Administration of blood products

[NativeSundance]

We had quite a debate about the administration of blood products the other night at work which became unusually heated. So I put the question out to all of you...

How fast do you run your prbc's? What type of tubing do you use? What size of angiocath do you run it through? This subject in particular was hotly debated. Stable patient in over 3-4, unstable as fast as you can. Special blood tubing that has it's on filter and so you can run ns with it. At least a 20 is recommended but can run safely 22

how fast do you run your ffp? What type of tubing do you use and through what size angiocath? Do you use a pump? Ffp can ran as fast as you want, still use blood tubing. Pump is optional, same size angio as above

How fast do you run your platelets? What type of tubing do you use and through what size angiocath? Do you use a pump? This subject was also hotly debated. Platelets can just be run in as fast as they will go often just by gravity. Still use blood tubing

Do you feel there is any difference in cell integrity when running your (trauma-emergent) blood in using a pressure bag as opposed to using a rapid infuser/warmer? As long as the vein is good, no problems

It will be interesting to see what some of your opinions might be!!

[proudmom]

If the patient has a PICC line, double or triple lumen, can you safely simultaneously administer D5 .45NS as another line in another port while you are giving blood transfusion in another port? Wouldn't it cause hemolysis as they both pass through the PICC line?

[ERRNTraveler, RN]

proudmom said:

If the patient has a PICC line, double or triple lumen, can you safely simultaneously administer D5 .45NS as another line in another port while you are giving blood transfusion in another port? Wouldn't it cause hemolysis as they both pass through the PICC line?

Yes, you can do this- they are running through different lumens of the line, and therefore exit the line into the blood stream at different points......

[RN Randy]

What about time? I've seen a lot of references to how fast, but no policies on total time. Last place I worked it was like this:

You have 30 min to have the blood running into the patient.

If 38 min and not running, it goes back to the bank where it is wasted.

Once running, it can't hang for more than 4 hours total time.

That's been the norm I've seen anyway.... input?

Thanks!

rb

[ERRNTraveler, RN]

Every place I have worked, the blood can't be hanging any longer than 4 hours. If the pt. is stable, it usually goes in over 2-3 hours, but for traumas or hemodynamicaly unstable patients, it gets run in as fast as possible (with a pressure bag or rapid infuser).

[canoehead, BSN, RN]

You can give blood with a 24G

They give it to kids though a catheter that size, and the kids are getting the same size blood cells as everyone else. If you want it in fast use a larger gauge, but there's no need to restick someone if they don't need the volume emergently.

[brainkandy87]

Well, my entire thought process on blood has changed and had to change after I came to the ER from the floor. On the floor, I used a pump and infused a unit over 3-4 hours. I wouldn't even let FFP run wide open on the floor. My thoughts on IV size has changed as well.

When I graduated, I worked with a CRNI who swore by the principle that you use the smallest IV that will accomplish what you need infused. So, she put 24 gauges in everyone, because our 24g angiocaths can run 1200 mL/hr. She taught me a lot of great things about IV's and I'm very, very good at IV starts because of her. However, I disagree wholeheartedly with this principle. I'd never put a 24g IV in an adult, especially one getting blood. I never put anything smaller than a 20g, because if I can't find a vein big enough to hold a 20g, I'm breaking out the US and finding their cephalic or basilic. If it's an emergency, I'm tossing an 18g in their EJ.

If I anticipate someone will be getting blood or FFP in the ER, I put in the biggest bore possible. Our 14g angiocaths are usually too long to throw in (3.25"), so I usually put a 16g in AC or above. With FFP, I leave it wide open and use the special tubing sent by lab. With platelets, wide open. With PRBC, if it's not a trauma/emergent transfusion, I usually start it fairly slow (just pull the slide back a tiny bit and eyeball it going in slow), get my 15 minute vitals and if everything is ok, I'll open it up a bit faster but not wide open. If it's emergent, it's started wide open and left wide open; trauma on a pressure bag or rapid infuser.

[Esme12, ASN, BSN, RN]

Great info.....even though this thread is 5 years old there are subjects with re-visiting.

[emtb2rn, BSN, RN, EMT-B]

Should be a sticky.