Returning wasted blood to a line? - Page 4Register Today!
- Jan 23, '07 by PICC ACEThe literature is vague on this subject. One study,however,did show that blood drawn up for the waste,when analyzed,showed significant clotting. The risk of injecting these clots back into the vasculature is worrisome. Furthermore,if you are not using a closed system to draw up the waste and sample,once you have disconnected the syringe from the line no way should you reconnect it--too much potential for contamination.
- Jan 26, '07 by northparkgrad.If you are using a close system when drawing blood, you can return your waste(10ml). But, if its an open system-where you will disconnect and waste. . .dont return the wasted blood, thats too much of a contamination.
- Feb 26, '07 by Dakkon76Quote from northparkgrad.I don't see how this addresses the issue of clotting?If you are using a close system when drawing blood, you can return your waste(10ml). But, if its an open system-where you will disconnect and waste. . .dont return the wasted blood, thats too much of a contamination.
I was told by an RN during my precepting that studies had been done showing a great deal of blood loss per patient because of wasting... but I don't see how it can add up to anything significant enough to make it worth the risk of clotting.
- Mar 5, '07 by gradcareQuote from DutchgirlRNSounds like a lot of blood for an abg. There are several papers looking at the mininum discard volumes for various tests. I think the least discard I remember reading about was 2.5 times the volume of the a-line to the sample port or 2.5 ml for the sampling system used by the authors. Also there is a growing body of work from PICU's also looking at mininum discards. perhaps your unit protocol writers shouldbe given these when the time comes to update???:smilecoffeecup: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.
- Mar 12, '07 by NURSJADEDQuote from burn outA 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.
Personally, I think the high infection rate on central lines is more likely due to Nurse's giving IVPs through ports in the line that have been laying under the pt, hanging on the floor, etc., without even wiping the port with alcohol. :smackingf I don't think it has as much to do with returning blood, not that I think that's a good practice anywhere besides Peds either.
- Mar 13, '07 by msjangirThe idea behind waste removal from a art line or cvl is fluilds and flush which is flowing in lines interfere with the results thats why we remove some blood before taking the actual sample. Second thing how much we should we remove it depends on which type of line pt is having. Thirdly now new studies dont support returning of waste which was taken with open system-source of contamination as mentioned in all above posts, now with new system in which we dont remove the syringe from line can be returned back. so always be wise what type of system you are using and act accordingly.
- Do you have a policy regarding this? If so, what references did you site? We have had instances where kids and newborns require transfusions because of our "waste". In adults, 5-10ccper draw as waste is ususally no big deal, but in kids with far less circulating blood volume, it is huge, especially over time.
- What type of system do you use?
- Quote from RYNOBLASTER30Could you cite the references regarding wasting "3xs the dead space"? How is dead space determined?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.
- Oct 16, '11 by pedsproThis is called an unregulated blood tranfusion.
I have thouroughly researched this for PICU and PEDS. You can return waste on a central line using a closed system and a heparinized syringe . However, you would need a Md. order (at least) . The Infusion Nursing Society does not support this practice.Where I work they even return waste on peripherals(not evidenced based paractice) However I do not and will not return waste on peripherals untill my management can provide me with some research.....(still waiting, it has been 2 years)
If blood volume is crucial one should consider alternate means of collecting a sample, as in I-stat .
The waste volume depends on the type of line your patient has.