Page 115 - ATP-P 11th Ed

Clamping – the line must be clamped or SECTION 1
pinched approximately 6 inches from the needle
to avoid air entering the line and preventing
negative pressure formation from gravity
pulling the liquid into the collection bag when
the cap is removed.

of the needle to approximately 10° or less and with a steady push, advance needle
to penetrate the vein wall. Thread needle approximately ½ inch inside the vein to
maintain a secure position and to lessen the chance of a clot forming. Consider
performing the collection with the bevel of the needle down to prevent occlusion of
the bevel opening by the vein wall, which can occur. This can be done by rotating
the needle 180° after inserting it bevel up. Alternatively, you can prop up the needle
using a rolled up 2-inch × 2-inch gauze or other item placed under the needle hub to
keep the needle raised to the proper angle.
You may see little or no “flash” of blood in the collection line until you remove
the clamp or pinch in the line. You should feel a “pop” when the vein is entered. If
there is no flash when the clamp or pinch is removed then the needle may be par-
tially withdrawn and venipuncture reattempted. Do not fully remove the needle
from under the skin without a clamp or pinch in the line because this may allow
air to enter the line. Air in the line can prevent negative pressure from forming
when the line is opened and the column of fluid is pulled down by gravity and
could lead to incomplete filling of the bag.
f. Loosen the constricting band or deflate the blood pressure cuff to 40–60mmHg and
maintain this pressure throughout the collection.
g. Place the collection bag below the donor’s heart and release the clamp or pinch in
the line.
If the flow is sluggish, consider removing the constricting band or deflating
the blood pressure cuff and reapplying or re-inflating respectively. This may be
necessary to ensure good back pressure from venous return and will lessen the pos-
sibility of incomplete filling of the collection bag.
h. Tape the needle down at the hub and tape the line to the patient’s skin to prevent it
from being pulled out.
i. Begin rocking the bag as soon as blood flow begins and continue gently rocking the
bag about every 2 minutes during collection to ensure thorough mixing of the citrate

104 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 105