I recently have been told of hospitals that conserve 'waste' when drawing from a central line using a stopcock. After the sample has been drawn for labs the 'waste' is then returned to the patient. What are other facilities doing and what is considered best practice?
Thanks.
Evidence-based practice is outlined in the Infusion Nursing Standards of Practice, 2011, from INS. Standard 57 Phlebotomy has 3 section including one on drawing samples for a VAD. It must first be noted that the decision to use a VAD for blood sampling is one based in risk vs benefits. Hub manipulation with subsequent contamination and increased risk of BSI are the risk. So not all patient should have their VAD used for drawing blood samples. What you are asking about is the reinfusion method where the "discard" volume of blood is reinjected back into the patient. This document states this should not be done due to risk of contamination and clot formation. There are 3 references listed with this statement and a rnaking of IV. The title of these references does not state if they were testing this procedure with or without a stopcock. There are many other methods more successful that reinfusion for blood conservation, however conservation is a great goal. Restricting use of the VAD for sampling to only once per day, use of point-of-care testing, and the mixing method are much better. Mixing method has been described in this forum and could be found by searching. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hello Pam:
The practice of conserving blood by reinfusing into the patient resurfaces at our community hospital from time to time. I get this question from ICU/NICU nurses where a stopcock method method is utilized. Many nurses feel that the system is a "closed" system and there is no risk for contamination therefore reinfusion of the blood is acceptable. After much discussion and research, it was ultimately decided that taking the chance on infusing any coagulated blood back into the patient was not a risk the hospital was willing to take.
The method of blood conservation, and also reduction of central line infections, at our hospital is to utilize peripheral veins for blood draws when viable peripheral veins are available. Our infection control practitioner prefers utilizing vein sticks when possible. Not only does it decrease wasted blood, but also reduces the false lab values related to PTT and heparin drips, and TPN and chemistry values.
I concur that reinfusion of blood is risky and other methods are safer and effective.
Lois Long Rajcan, MSN, RN, CRNI
IV/PICC Team Leader- Clinical level 4
Chester County Hospital, West Chester PA