Returning wasted blood to a line?

[aquaphoneRN]

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?

[jdkrn]

Do you have a policy regarding this? If so, what references did you site? We have had instances where kids and newborns require transfusions because of our "waste". In adults, 5-10ccper draw as waste is ususally no big deal, but in kids with far less circulating blood volume, it is huge, especially over time.

Thanks

[jdkrn]

What type of system do you use?

Thanks

[jdkrn]

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.

Could you cite the references regarding wasting "3xs the dead space"? How is dead space determined?

thanks

[pedspro]

This is called an unregulated blood tranfusion.

I have thouroughly researched this for PICU and PEDS. You can return waste on a central line using a closed system and a heparinized syringe . However, you would need a Md. order (at least) . The Infusion Nursing Society does not support this practice.Where I work they even return waste on peripherals(not evidenced based paractice) However I do not and will not return waste on peripherals untill my management can provide me with some research.....(still waiting, it has been 2 years)

If blood volume is crucial one should consider alternate means of collecting a sample, as in I-stat .

The waste volume depends on the type of line your patient has.