[pointhope]

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

[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

[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.

[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?...............

[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.

[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.

[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!!

[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.

[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!