Answering your questions; back flushing a blood bag with saline.Q Our hospital's surgery department rarely does procedures that require blood transfusions blood transfusion, transfer of blood from one person to another, or from one animal to another of the same species. Transfusions are performed to replace a substantial loss of blood and as supportive treatment in certain diseases and blood disorders. during surgery. Recently, however, we had a patient who received two units of blood while in surgery. The lab was informed later that the nurse-anesthetist involved in the procedure back-flushed the blood bags with saline prior to starting the transfusion. He said that this was a common practice in surgery, and that it served two main purposes: 1) to decrease the viscosity of the packed RBCs; and 2) to help pre-warm the blood. We have never heard of this practice prior to this case. A check of the literature shows that the 1994 circular of information for the use of blood components listed this as a common practice; however, the 2002 edition does not. The current AABB AABB American Association of Blood Banks. AABB American Association of Blood Banks A professional, non-profit organization established in 1947 and dedicated to the education, formulation of standards, policy and other facets of technical manual does state that saline may be used to reduce a blood component's viscosity but does not say if this should be routinely done. Is back flushing a bag of packed cells Noun 1. packed cells - a preparation of blood cells separated from the liquid plasma; "packed cells are given to severely anemic patients in order to avoid overloading the circulatory system with too much fluid" a routine procedure practiced by anesthetists everywhere, or is this more an "old school" way of doing things that is not necessary? A The questioner has unearthed Unearthed is the name of a Triple J project to find and "dig up" (hence the name) hidden talent in regional Australia. Unearthed has had three incarnations - they first visited each region of Australia where Triple J had a transmitter - 41 regions in all. a practice that is part of the "art of medicine." Anesthesiologists in training learn that adding saline to red cells can be helpful when infusing units through somewhat marginal IVs. This kind of information is a trick of the trade and is based more on personal experience than on scientific studies. I think most anesthesiologists would agree that the practice can be helpful from time to time, but that it is no substitute for a large-bore IV, infusion pumps infusion pump A device designed to deliver drugs and/or 'biologicals', at low doses and at a constant or controllable rate; ↑ rates of delivery in such devices may be associated with local hemolysis, compromising the potential benefits of a calibrated delivery , and blood warmers blood warmer A device that warms blood stored at 4°C to body temperature. See Cold antibody. . Since the practice has been going on for years and appears to be effective and relatively harmless, I see no reason to interfere. [ILLUSTRATION OMITTED] --Richard M. Scanlan, MD Director Transfusion Medicine transfusion medicine Blood banking A subspecialty of clinical pathology or internal medicine which is involved in Pt management through administration of blood cells and blood products including fresh-frozen plasma and cryoprecipitate; TM specialists are versant in Oregon Health and Science University Portland, OR Edited by Daniel M. Baer, MD Daniel M. Baer, MD, is professor emeritus of laboratory medicine at Oregon Health and Science University in Portland, OR, and a member of MLO's editorial advisory board. |
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