[NrsBtrfly2005]

Hi everyone,

I am a new nurse working in the SICU and feel that every night I work is a challenge - but, I love it! I learn so much every day!

Just wondering, do you find in your hospital that physicians routinely ordering lasix in between units of PRBCs (or following administration of PRBCs)? Does your ICU have standing orders for blood administration which include lasix administration during blood transfusions? Lately, I have noticed that some of our physicians are NOT ordering lasix in between PRBCs, causing two recent patients to go into failure/pulm. edema due to fluid overload. Obviously, this causes chaos! The nurse and RT place the patient on high flow NC/non-rebreather (if not already vented) to maintain optimal sats, order a STAT ABG, and call the MD in the middle of the night asking for a lasix order. (**Not to mention the undue distress caused to the patient**). I have seen this happen to two patients in the past two weeks (unfortunately, one happened to be my patient - which I felt horrible about for days - luckily I caught it early and intervened in a timely manner). Bottom line - LESSON LEARNED. I will be calling to ask for a lasix order from now on!!

Also, while you are running a transfusion, do you routinely shut off the routine ordered IVF during that transfusion (in hopes to prevent fluid overload)? Any input would be greatly appreciated, because as a new nurse in the ICU I am constantly seeking new approaches and methods to maintain SAFE, EFFECTIVE, and OPTIMAL patient care.

PS. Both of these patients where 70-80 yrs. old.

THANKS
NrsBtrfly2005

[DutchgirlRN]

Originally Posted by NrsBtrfly2005

Just wondering, do you find that physicians routinely order lasix in between units of PRBCs Does your ICU have standing orders for blood administration which include lasix administration during blood transfusions? Lately, I have noticed that some of our physicians are NOT ordering lasix in between PRBCs, causing two recent patients to go into failure/pulm. edema due to fluid overload. Obviously, this causes chaos! one happened to be my patient - which I felt horrible about for days - luckily I caught it early and intervened in a timely manner). Bottom line - LESSON LEARNED. I will be calling to ask for a lasix order from now on!! THANKS
NrsBtrfly2005

Lasix is routine between units in the elderly. If a doctor doesn't order it I question it. Usually they're like "oh yeah thanks I forgot". I do not run the other IV fluids unless it's TPN or another specialized drip. You intervened, you did the right thing and you have nothing to feel bad about. The doctor is the one who dropped the ball. Good Luck, I'm glad you're enjoying your job so much.

[hrtprncss]

Hi glad you're liking SICU!!! In response to your question.... Usually it's ordered but not all the time, depends on your pt's fluid status etc.. Second question, I turn off the maintenance while I give the blood product. Sometimes I ask the MD, that is if the pt is hypovolemic if they want to continue the IVF at the same time. Most of the time they say no, and resume after blood tx.

[dorimar]

It depends on the patient's history, age, and fluid status prior to the transfusion. On someone young with no heart history, the lasix should not be necessary with just 2 units. Also fresh post-ops usually need the fluid. On a paitient with HX of CHF, I will ask for a lasix order. It does help if you have a Swan to guide you &/or the physician. Do not feel bad. You picked up on the overload just as you should have. I NEVER have a problem calling the doc in the middle of the night. Also, i DO turn off the maintinencefluids while transfusing.

[NrsBtrfly2005]

Thank you all for your input. I really appreciate it!

NrsBtrfly2005

[Phishininau]

I always turn off the maintenance fluids, unless there is a vasoactive, sedative, or tpn running. Any base fluids...off. I also try to get an order for Lasix if the patient is symptomatic or has a heart history. If I know the doc well enough I will VORV it and move on. The ones that I work with for the most part do not mind, and I know which ones to call. That is all a matter of experience.

There is, however, no protocol for giving Lasix at my facility.

[AtlantaRN]

yes, always turn off maintenance fluids, unless ordered otherwise...

you can give blood over 4 hours, it is wise especially with the elderly or those with cardiac hx; to use the full 4 hours for administration

linda