Quote from jennykaye
Of course after it was checked off by another nurse. After the blood reaches the pt. I was doing the required staying with pt. for the first 15 minutes. I set the pump rate at 42ml/hr (my mom who is a veteran nurse always set her first 15 minutes at 25ml/hr) for my first 15 minutes. After the intial 15 minutes are up and I see no sign of a tranfusion reaction I bump the rate up to 125ml/hr.
My preceptor acted as if that was the most wacked out thing I could have ever done. She said "what are you doing? That is no way to do this. Where did you go to school?". I proceded to explain my rationale. During my explanation she put the rate up to 125ml/hr and said "Now just leave that alone." Then she exited the room with out even giving me the opportunity to finish or even discuss my rationale with me. Once again I was standing there observing and evaluating my pt. under someone elses nursing judgement.
I would like input on what any of you have done when starting blood. I should also note that I am aware that the intial 15 minutes does not start until the blood enters the pt. vein. So I do run it at a faster rate until it reaches the vein, then I reduce the rate.
If I would have handled the situation differently I should have told her to stay with the pt. for the first 15 minutes as I did not want to be held accountable for a potential adverse reaction.
I'm not crazy about your preceptor's handling of the situation, but unless there's a policy which requires infusing blood at a slow rate for the first 15 minutes, I personally would not have started it that way.
What was the order? If it said "infuse at xx/hr." then I think that's what you need to do. (not sure what the practice would be ... when I hang blood in the ER, 90% of the time we do not put it on a pump, we simply run it wide open via gravity.)
I do understand your logic, but as another poster pointed out, a very slow infusion during the first 15 min. may simply delay any reaction the pt. may have ... until beyond the 15 min. mark when you are no longer in the room to observe.
The part of your post that I bolded puzzles me ... surely you prime the line before connecting the tubing to the pt.'s IV ... so the time of the start of the infusion is immediately when you press "start" on the pump, right?