Hemo: Running back the Old way??

[angieskidney]

I don't know what they call it everywhere else but I have heard it called "Run Back" when you run back the blood at the end of your run on hemo. I am in a Self Care unit (as I mentioned before) so I "run myself back" instead of the nurse doing it.

The reason I am posting it the last 2 times I could not run myself back as it would just sit there and the arterial would start alarming. The one day the nurse squeezed the saline bag but this time the nurse said she would run me back the "old way" and told me to tell all the future nurses to run me back the old way as well because my fistula is stronger now. 

I have never seen anyone else have this problem. I was wondering if any of you had ever come across this? Also some of you older veterans might have done this "run back the old way" so maybe you can tell me. Who knows. Thought I would ask Thx!

[Zach]

I'm not quite sure what you mean ... but let me have a moment.

In the old days, with a nurse present, we (I started in a self-care unit)

 ... returned by air by removing the arterial tubing from the arterial needle, ran the pump and let the air push out the blood from the arterial tubing through the filter, all the way to the venous needle connector.  But not into the patient!

 ... returned by saline by removing the arterial tubing from the arterial needle, sticking the arterial tubing point (yes, in the old days they had a point, sort of) into the saline bag, ran the pump and let the saline push out the blood from the arterial tubing through the filter, all the way to the venous needle and into us.

... returned arterial blood first, by stopping the blood pump, opening the saline connector, and letting gravity or squeezing the bag to push the arterial blood into the needle.  That's followed with returning the venous blood with the saline open and using the blood pump to return the remaining blood through the venous tubing, the filter, and finally into your venous needle.

Are one of those methods what you were referring to?

[bioya]

If I understood what you are saying, we call that part of the treatment "rinse back". I would NEVER under any circumstances allow anyone to squeeze the bad of fluids to rinse back my blood. You don't know the pressure you are getting and you don't know if there maybe a chance of getting air in the lines. If your machine is alarming, that means there is a problem. You must stop and identify the problem, and address that problem. I may be the only one that feels this way, but being a dialysis RN of many years, I would never allow anyone to use pressure on a bag of saline. I don't know.... maybe I am being too cautious. Good luck to you!

[Epoman]

If I understood what you are saying, we call that part of the treatment "rinse back". I would NEVER under any circumstances allow anyone to squeeze the bad of fluids to rinse back my blood. You don't know the pressure you are getting and you don't know if there maybe a chance of getting air in the lines. If your machine is alarming, that means there is a problem. You must stop and identify the problem, and address that problem. I may be the only one that feels this way, but being a dialysis RN of many years, I would never allow anyone to use pressure on a bag of saline. I don't know.... maybe I am being too cautious. Good luck to you!

What about a manual rinseback? I was trained to squeeze the shit out of the saline bag to return the blood. I would do this in case of emergency.

[Zach]

If I understood what you are saying, we call that part of the treatment "rinse back". I would NEVER under any circumstances allow anyone to squeeze the bad of fluids to rinse back my blood. You don't know the pressure you are getting and you don't know if there maybe a chance of getting air in the lines. If your machine is alarming, that means there is a problem. You must stop and identify the problem, and address that problem. I may be the only one that feels this way, but being a dialysis RN of many years, I would never allow anyone to use pressure on a bag of saline. I don't know.... maybe I am being too cautious. Good luck to you!

I agree.  Squeezing the bag is a bad idea.  My surgeon said it can cause turbulence, which can lead to clotting.  But I see it used all the time.

[Zach]

What about a manual rinseback? I was trained to squeeze the shit out of the saline bag to return the blood. I would do this in case of emergency.

Hey after-all, an emergency is an emergency!       

[angieskidney]

... returned by saline by removing the arterial tubing from the arterial needle, sticking the arterial tubing point (yes, in the old days they had a point, sort of) into the saline bag, ran the pump and let the saline push out the blood from the arterial tubing through the filter, all the way to the venous needle and into us.

... returned arterial blood first, by stopping the blood pump, opening the saline connector, and letting gravity or squeezing the bag to push the arterial blood into the needle.  That's followed with returning the venous blood with the saline open and using the blood pump to return the remaining blood through the venous tubing, the filter, and finally into your venous needle.

Are one of those methods what you were referring to?

The 2nd one (the one I coloured red) is the way she did it today. The 3rd one (the one I coloured blue) is the way the nurse did it on Monday.

[Zach]

I guess I'm not as useless as I thought.     

[Bajanne]

In my unit, they call that process ' washing back'.

[susie q]

Nurses here call it re-transfusing.. 

[angieskidney]

'Rinse Back' is the term I heard most Americans use but it is called "Run Back" in Canada. I had never heard "Washing Back" before .. but they all mean the same thing, right?

[BigSky]

Here is called rinse back.

Here most of the time they unconnect the arterial and connect it to the saline bag and start the pump and give saline until cleared. 

Once in a while a nurse will use the 3 rd method people are talking about.  Not very often though.

I'm not quite sure what you mean ... but let me have a moment.

In the old days, with a nurse present, we (I started in a self-care unit)

 ... returned by air by removing the arterial tubing from the arterial needle, ran the pump and let the air push out the blood from the arterial tubing through the filter, all the way to the venous needle connector.  But not into the patient!

   I really didn't care much for that method at the time.  Nothing like a little scare when the air gets close to the end before they clamp it.

[angieskidney]

Ya I didn't like the sound of that air method myself.  I am glad my unit does not do that

[JerseyGirl]

Yep it's called rinse back in America.  In the old days we used to "squeeze the shit" out of the saline bag to get the RBC's back via the arterial.  I don't think that is good practice today but in an emergency you have to do what you have to do.  In the real real old old days when we were allowed to have an all RN staff I used to love to give the air rinse back described when you put the arterial needle in the saline bag, rinse the arterial to the blood pump and then air rinse the rest of the system back.  They were great rinse backs - got all the blood back to the patient!  However, you needed much time to do it correctly and back then in the 80's we did have more than enough time as the ratios were low.  But these days with unlicensed staff with not alot of time noone is taught my old way - thank goodness!

[angieskidney]

Well they now have to do the "old way" with me as the blood is not "running back" anymore

[bioya]

In our Gambro/DaVita unit we were told by our RD (now ROD)  that if we ran the saline back.. WITHOUT  a pump  (Squeeze back)... we were fired on the spot, no if's, no and's, no buts. Too many things can go wrong. However, if someone is going out, and its life or death, I would take my chances. Good luck to you all.

[Panda_9]

We call it "Wash back". We were taught 2 methods. The best way is to connect the arterial line to the saline bag and start the pump. This way you get back as much blood as possible. The other way is called "running back via closed circut". This is usually done if you cannot disconnect the lines quick enough. All it is is you unclamp the saline, clamp the arterial, and start the pump. After that is done, unclamp arterial and gravity runs the blood back. I dont run back the arterial line as there is no air or clot catcher.

[angieskidney]

We call it "Wash back". We were taught 2 methods. The best way is to connect the arterial line to the saline bag and start the pump. This way you get back as much blood as possible. The other way is called "running back via closed circut". This is usually done if you cannot disconnect the lines quick enough. All it is is you unclamp the saline, clamp the arterial, and start the pump. After that is done, unclamp arterial and gravity runs the blood back. I don't run back the arterial line as there is no air or clot catcher.

Ya I am back to the Run Back as you mentioned as the 2nd method. Turns out that it was because I had a collapsed fistula. Since the Fistulogram fixed it I am now able to run back again