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An Investigation of the Safety of the Blood Reinfusion Step Used With Tunneled Venous Access Devices in Children With Cancer

St. Jude Children's Research Hospital, 322 N Lauderdale Ave, Memphis, TN 38101

Tori Wentz, RN, BSN

St. Jude Children's Research Hospital, 322 N Lauderdale Ave, Memphis, TN 38101

Walter Hughes, MD

St. Jude Children's Research Hospital, 322 N Lauderdale Ave, Memphis, TN 38101

Ted Pearson, MS

St. Jude Children's Research Hospital, 322 N Lauderdale Ave, Memphis, TN 38101

Amy Sims, RN

St. Jude Children's Research Hospital, 322 N Lauderdale Ave, Memphis, TN 38101

Bonnie Mason, RN

St. Jude Children's Research Hospital, 322 N Lauderdale Ave, Memphis, TN 38101

Michael Pratt, RN, MSN

St. Jude Children's Research Hospital, 322 N Lauderdale Ave, Memphis, TN 38101

Bradford A. Austin, RN, CNOR

St. Jude Children's Research Hospital, 322 N Lauderdale Ave, Memphis, TN 38101

Infection has been identified as the most serious potential complication of the indwelling catheter. As a result, the primary nursing goal using the catheters is to prevent infection. Nurses must frequently manipulate the catheters when securing blood specimens and are concerned that this manipulation may serve as a source of infection for the immunocompromised pediatric oncology patient. One particular step in catheter manipulation during blood sampling is blood reinfusion, ie, residual blood in the catheter is withdrawn and set aside while a second sample is collected for laboratory analysis but is subsequently returned to the patient through the catheter. The purpose of this study was to examine this nursing procedure for its potential of contaminating the blood sample that was to be reinfused, or for the potential of reinfusing a sample that contained preexisting pathogens independent of the procedure itself. An experimental design was used with 21 patients randomly assigned to an experimental group (unclean procedure to exaggerate the potential to incur pathogens during the process), and 21 randomly assigned to a control group (usual clean procedure followed with the reinfusion sample). The usual blood sampling procedure was altered for all participants as the typical amount of blood that normally constitutes the reinsertion sample was not reinserted, but was instead used to complete certain microbial analyses. Of the 42 participants, 17 were male and 25 were female; 35 were white and seven were black; 22 were diagnosed with leukemias and 20 with solid tumors. The age range for participants was 2 to 20 years (x = 9.4 years, SD = 4.8). The two groups of participants did not differ for age, diagnosis, phase in treatment, hematologic indicators, or other demographic variables. No colony-forming units were noted in any of the collected samples for either of the two groups. The study findings may be interpreted as an indication that the current institutional procedure for collecting blood samples, when carefully followed, is not serving as a potential source of infection for nonneutropenic pediatric oncology patients.

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				K. Adlard Examining the Push--Pull Method of Blood Sampling From Central Venous Access Devices Journal of Pediatric Oncology Nursing, July 1, 2008; 25(4): 200 - 207. [Abstract] [PDF]