Is this ever acceptable?

pghfoxfan · Dec 19, 2009

I have given patients back their blood, but I have done in a sterile environment and in a timely manner(within seconds of drawing) 10 cc's of blood might not be much once a day, but can add up if you are drawing ACTs every 1/2 hour for example (such as during an A Fib ablation, when a patient is heparnized for 6 hours). You would be wasting a lot of blood.

llg, PhD, RN · Dec 19, 2009

Spoken like someone who's never worked in a NICU We never, ever waste blood.
When drawing labs from a UAC/UVC, we always give the blood back. I was horrified the first time I saw a "big people" nurse waste 10 ml of blood! Some things depend on your background. Maybe the traveler was a former peds nurse.

... and back in the olden days (the 1970's and 1980's), we didn't even have closed systems ... and changing a stopcock was next to the umbilical artery catheter was nearly impossible because their connection was so precarious. The same stopcock stayed on the line for several days. We drew off a little blood, set is aside on the bed so that the tip of the syringe wasn't touching anything ... then we drew the labs ... then returned the blood to the baby ... then flushed the line.

I did that hundreds of times. That's how ALL neonatal ICU's did it back then. Babies couldn't afford to lose the couple of cc's of blood necessary to clear the line of IV fluid. NICU's still return the blood: they just have closed systems now.

NessaNurse · Dec 19, 2009

When I worked Peds at a children's hospital Policy said NOT to give the blood back..even on NICU/PICU..but some nurses did do it. I never did because of the risks associated with the practive. When drawing most labs I used the minimum waste allowed (I would call lab to see what the minimum would be to get correct values) and if the minimum was very large I would do a peripheral draw rather than waste 10 ml on a teeny anemic baby...so really even though some nurses did give the blood back..it was not acceptable per policy

al7139, ASN, RN · Dec 19, 2009

In my hospital we do reinstill the blood, but only if we use a closed system and sterile procedure. Otherwise we draw a "blank" (either by syringe or vacutainer), draw the labs and waste the blank, and flush the line. We only use this procedure for a central line or port. We do not use peripheral lines for lab draws except in a dire emergency. If a pt has a PIV we must stick them to get labs.

Amy

blamejoe · Dec 19, 2009

I would never access a port and reinstill anything that did not come from a sterile environment. Did you ever draw off your labs and see how that junky yellow lipid layer floats to the top in your syringe? Yuck. If your patient for whatever reason needs those few mls, then the practice should be different. CBCs can be done with capillary slide smears, tubes can be filled 1ml in most decent labs and still get accurate results. Pediatric blood tubes can be used. Though inconvenient to the lab, different depts. (tox, immunology, etc.) can share samples instead of needing new tubes, in the interest of causing no further harm to the patient.

In our hospital we only waste 5mls. Ports tend to hold 3-5ccs of blood in my largest adult patients, so discarding more than that, unless it is hospital policy, could be changed.

I wouldn't listen to the "back in the day" nurses (no offense); practice in all areas has changed for a very good reason.

blondy2061h, MSN, RN · Dec 19, 2009

I had a Jehovah's Witness patient I questioned if it would be okay to do this with. His hgb was 5 and he was obviously refusing transfusion. Nursing said no- way too risky with infection. The patient said no- that counted as an autologuous transfusion which wasn't acceptable.

nuangel1, BSN, RN · Dec 19, 2009

no .i would not do it.

medicrn13 · Dec 19, 2009

Negative...never heard of it until just now. Using an open system? A plain ol' syringe? That's even dumber. That may have been "how it was done back in the day..." but with all we know about infection these days...too risky...

Midwest4me · Dec 19, 2009

good question as i recently battled my administrator in the chronic dialysis clinic (i quit not long ago). on dialysis caths when drawing labs she insisted we pull 10ml off, draw our labs, then reinstill the 10ml back to the pt. i refused!!! her rational was dialysis pts cant afford to loose the blood, but my opinion is dialysis pts cant afford the possible hemolysis, infections potential etc. i should send this link to her lol. ****** if your here hope you read it!! she still has this practice!!!

i used to work hemodialysis years ago and the practice most certainly included returning the blood, though i can't recall if it was 10 mls.

Emergency RN · Dec 19, 2009

access port
draw 10 ml blood, in a srynge, as though to waste
draw labs
re-instill original 10 ml blood
this was not done in a closed system.
is this ever acceptable?

actually, you can make the entire blood draw and return within a temporary closed system, by using a vacutainer, reservoir syringe, and three way stopcock.

port 1. connect to patient

port 2. connect to reservoir syringe

port 3. connect to vacutainer

1. aspirate blood and excess fluid into reservoir syringe.

2. turn stopcock closed lever to reservoir

3. collect your specimens via vacutainer

4. turn stopcock closed lever to vacutainer

5. return reservoir blood to patient

6. turn stopcock closed lever to patient

7. discard vacutainer and reservoir syringe

8. flush your ports as usual

the above is the method i use whenever venipuncture is impossible in a patient that is dangerously anemic, where blood needs to be drawn from a port.

i've also given patients im shots right through their clothing in emergencies (acute psychosis being held down by several persons in need of immediate im sedation, we had no time to take off his clothes and i doubt that he would have let us).

obviously, are these things optimal? of course not. but one really needs to look at the acute needs of the patient and do the thing that is in his best interest that has the greatest impact at the moment of crisis.

needless to say, aseptic technique is great and generally should be adhered to, but not so blindly that it negatively impacts or works to the patient detriment, by preventing us from doing what the patient critically needs most. that's sorta like saying we should withhold chest compressions because we fear breaking the poor patient's ribs.

imho, it's always better to address my patient's needs; and not my textbook's.

shiccy · Dec 19, 2009

If it's a dialysis cath like a QM, then you're instilling bloody heparin ... not the best idea.

If it doesn't have heparin in it, then you're in danger of placing clotted blood back into the system / body. Not good, obviously!

DeLana_RN, BSN, RN · Dec 19, 2009

This was policy in the chronic dialysis clinic where I used to work (same national company as the one Lacie used to work for), but only if the pt had a heparinized central line (perm cath) and if monthly labs included a PTT; in this case you were to draw 30 cc of blood into 3 10-cc syringes and return the blood after all labs were drawn (usually 5-6 tubes). For all other labs - weekly hgb, monthly labs not including PTT - waste was not returned.

I never did feel comfortable with this practice. Dialysis pts are usually anemic, but they get epogen for that; infection seems to be a much more serious risk to me.

DeLana