Returning wasted blood to a line? - page 2

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... Read More

  1. by   Dinith88
    Quote from augigi
    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???
  2. by   MurseNeutron
    on trauma patients with low h/h or volume defiencies i would return the blood. oooo btw, vamps rock!
  3. by   aquaphoneRN
    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?
  4. by   DutchgirlRN
    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.
  5. by   RoxanRN
    Quote from aquaphoneRN
    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").
  6. by   augigi
    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!
  7. by   zipporah
    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.
  8. by   petsrn74
    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.
  9. by   bluesky
    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.
  10. by   burn out
    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.
  11. by   lisacammel
    never, ever push anything through an arterial line!
  12. by   OkieICU_RN
    Quote from lisacammel
    never, ever push anything through an arterial line!
    It is perfectly acceptable to "push" blood return back into an arterial line provided it is within a closed system such as the VAMP device. Of course you also have to flush with a heparin solution or NS, from your pressure bag, through your A-line system after the draw.

    We aren't talking about pushing drugs through a A-line, yes....that's a no-no.
  13. by   RYNOBLASTER30
    According to the literature, you only need to waste about 3x's the dead space of the line from which you are drawing from. Most facilities have protocols that say anywhere from 5-10mls. 3x's the dead space is probably less than 3 ml. We tend to over do it because that's what we where taught. Also remember if you get erroneous labs, make sure to compare them to previous labs drawn. I love it when a Hemoglobin comes back like 3-4 grams lower. The patient has no evidence of bleeding and isn't tachycardic. Remeber always to draw from the proximal port to, to prevent fluid from being sucked in if drawing from the other ports. Hope this helps, and remember always to use common sense and you will be one of the few. Good luck.

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