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

[MunoRN, 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.

While it's true that contact with the interior surface of a device can initiate the early stages of clot formation, simple platelet aggregation doesn't actually have the ability to damage organs, platelet aggregation actually occurs normally in the body, it's more developed clots that can cause damage.

The practice of pulling blood into a device, getting a lab sample, then reinfusing the waste is actually a practice well established to be safe and to reduce iatrogenic blood loss. Commonly referred to as a "VAMP", devices for this purpose are now often a built in part of transduced tubing and are also available as an add-on device. You don't necessarily need a device specifically marketed for this purpose, commonly available equipment such as a three way with two syringes or a splitter can serve the same purpose. The devices have been in use for decades with broad adverse event surveillance and no significant risk has been found relating to this practice.