Trauma Blood Transfusions

  1. Anyone out there had to infuse multiple units immediately and if so what advice can you give. How to assess for transfusion reactions when the time to infuse is less than 15 min per unit? What about many units simultaneously? Ever heard of this as a possibility? Published sources (rules) for this subject would be appreciated
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  2. 13 Comments

  3. by   Indiana ED RN
    In the times I have had to infuse rapid infusions I did not worry about a transfusion reaction. The rational on this is the blood is more important than a transfusion reaction (minor). Normally if you use O neg or type specific the likely hoods are low.

    There is the rare case that you will have one....but will the patient die without the blood?

    Just my thought

    Me

  4. by   TraumaNurse
    I agree. When a trauma patient is requiring 10, 20 or more units of blood products...tranfusion reactions are secondary. Better to have a reaction to blood then to die from lack of it! Also, there are much worse things that can happen to a person from rapid infusion of multiple blood products than tranfusion reactions....like ARDS.
  5. by   AngelGirl
    Advice please.....What is the NUMBER of liters of saline (or other crystalloid solution) safely hung prior to administration of blood for an exsanguinating pt?...............
  6. by   tony summers
    When i've had a trauma pateint in we've just one bag of fluid after another and not worried about counting it until the patient had left and just changed over when the blood has arrived and carried on regardless.

    We often will put up multiple units of blood when tranfusing patients in an emergency because it is more important that they get the fluids/blood than worrying about any potential reaction. In 9 years working in A&E i've never seen a reaction in a rapidly tranfused patient only in those that recieve regular tranfusion.
  7. by   veetach
    we dont count either, Just pressure it on it. I can pressure a unit of blood in less than 7 minutes. Just did it last week, we had a pt with blown varices, gave all available PRBC in a 3 county area and topped it off with FFP. He died anyway.
  8. by   ERDIVA2B
    We use the level one rapid infuser which gets it in in a couple of minutes, 4 units max and hopefully by then right to OR!!
  9. by   TraumaNurse
    Angelgirl,
    The standard I have used in the past in 4 liters of crystalloid prior to blood in the trauma patient. These patients need a lot of crystalloid as well as colloids. Of course you have to remember not to hang blood on lines or a rapid infuser that has LR infusing, so if you think the patient will require blood products hang NS first.
  10. by   TraumaNurse
    ERDIVA2B,
    4 units max is the manufacturers recommendation. In a real rescusitation, you will not be stopping the rapid infuser at 4 units. If that were the case, you would be changing out the tubing every 10 minutes or so. If the filter clots, you can change the filter. If no extra filters are available then you will have to get a new set-up when the filter clots. Of course, this is not the exam or text book answer, it's real life! Welcome to the world of emergency medicine!
  11. by   Iam46yearsold
    Love the level one. Love to run it in one of those really challenging traumas.

    Did use on a epistaxis patient the other night. He got 4 units of NS and $ units Packed cells. Then FFP and Platelets on top. He actually walked into triage. Never seen so much blood coming out of a nose. Then he collapsed. Pulseless tachycardia. Responded quickly to fluids and blood though. He actually got his color back.

    One of the young male nurses, slipped in blood, a lacerated his scalp. be awhile before lives that down.
  12. by   Looking4Seaglass
    Trauma blood is more important than a reaction to it.
  13. by   MajorDomo
    From Roberts/Hedges Clinical Procedures in Emergency Medicine: "In the setting of hypovolemic shock and continues hemorrhage, there is no limit to the transfusion rate and multiple units may be transfused simultaneously, even under pressure."

    Tricks of the traded: If you don't have a Level One or a Belmont, pressure bag the units in and wrap the blood tubing around either the patients limb or the tubing of a warming blanket to prevent hypo-thermia. Or you can add warm saline to the blood bag.
    When using a rapid infuser I tend to infuse 500cc NS after every 4 units of blood product, seems to prevent the clotting problem at the filter.

    MajorDomo
  14. by   mmutk
    Quote from ERDIVA2B
    We use the level one rapid infuser which gets it in in a couple of minutes, 4 units max and hopefully by then right to OR!!
    You put blood in the Level 1 ?

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