There is some debate in my clinic on how to do a rinseback . Should the arterial line be rinsed back first? Or should the venous line rinsed back first? And could someone give me a reason why one is preferred over the other? Thanks
Posts: 1 | Location: lannon,wisconsin,USA | Registered: 11 February 2003
We rinseback the venous (meaning post saline tee) first then squeeze the saline bag and rinseback the arterial line.
Our reasoning is that a small clot can and frequently does form in the saline tee. If the arterial were to be rinsed back first, the clot could be infused into the patient.
Posts: 875 | Location: Baltimore, MD USA | Registered: 24 October 2001
We use a 10cc syringe to flush the arterial first. Then the arterial line is connected to the second port of the saline line and the blood pump started to rinse back the venous.
The reason is that the doctor feels like squeezing the saline bag and forcing saline into the arterial side will cause damage to the graft or perm cath in the long run.
Second reason it is company policy.
Posts: 124 | Location: ardmore,ok | Registered: 08 December 2002
Originally posted by slt7700: There is some debate in my clinic on how to do a rinseback . Should the arterial line be rinsed back first? Or should the venous line rinsed back first? And could someone give me a reason why one is preferred over the other? Thanks
I was ALWAYS taught (at conferences and training classes for dialysis) to rinse the arterial back first because you don't want any clots to form in the arterial line while your waiting for the venous line to be rinsed back. So--Arterial first, Then--Rinse venous back
It makes sense.
Although, I have seen it done several different ways--and no one has seemed to die yet.
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I have requested that techs not squeeze the bag when they rinse me back. I have read numerous posts on this procedure not being safe and I agree that is so. The problem is, techs will get in a hurry to get patients off and have no concept of how hard they are squeezing the bag. Before I knew of the risk, I experienced techs squeezing too hard creating an uncomfortable feeling of excessive pressure in my access. So, I know first hand what it can do. Eventhough I've told the same techs numerous times not to use this procedure, they often forget and have to be reminded. Then they go right down the line to the next patient and squeeze the bag on them. In the past, I've had techs roll their eyes at me and tell me there's nothing wrong with this procedure, but at my current unit, although their protocal is to squeeze, the patients's rights are very much respected if he opts not to have the bag squeezed. Although all the techs respect my choice on this, I can only think of one time that a tech asked me for the reasoning behind it. Not too many seem to care what the connection is.
I've seen it done several ways at our clinic, but most of the techs and nurses seem to rinse about 10 cc into the venous side of the T to clear it, then they rinseback the arterial side before doing the venous side.
Posts: 15 | Location: Lawrence, MA | Registered: 12 November 2002
Priming sets with the "Y" short tubes can be used to return the entire blood circuit in a prograde fashion which seems to make the best sense. If the blood is running in this direction during the treatment then return should be in the same direction. Returning in a retrograde direction can send clots formed during treatment in the arterial line to the patient. As mentioned previously a 10 ml syringe of saline can be used to return the portion of blood remaining in the arterial needle. Prior to connecting the arterial line to the short tube use it to fill your syringe without using a needle.
