Reinsert Blood from CVC

[RonaIsaNurse]

I am working on ped unit, a newbie. For ptient w CVC, it's known to draw 5-10 cc blood first for a waste and re draw another blood for samples. And in my hospital, nurses re inserted the first draw to the cvc for Hb issue~ i am sure that blood must be contained an active clotting factor so it's must be high risk if reinsert it~ my fellow didnt hear me as i am newbie. I tried searching some articles but i found none. What do you think n do you have an article rt it? Thanks

[applewhitern, BSN, RN]

I worked in a pediatric intensive care unit for years. We did indeed return the blood. We were very careful and fast, too, so the blood really didn't stay in the syringe but a few seconds. If it took too long, we didn't return it. I know that sounds dangerous, but those critically ill kids simply could not tolerate losing so much blood as blood draw waste. We would be getting labs on some of them all day long.

[Wuzzie]

We drew ours into a heparinized syringe. We'd first pull up 10u/ml of heparin and then squirt it out. Never had any issue with it. I have also used the VIA system which was awesome.

[RonaIsaNurse]

Is there any policy rt it? Nice explanation tho~

[RonaIsaNurse]

I see~ we never use heparinez syringe~ i learn something new~ if you have any policy w your answer, that must be good~ i am stipl newbie tho~ we also reinsert a waste blood draw to stable young adult patients n no count the time~ i know they so it quickly but i think it's not that quick. That's why kindda concern

[Triddin]

Why not use a vamp? Then you can return the blood without wasting it and it stays within a closed system

[RonaIsaNurse]

Unfortunately, we dun have vamp here ~

[Triddin]

It might be something to talk to your manager about to stock them. You can present them as an opportunity to improve pt care

[NICU Guy, BSN, RN]

In the NICU, we return the waste blood when we draw labs from an Arterial line, but only when we use the closed system (Hummi Micro Draw system) because there is no opportunity for contamination. The waste syringe contains no added heparin because the infusing fluids contain heparin and the whole procedure, from drawing the waste/ drawing the sample/ re-instilling the waste, takes less than a minute.

[IVRUS, BSN, RN]

One should NEVER reinfuse a drawn waste which has been disconnected from the IV catheter. That puts the patient at too much risk. IMO, Nurses drawing from lines should use the MIXING method: Attach a 10 cc NS syringe and flush the line; Leaving empty the syringe attached, pull back 5 cc of blood, reinfuse, pull back another 5 cc, reinfuse, do this 4-5 times, with the 5th time being your specimen. This mixing method greatly reduces the chances of iatrogenic anemia, and one doesn't have to worry about the blood clotting.

[/username, BSN, RN]

Absolutely not. The moment the blood hits something foreign (in this case, your syringe), the clotting cascade is activated. Within seconds, you will have microscopic clots forming, and in less than a minute, you will have clots that are large enough to lodge in end organs or capillaries and cause damage. The fibrinogen in the patient's bloodstream may be able to break down the clot before it causes damage, but that's a risk that isn't worth taking.

In addition to the issue of clots, there is maybe an argument to be made for increased risk for infection, but as long as you are utilizing proper aseptic technique, this is insignificant.

[MunoRN, RN]

One should NEVER reinfuse a drawn waste which has been disconnected from the IV catheter. That puts the patient at too much risk. IMO, Nurses drawing from lines should use the MIXING method: Attach a 10 cc NS syringe and flush the line; Leaving empty the syringe attached, pull back 5 cc of blood, reinfuse, pull back another 5 cc, reinfuse, do this 4-5 times, with the 5th time being your specimen. This mixing method greatly reduces the chances of iatrogenic anemia, and one doesn't have to worry about the blood clotting.

All connections to a system include a risk of contamination, it's not particularly different for reinfusing waste. It's certainly reasonable to eradicate all unnecessary connections, although practice recommendation groups could certainly do a better job of recognizing the risk of excessive connections and change their practice of recommending additional manipulations that aren't well justified.

As a comparative risk, the risk of an extra connection is clearly less than that of iatrogenic blood loss, and while there are better options that don't require the waste syringe to be removed, if the nurse is going to limit their options to either wasting up to 10mls of the patient's blood or an extra connection then the option with less established risk is to give the waste back.