Hello
Is it safe to reinfuse blood drawn from a CVAD via a syringe when checking line patency? Some said it is safe to reinfuse the blood back to patient to minimize risk of anemia, while others believe this practice contribute to line infection and/or introducing potential clot to patient. Any advice would be appreciate it.
Best - Deedee
Blood aspiration for checking patency and drawing a blood sample are 2 distinctly different procedures. Aspiration for blood return only means you need to pull back enough blood to observe that it is the color and consistency of whole blood and that it flows easily. You do not even need to pull it back through the needleless connector if you have an extension on the catheter. You do not need to aspirate any specific amount; there should not be enough time for clots to form; and you should never disconnect the syringe so infection risk are minimized. You are using the same saline filled syringe as what is used for routine flushing - attach, flush 1-2 mLs, aspirate, then flush the remaining saline in. There is no evidence that bloodstream infection or a local infection is attributed to aspirating for a blood return. Drawing a blood sample can add risk of infection due to the use of multiple syringes or vacuum tube holders. If using the discard method, you would need to flush, then aspirate the designated number of mLs, detach this syringe and attach a new syringe or the vacuum tube holder, then attach another flush syringe at the end. If using the mixing or push-pull method, you would use the same saline filled flush syringe for flushing, then aspirating and reinjecting 5 times, then detach old and attach new syringe. All blood sampling procedures have much more hub manipulation. As you can see, the mixing or push-pull method is all about aspirating and reinjecting the blood without syringe disconnection. There is no issue with aspirating for a blood return and there is great risk of extravasation into other structures if the catheter is no longer inside the vein. It is the standard of care required for all VADs, peripheral and central.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you for the quick response. We've been practicing the same way as you mentioned above. However our IPAC mentioned that if we don't withdraw and discard the few mL of initial blood when we accessing and establishing patency in a dormant catheter, we are introducing microbes that dwell within the lumen to patient's bloodstream (causing patient to have rigors or bloodstream infection). The patient population is malignant hematology.
Every VAD will have some degree of intraluminal biofilm. That is a given. But this is adhered to the catheter wall. There is no evidence that fully aspirating and discarding "a few mL" with each dose of medicaiton is not supported by any standard or guideline or any evidence of any type. That would certainly lead to iatrogenic anemia and should not be done.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you Lynn - this is very helpful.