Returning wasted blood to a line?

Specialties MICU

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When you draw blood from a central line, or an a-line, or a peripheral IV, you first draw out a few mLs of "waste" blood, then you draw your labs, then flush.

What do you all think about the idea of drawing your waste blood, drawing your labs, RETURNING THE WASTE BLOOD TO THE LINE, then flushing?

I had read about this on a previous post a while ago. I havn't done it.

And a seperate question, how many mLs is sufficeint waste?

Specializes in PICU, Pediatric Cardiac.
I'm unsure about pediatrics/nicu, but do you mean you'll draw a syringe-ful of blood, remove it, use another syringe to draw the specimen, then re-instill the blood from the first syringe? And do you know if the '90 second rule' is just facility policy, or common/best practice? Thats really puzzling to me. Thanx for the ino.

At least in adults, it's called 'waste' for a reason.

Yes in peds/picu/nicu a "waste" syringe is aspirated to clear the line of heparin and/or electrolytes if from a cvl so you'll be able to draw a "clean" syringe of blood for your sample that tested. That way you don't get false readings ie high ptt or elevated K or glucose b/c not enough "waste" was aspirated. As I said before, in the small patients we give back "waste" because they have a low blood volume and keeps them from getting a blood transfusion if they require frequent lab draws. Same thing for the ped. cardiac patients as well. The 90-sec rule is common/best practice from what i understand because that was what I was shown and learned when I started nursing 6 yrs ago. It was commonly seen in several facilitites I worked, I even asked them if they returned "waste" blood and some say they do.

Each facility or unit has there way of doing things. I've returned the first aspirated syringe to my patients for so long that it becomes habit; from the tiny newborn to even the bigger kids. But with each facility I work in, I've always asked first and the common response is they do for the small patients b/c of blood volume.

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Specializes in CCU/CVU/ICU.
Perhaps this is true for you, but not for any (Australian) unit. We use a 5ml syringe to draw waste off, discard, use an ABG syringe for the sample, then flush.

POint taken. It was perhaps naive of me to assume everyone was using a closed system. At my place we use 'safeset' blood-sparing draw-systems...similar (but different) than the VAMP system mentioned by a previous poster. They're very convenient for drawing off samples, abg's, etc...and allow for the 'waste' to be instilled back into the patient.

Do you think that in all of Australia these things arent used? Or do you think it just depends on the hospital/unit???

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Specializes in Skilled rehab,surgical,ICU/trauma/burns.

on trauma patients with low h/h or volume defiencies i would return the blood. oooo btw, vamps rock!

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I'd never heard of a vamp before it was mentioned here. Wish we had them in my ICU. Although I guess on an adult patient, even one with a low H+H, 5mL of blood isn't going to make much difference. Anyone have a link to a picture of a vamp?

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Specializes in OB, M/S, HH, Medical Imaging RN.

Our protocol is 10cc of waste. I personally would not want anyone putting 10cc of blood back into my system. Too much chance of contamination and I can live without the 10cc.

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Specializes in CCRN, CNRN, Flight Nurse.
Anyone have a link to a picture of a vamp?

There are various types out there.

Pressure Monitoring Products

The ones my facility use are both from Abbott Critical Care Systems (wish I could find a link):

84" Arterial Pressure Tubing, Safeset Reservior and Blood Sampling Port

- List # 42323-02 ("Vamp" to add to existing Artlines/pressure lines).

84" Tubing, Disposable Transducer, 3ml Squeeze Flush, Macrodrip (Pole

Mount) - List # 42642-06 (Artline/pressure line setup including

"Vamp").

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Specializes in Critical Care, Cardiothoracics, VADs.

I've worked in several Australian ICUs in different states and never seen one. Sounds interesting, esp for someone with frequent ABG sampling/bloods. I think I'd feel odd giving it back, after doing this for 10 years though!

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It is a shame to transfuse our patients to replace phlebotomized losses. There are risks to transfusion that are dose dependent and involve morbidity and mortality. The presence of lines doubles the blood loss that ICU patients experience. There is excellent research out there to promote blood conservation and only thoughtful transfusion. I am so pleased that my facility has adopted VAMPs for all arterial lines, and central lines. We have a great intensivist team.

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Specializes in PICU, Peds transport, ER.

In our PICU we flush with 5-10 cc's NS first then draw off the same amount as a waste. We also routinely give back our waste if drawn from a central or arterial line. We do not do this with periperals. We also follow the same concept as long as you can give it back in a timely manner and use clean technique. The reasoning is some of our patients are so small they need all they can get.

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Specializes in Critical Care, ER.

I have been to facilities with and without vamps. I find them especially useful when I have a pt on an insulin drip with q 1 hr accuchecks with fingers that have been completely macerated. With the vamp, I can draw a small sample of blood every hour without having to feel guilty about wasting too much blood or turning my pt into a pin cushion.

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A recent memo from our Lab director stated that central line draws (which are only done by RNs) are twice as likely to be contaminated than peripheral sticks by phlebotomist(this was on blood cultures). I think I will continue to throw away the waste.

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never, ever push anything through an arterial line!

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