question about rinsing back

Specialties Urology

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Hello,

I'm an RN new to dialysis, only in training a month now. It is overwhelming but will do my best. I have read here that squeezing the bag is only good if there is a strong fistula. What about with catheters? Is squeezing the bag not a good idea? I was taught that way- squeezing back the arterial routinely for all pts and letting the pump rinse back the venous....however they just showed me the open way- to disconnect the arterial bloodline and use 10ml saline to rinse back arterial needle line while connecting the arterial bloodline to the saline y port and letting the pump rinse the whole circuit back-...the lines do get much clearer so I can see how the pt gets more blood back. If aseptic technique is maintained , is this the best way for catheter rinse back? I've been taught so many different ways at this point that I'm really confused. Thanks anyone

Susan in GA

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Dear Susan, What does your facility policy for rinseback of blood? That is where you need to start because in a court of law, the policy is the Bible. If you are not following the policy, and, God forbid, something happens, you will be held responsible for the problem. Now, back to the question, (sorry about the rant, but I am an educator in the dialysis world).... I have worked in clinics where the policy was disconnection of the arterial line, but have also worked in facilities where the policy was to rinseback the other way you have mentioned. Personally, I can find positive and negative things in both. With the disconnection method, there is much less risk of air being pushed into the person because the air bubble detector is at the venous chamber and it would be bypassed if the other way is used. On the other hand, there is a lot less chance of contamination for the patient with the "closed" system. Either way, start with your policy and continue to search any recent published studies that recommends one way over the other. Sorry this is so long, but I am quite wordy sometimes.

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Specializes in Acute Dialysis.

Squeezing the bag is always controversial. Sometimes to return the arterial side without disconnecting you must squeeze the bag to prevent blood backflow. A few pts I have seen will back blood all the way to the saline bag. It is best to not squeeze because of all the pressure squeezing does cause and the potential for damaging the access. There is no way to monitor how much pressure is being used to squeeze. Some companies have policies that allow to air return the arterial side. Disconnect the arterial and allow air to enter the line until the blood reaches the arterial chamber then clamp the arterial line and open the saline. This method is also controversial because of the open system and possible blood exposure. The company I used to work for had lines custom made by Medisystem for the Fersenius machines that had an additional leur lock y-port where the saline connected to the bloodlines. This allowed the arterial line to be disconnected and attached directly to the saline line. The blood was easily returned through the machine. I have personally used all 3 methods at one point or another. I vastly prefered to use the y-port method when it was available.

The final answer has to remain whatever method is the company policy. DO NOT trust that everyone, even your preceptor, is following company policy. Look it up for your self.

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What are current FMC policies now, Davita policies?

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Silverfoxxy, Did DaVita purchase a FMC clinic in your area? I know that DaVita bought Gambro....

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Specializes in Corrections, neurology, dialysis.

In our facility (Fresenius) we squeeze the bag to rinse back the arterial line on patients with grafts or fistulas. We NEVER squeeze the bag to rinse back catheters because the catheter is so close to the heart.

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Specializes in Renal, Haemo and Peritoneal.

I use the "open" method on all my patients with fistulas unless i am running off in a hurry as I will never be caught with someone shooting blood back into the saline bag. With permacaths/vascaths we always use the "closed" method as the risk of serious infection is so much greater.

Overall though, it is up to personal choice in my unit as to whether you run off open or closed with fistulas.

I don't like squeezing the bag though due to the inherent risk of damaging the fistula. There should be no need to do this with a catheter due to the lower pressuer in a large vessel

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I just finished formal training with FMC yesterday (though I work for another company who had a contract with them for training) and the question came up just yesterday and the instructor said that yes they are allowed and it is policy to squeeze the bag during rinseback of the arterial line to a catheter. Personally , so far I never squeeze hard- just steady gentle pressure

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Dear Susan,

I am in the exact situation--new to dialysis and overwhelmed right now. My facility has a policy of hooking the arterial line to the saline and rinsing back that way. It seems to give back the most blood. Good luck--on my way for another day of training!

Lorrie Booth:nurse:

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