a syringe, I wouldn't want to give it back to a PICC.

nyapa, RN · Apr 23, 2008

The syringe is no longer sterile once you lay it down, even if you replace it with the originial cap. Also, the blood coagulates quickly. You could be setting up a clot in the line and lose the line.

And following your argument, there is then a risk of infection via the PICC line. We are so cautious when introducing syringes and medications via these lines, after all.

DeLana_RN, BSN, RN · Apr 23, 2008

In outpatient dialysis, we would have to draw monthly labs including PT/PTT, which required removing 30 ml of blood prior to filling any tube. Policy was to draw this into three 10-cc syringes, recap those and set them aside, and them to return the blood via the dialysis access (central line/dialysis cath or peripheral AV graft or fistula, which had been accessed with a fistula needle).

Of course, the dialysis machine removes any microclots before returning the blood, but the pts were not yet on the machine (labs were drawn prior to starting dialysis) so if there were any, they would have been returned to the pt. I always wondered about that.

The reason for the policy was that these pts are chronically anemic and simply could not afford to lose more blood (but then again, sometimes our machine blood lines clotted and we would be unable to return about 250 ml of blood... so 30 ml - plus what was drawn into the tubes - once a month doesn't seem like all that much)?

DeLana

running_nurse · Apr 23, 2008

In PICU we ALWAYS returned our blood unless it started to clot. If you have a 8kg baby who is getting multible labs q 4 hours and it's only access is A-line/Central line, we still needed to draw at least a 5cc waste. 5ccx6 times a day is A LOT of blood for a little one, and they need all they can get! So although all the points above our valid, that was our practice in PICU. Very quick!

usiv · Apr 23, 2008

when I worked peds, we routinely returned the waste, but with adults, we never do.