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Answering your questions; back flushing a blood bag with saline.

Q Our hospital's surgery department rarely does procedures that require blood transfusions 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 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 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 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, and blood warmers. 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

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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Author:Scanlan, Richard M.
Publication:Medical Laboratory Observer
Geographic Code:1USA
Date:Dec 1, 2006
Words:343
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