[Nurse1966]

I'll try to make this short...had a pt who was ordered 8 units of FFP. Oddly enough, I've never given FFP before, so had questions. I couldn't find an policy/protocol on infusing it, so asked senior nurses, who said you treat it like PRBC's, but infuse over 15 minutes. Which translates to stay with the pt for the entire 2+ hours it would take, which is impossible since I had three other patients, it was a rough morning. Anyhow, the next workday, I asked around and was told that we were supposed to consult Perry & Potter for procedure info. I looked in the text we keep on the floor (was published in 2000) and it never specifically said how to run FFP. So, how do you infuse FFP? I was told the FFP doesn't contain antigens, so risk of allergic reaction low. What also concerns me is, I've heard now, that some blood banks will put more than one unit into a bag, but without a policy or anything, how do I know how many units were in the bags I hung? How much is in a typical unit of FFP? Each of these units were 250cc to 350cc. Guess I'm just obsessing because the patient coded after the third unit. He was tail end liver failure and had been DNR until I took over . He did finally die the next day, with family at his bedside. Any input is appreciated!

[RN2B07]

Hi...I am very sorry to hear about your day, I would be freaking out as well. I have only given FFP once and our hospital policy states plasma may be administered rapidly (approximately 300 mL in 15 to 30 minutes)...so you were right in doing that. I had administered 4 units..and 1 unit per bag. Our bags will state on label that it is 1 unit. Whether that is universal or not I am not sure. Again I am sorry to hear about your experience but it sounds like you have done everything right...what did your charge nurse say after the pt. coded. I would think reports must have been done, did he/she reinforce your actions to be right??

[Nurse1966]

It was a BAD Saturday. The code team had been real busy that morning, and had seven other patients for transfer to ICU, so the nursing supervisor didn't say much of anything. There's never really any follow up. Thankfully, our on call Resident was right there from the beginning. Thanks for your response!

[RN2B07]

Yes risk of rxn is low...but did your pt. show any s/s of a rxn?? Any change in vitals?

[NYNewGrad]

We run FFPs pretty frequently on floor. And yes, blood bank will often combine 2-5 units of FFPs in one bag and we still run it over 15 - 30 minutes. Sometimes it says on the bag how many units and other times I would call them to clarify.
How else do you run 5-10 FFPs with 6 other pts?!

[Nurse1966]

The pt was unstable when he came to the floor, his pressure was 80's/40's (which for him was good). He was endstage chirosis 2* Hep B & C. His urine output was nonexsistent, all his labs were abnormal, they couldn't even get a PT/INR to read, it was so high. He developed some wheezes/rhonchi, gave him Lasix, no output at all. The docs insisted he get the FFP even though he was definetely overloaded w/fluid. I don't know if dopamine or dobutamine would've had much effect with his liver so bad. It was one of those situations where there's no good outcome as is often the case with IVDA's when they come to the end of the road.

[DarlinNurseRed]

Gosh this patient and situation sounds exactly like my patient the other day-PRBCs, FFP, Lasix, boluses, no output and a doctor who talked to me like I was an idiot.

[General E. Speaking, RN]

Originally Posted by DarlinNurseRed

and a doctor who talked to me like I was an idiot.

don't you just hate that

[gitterbug]

Take VS prior to calling BB for FFP. You also need to have at least a 20g
med-lock site, that is patent and flushes well. Pick up FFP, check FFP per BB and floor protocol, hang FFP(our tubing is supplied by BB). If FFP is still running after 15 minutes, repeat VS. Our gtt rate is rapid unless ordered
differently by physician or patient has severe respiratory problems. I have never had a unit of FFP hang more than 30 minutes, but if it has not infused in 4 hours, it needs to be taken down, the physician called and and incident report filed. Of course, the patient needs to monitored more closely after the FFP is completed. Like VS 2 hours after completed, check for rash, monitor lungs and kidneys. This is the older way of administering FFP but no place I have ever worked taught me better than the first one were FFP
was given often.

[Daytonite]

First, you did nothing wrong. This patient needed the plasma for the platelets and probably the protein as well. FFP has clotting factors (lots of platelets) and serum in it. Sounds like your patient had one foot in the grave already. It was frequently used during the Korean War in place of blood which was often unavailable. Yes, they frequently combine several units of it together. You usually run it in as fast as possible. ABO compatibility is not usually a big factor with plasma since all the RBCs are removed. The first link I've listed gives you a table of the various components of blood that are transfused. FFP is on the list. You might want to print it out and put it on a clipboard to carry around with you for future reference. The rest of the links include information about transfusions, transfusion reactions, or information about plasma. Read up and now you'll have all your questions answered and be a mini-expert on this!

http://teach.lanecc.edu/nursingskills/blood/transfusionProducts.pdf - a table of the various transfusible blood products

http://www.muw.edu/nursing/IV.htm - the last half of this document has information about the procedure of blood transfusion and transfusion reactions

http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/B/Blood.html - here is a biological review on blood with a discussion about plasma and what is in it.

http://library.med.utah.edu/WebPath/TUTORIAL/BLDBANK/BBPROC.html - a short explanation about plasma and packed cells

http://library.med.utah.edu/WebPath/TUTORIAL/BLDBANK/BBTXRXN.html - adverse reactions to blood products – transfusion reactions