Transfusing blood in an emergency situation

[Enthused RN]

I'm still a nursing student and I haven't had any experience with critical situations where blood products are urgently needed (I've transfused blood but it wasn't where the patient was actively bleeding out, hemoglobin dropped low enough to warrant it).

Per textbook, you should infuse the blood slowly at say 50ml/hour for the first 15 mins and watch for a reaction and then increase the rate if there is no reaction. However, if the patient is critical/bleeding out, do you suspend that rule and just "pour" that blood in as fast as it will go and hope they don't react? I'm guessing that the pros (getting the hemoglobin and BP back up) outweigh the cons (possible chance of a reaction) in such a situation. Is that right?

[SionainnRN]

Gotta love the Level 1. I started out in trauma ICU and I had a short stint in med/surg and it was such a shock to put blood on a pump! We always either just let it hang or were pressure bagging it in, so the whole running it in over 3 hours was a new experience. Luckily I'm now in the ED and back to pressure bags and level 1!

[That Guy, BSN, RN, EMT-B]

I used to work the floors and it was a good night to get 4 bags into one pt. Now I can do that in oh 10 minutes on a bad day. I love how the rules change in the ED for us.

[ED18yrs]

Wow, 53 units. Your lab techs deserve a handshake. I like the Belmont over the Level 1. Haven't used the new versions of the Level 1, though. Love working with ED docs and trauma surgeons that put in immediate Cordis.

[MursingMedic, DNP, RN, EMT-P]

@PMFB-RN,

I love your profile pic! I might be stealing it for other purposes. :)

[PMFB-RN, RN]

Some trauma bays stock a few units of O- blood in the bay in order to facilitate getting blood hung and transfusing rapidly in the case of a huge bleed. Blood can also be run through a rapid transfuser such as a Level I. Make sure the person in charge of it knows how to properly operate it unless you want to see what happens to a unit of O- at high pressure. XD

I've seen that, looks like a slaughter house. A little blood makes a huge mess.

[AnnieOaklyRN, BSN, RN, EMT-P]

Look at it this way:

Is the patient likely to die more from a transfusion reaction or more from bleeding out because you gave the blood to slowly. Most emergent blood transfusions are O negative, so there is less risk of a reaction without the Rh factor as my understanding goes.

Annie