New grad - hanging blood

  1. Hello to all. I recently posted on being fired. My hopes are back and I am now once again hitting the employment scene. The nursing career should have me a job in no time!!
    I have an additional question about hanging blood. My nursing judgement on this procedure differed from my preceptor's. The pt. was an elderly women who has never had a blood transfusion before. Trying to be independent and show my preceptor that I am capable of making appropriate and safe nursing judgements I got the blood going on my own. 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 tha 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.
    Any input wuld be greatly appreciated! Have a great day!!!

    Jennifer :smilecoffeecup: (time for my am coffee!)
    •  
  2. 12 Comments

  3. by   AtlantaRN
    I see what you are saying, because less blood is entering the patients system, if they are going to have a reaction it won't be as severe as if they had it at a rate of 125............

    I guess I never really thought about it. If she set the rate at 125, then in 15 minutes patient will have received 31ml. If set at 42, then patient will have received 10.5ml. I don't know how much blood it takes to produce an adverse reaction....In 10 yrs, the only reaction i've witnessed was to antibodies as the patient had received a total of 4 units from the same donor.

    linda
  4. by   canoehead
    What you did is what I would do and what has been policy in all the hospitals I've worked at. I think your preceptor acted inappropriately as well at the bedside, and then later in not giving you an explanation, or going over that hospital's policy. There is no way I would expect a new RN to hang blood for the first time alone in any case, you have to review policies and paperwork at the very least, even with an experienced RN.
  5. by   PANurseRN1
    We just set the pump for whatever the rate is ordered. You're doing vs so frequently in the beginning that you'll most likely be right there if the pt has a reaction.

    Of course, you need to follow hospital policy, not what someone else tells you. That gets more people into trouble than you can imagine.
  6. by   Altra
    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?
  7. by   cardiacRN2006
    I never use a pump for blood.

    But otherwise, once the blood reaches the pt, I slow the rate waaaay down and watch for the first 15 minutes. Regardless of their age, diagnoses, or prior history with blood. If they have a transfusion reaction, it's better if they've received less blood.
  8. by   cardiacRN2006
    Quote from MLOS

    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?
    If I had to guess, the OP probably primed the line with NS, then spiked the blood, and then turned the pump on a high rate until the blood reaches the pts vein. Then she turns the pump down to her desired rate.
  9. by   PANurseRN1
    Quote from cardiacRN2006
    If I had to guess, the OP probably primed the line with NS, then spiked the blood, and then turned the pump on a high rate until the blood reaches the pts vein. Then she turns the pump down to her desired rate.
    Why???

    I have always hung a primary line of NSS, then piggybacked the blood to the lowest Y site on the primary tubing. Absolutely always on a pump except when I'm in the ED and we're running open wide.

    If your one and only line has blood all through the tubing, what do you do if there is a reaction? If it's piggybacked into the lower site, you can just disconnect and then you still have your main line of NSS.
  10. by   nesher
    Bottom line - follow your hospitals policy and procedure - which by the way your preceptor should go over with you prior to doing new things like hanging blood!!!
  11. by   AuntieRN
    The way my preceptor taught me was: prime tubing with NS, then spike blood, clamp off NS, unclamp blood, set pump to 100ml/hr, 15 minutes starts when the blood actually hits the pts veins, then if no reaction turn pump up to 125ml/hr. I am sorry you had such a bad experience with your preceptor. Wish everyone had one as awesome as mine is. I am going to miss her next week when I am on my own.
  12. by   P_RN
    What I have always done pump or not is to prime the line with saline. Roll off the saline and roll on the blood clamp.

    Let that run out into the sink or trash until about 20" of saline is in the line. Make sure the IV is good and no other fluids are still in the cath. Put the blood set onto the cath. let it run at 50 for the 15 mins. Watch etc. vitals etc. I've run plenty with and plenty without a pump.

    Then depending on whole or packed cells divide the amount by 2 or 3 depending on the patients age, fluid balance etc. or the doctors order.

    For packed, run it at about 125 and check frequently to make sure the cath is still good. Don't want a packed cell hematoma do we?

    For more than one unit as long as it is within a 4 hour time frame you can use the same blood tubing. Otherwise you need new tubing, same saline can be used. No blood should hang over 4 hours.
  13. by   quinnila
    We run blood by gravity. If you use a pump at 125/hr and the PRBC = 225ml won't it go in too fast?
  14. by   PANurseRN1
    I have always transfused based on the parameter set by the doc, e.g. "2 units PRBC, each unit over 3h." You set your rate based on the volume to be infused over the time to be infused. I've never heard of one hard and fast rate to use to transfuse.

close