Returning blood

silverfoxxy · May 10, 2006

New to dialysis. Squeezing bag referring to fistula not cath. Some staff have said ok, others say learned not to squeeze. What causes BP to be elevated after return of blood when BP good during treatment? Like to get others opinions as many in units do not have alot of experience and are new.

NephroBSN, BSN, RN · May 10, 2006

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AmyLiz · May 11, 2006

New to dialysis. Squeezing bag referring to fistula not cath. Some staff have said ok, others say learned not to squeeze. What causes BP to be elevated after return of blood when BP good during treatment? Like to get others opinions as many in units do not have alot of experience and are new.

BP goes up after blood return simply because of the increase in fluid volume. As for squeezing the bag...I don't do it...I use the machine, since it's easier to monitor exactly how much saline you're infusing.

silverfoxxy · May 12, 2006

Thanks Amy and Nephro.

TBROOKS550 · May 28, 2006

If you are squeezing the bag, does that mean that you aren't returning the blood through the air detector?

silverfoxxy · May 29, 2006

TBRooks. When returning blood you can let the saline return on its own or with your hand, squeeze the bag. Not sure why some do it, guess they figure it is time saving. Are there parameters i.e. BP will be 20 pts higher when you return blood?

Fiona59 · Jun 7, 2006

I was told that the bag was squeezed when the graft or fistual was "powerful", you know when the blood backs up out into the saline lines.

bogchi2000 · Jun 11, 2006

Don't squeeze the bag for patient with new fistula as you will damage the fistula and the vein might collapse might as well do the open method conclusion.. It is not advisable to squeeze the bag unless the patients has a very strong "A" site that causes the back flow.

km5v6r, EdD, RN · Jun 14, 2006

What are your thoughts on squeezing bag of saline versus allowing saline to return blood via regular IV infusion. Have read that the squeezing is just for staff to save time. What is done in different units?

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.

Kathy

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amicro · Jun 22, 2006

I have an IJ Tessio catheter and am new to this dalysis center. Recently I noticed that my nurse pulls back blood before flushing the final heparinized saline through. Ofcourse, twice they have had to use retiplase. I tell them not to aspirate but leave the clear heparinized saline in the cath but they claim they have always aspirated. Isn't the problem the blood mixed in with the flush that sits in the line?

amicro · Jun 22, 2006

I think where it matters most is with aN IJ catheter or new access - fistual or graft. The danger is the risk of damaging the blood vessel. Do you aspirate blood into the final flush for a Tessio catheter?