Returning wasted blood to a line?

Specialties MICU

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When you draw blood from a central line, or an a-line, or a peripheral IV, you first draw out a few mLs of "waste" blood, then you draw your labs, then flush.

What do you all think about the idea of drawing your waste blood, drawing your labs, RETURNING THE WASTE BLOOD TO THE LINE, then flushing?

I had read about this on a previous post a while ago. I havn't done it.

And a seperate question, how many mLs is sufficeint waste?

never, ever push anything through an arterial line!

It is perfectly acceptable to "push" blood return back into an arterial line provided it is within a closed system such as the VAMP device. Of course you also have to flush with a heparin solution or NS, from your pressure bag, through your A-line system after the draw.

We aren't talking about pushing drugs through a A-line, yes....that's a no-no.

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According to the literature, you only need to waste about 3x's the dead space of the line from which you are drawing from. Most facilities have protocols that say anywhere from 5-10mls. 3x's the dead space is probably less than 3 ml. We tend to over do it because that's what we where taught. Also remember if you get erroneous labs, make sure to compare them to previous labs drawn. I love it when a Hemoglobin comes back like 3-4 grams lower. The patient has no evidence of bleeding and isn't tachycardic. Remeber always to draw from the proximal port to, to prevent fluid from being sucked in if drawing from the other ports. Hope this helps, and remember always to use common sense and you will be one of the few. Good luck.

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Specializes in Critical Care, ER.
Yeah, there's no literature on this.

My fear is that the blood will clot, and it doesn't seem worth the risk to return 5 - 10 mL of blood.

Interesting points you bring up about autotransfusers.

Anyone know how PRBC blood from the blood bank is processed to prevent clotting?

You're kidding, right?

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Specializes in SICU.
Yeah, there's no literature on this.

My fear is that the blood will clot, and it doesn't seem worth the risk to return 5 - 10 mL of blood.

Interesting points you bring up about autotransfusers.

Anyone know how PRBC blood from the blood bank is processed to prevent clotting?

Citrate is mixed with blood products to prevent clotting. They are using citrate anticoagulation with CRRT on our unit to help with clotting issues r/t the therapy. Interesting I thought...lol

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Specializes in MICU, ER, SICU, Home Health, Corrections.
I'd never heard of a vamp before it was mentioned here. Wish we had them in my ICU. Although I guess on an adult patient, even one with a low H+H, 5mL of blood isn't going to make much difference. Anyone have a link to a picture of a vamp?

Here's the system we use. It's blunt needle compatible and quite user friendly.

http://www.hospira.ca/english/safeset.aspx

I can say from back in the 80's in NICU, we did indeed draw, collect, then return on the peanuts, under a time limit as mentioned.

rb

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Specializes in Critical Care, Pediatrics, Geriatrics.
I'd never heard of a vamp before it was mentioned here. Wish we had them in my ICU. Although I guess on an adult patient, even one with a low H+H, 5mL of blood isn't going to make much difference. Anyone have a link to a picture of a vamp?

I have never seen one in the facility I work at, but during one of my clinical rotations in a Burn ICU this is what they used. It was really great.

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The literature is vague on this subject. One study,however,did show that blood drawn up for the waste,when analyzed,showed significant clotting. The risk of injecting these clots back into the vasculature is worrisome. Furthermore,if you are not using a closed system to draw up the waste and sample,once you have disconnected the syringe from the line no way should you reconnect it--too much potential for contamination.

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Specializes in Adult Critical care.

If you are using a close system when drawing blood, you can return your waste(10ml). But, if its an open system-where you will disconnect and waste. . .dont return the wasted blood, thats too much of a contamination.

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Specializes in 2nd Year RN Student.
If you are using a close system when drawing blood, you can return your waste(10ml). But, if its an open system-where you will disconnect and waste. . .dont return the wasted blood, thats too much of a contamination.

I don't see how this addresses the issue of clotting?

I was told by an RN during my precepting that studies had been done showing a great deal of blood loss per patient because of wasting... but I don't see how it can add up to anything significant enough to make it worth the risk of clotting.

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Specializes in gen icu/ neuro icu/ trauma icu/hdu.
Our protocol is 10cc of waste. I personally would not want anyone putting 10cc of blood back into my system. Too much chance of contamination and I can live without the 10cc.

Sounds like a lot of blood for an abg. There are several papers looking at the mininum discard volumes for various tests. I think the least discard I remember reading about was 2.5 times the volume of the a-line to the sample port or 2.5 ml for the sampling system used by the authors. Also there is a growing body of work from PICU's also looking at mininum discards. perhaps your unit protocol writers shouldbe given these when the time comes to update???:smilecoffeecup:

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Specializes in Medsurg, Tele, ICU.
A recent memo from our Lab director stated that central line draws (which are only done by RNs) are twice as likely to be contaminated than peripheral sticks by phlebotomist(this was on blood cultures). I think I will continue to throw away the waste.

Personally, I think the high infection rate on central lines is more likely due to Nurse's giving IVPs through ports in the line that have been laying under the pt, hanging on the floor, etc., without even wiping the port with alcohol. :smackingf I don't think it has as much to do with returning blood, not that I think that's a good practice anywhere besides Peds either.

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Specializes in CRITICAL CARE.

The idea behind waste removal from a art line or cvl is fluilds and flush which is flowing in lines interfere with the results thats why we remove some blood before taking the actual sample. Second thing how much we should we remove it depends on which type of line pt is having. Thirdly now new studies dont support returning of waste which was taken with open system-source of contamination as mentioned in all above posts, now with new system in which we dont remove the syringe from line can be returned back. so always be wise what type of system you are using and act accordingly.

Mahirn

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