Do you rinseback the patients blood via the venous needle or do you apply pressure to the saline bag and rinsback the arterial bloodtubing section an then use the blood pump to return the venous blood? Comments

I was taught to rinse art. line back with gravity, when able, apply gentle pressure to the saline bag if necessary. Return rest of blood via the venous needle with the blood pump...

This always makes me a bit nervous as the potential for air embolus is present, one MUST be diligent and WATCH what you are doing at all times.

Still makes me uneasy.

I hear that other units rinseback all blood with the pump. I assume they are disconnecting art. line and flushing art. needle manually. But where do they hook up that art. line?

You are doing what I was afraid lots of units are still doing- you are right about the air embolus issue- but why I am asking is due to the potential injury to the vascular access by pushing on the NSS bag to rinseback the arterial line segment (gravity alone will not rinseback a fistula/graft with true arterial flow and pressure). The easiest way with almost any machine type is to disconnect the arterial line and attach the line to the bloodtubing and use a loop to rinse back the arterial segment with the NSS and the blood pump on- this gives the full rinseback with an air detector and prevents excessive force on the vascular access (espically a fragile fistula). Bloodlines vary- but most will have a site to attach the arterial end of the blood line(would not use the fistula needle into the med port of the NSS bag due to high risk of a needle stick and potential contamination of the needle- you would never pull out a fistula needle and re-insert it into the patient- so why would you insert it in the blood circuit?). The vascular access needs to have a 10cc NSS syringe attached and the blood flushed out of the neelde/catheter with the NSS. Care must be taken to keep the arterial bloodline end and needle/catheter end sterile. Look at your blood lines and see if you could try this at your unit- let me know what you think or any questions about the closed system rinseback.

Another option:
1. Turn off the pump
2. Clamp both sides of the art line/fistual connection
3. Disconnect the art line.
4. Keep the NSS art line port clamped
5. Turn on pump slowly while releasing clamp from art/fistual side.
6. Once blood reaches the NSS port, switch clamp off NSS port and clamp the art line anywhere pre NSS port. Saline will now push blood back to the patient.
7. Turn up to normal BFR rinseback speeds
8. Follow remaining rinseback and disconnection procedures

I'm trying both rinseback recommendations at work now...the process laid out by TecDude is quite similar to how we drain our lines and has been the easiest. The hardest part?? Training or attempting to train old dogs new tricks...especially when I'm one of the new dogs on the block. Wish me luck!

A question was e-mailed to me about the speed of the blood pump for return of the system via the venous needle. What is the correct speed to prevent any compromise to the cardiac function. I answered at 150 or 200 ml/min- the rinseback should be calculated into the treatment fluid removal and not cause as stress when the blood is returned to the patient. Any other thoughts-agree or comments as to why this should be different? Have any reference info on this issue?-

We retrun blood at =/< 150ml/min. Many of our transient population complains that we return too slow. "They return it at my treatment bloodflow, not so slow...", is frequently said. Why don't we return faster? Risk of damage to fistula/graft and of altered cardiac status in regards to increased fluid volume.

Return at normal treatment BFR. It's the same volume whether at 100 or 500 BFR.