Blood transfusion

surviveslu · Jun 24, 2011

Let's say you have a bag of PRBC about 370cc. But receive not instructions from the doctor as to how long to infuse the blood. You know the tubing is 10gtts/min. Do you assume the infusion is about 2hrs to get the rate? Then you count the drops to exactly 31 in a minute. This bag is hung to gravity.

[(370cc/2hr)*10gtts)\]/60min = 31gtts/min

turnforthenurse, MSN, NP · Jun 25, 2011

At my hospital, blood must be hung within 30min of retrieving it from the blood bank, otherwise it needs to be returned. And blood cannot hang for more than 4 hours because cellular breakdown plus there is a high risk of bacterial contamination by that point.

BabyLady, BSN, RN · Jun 25, 2011

I am looking for information on what the risks are of infusing blood over longer periods of time than the usual 4 hrs., 6 hrs to be specific. The only info I have been able to find so far are an increased risk of infection due to bacteria growth on the filter. Any & all information would be appreciated, thanks

Wouldn't that be enough of a reason not to hang it longer?

turnforthenurse, MSN, NP · Jun 25, 2011

Depends on the patient, the situation, and your facility's policy. At my facility, blood must be hung w/in 30min of retrieving it from the blood bank. You have 4 hours to infuse it. The norm seems to be w/in 2 hours, but of course you might administer it at a slower rate for patients who have a history of CHF or something. In emergent situations, you might rapidly infuse blood. It just depends.

As for the Lasix, it is because patients can be at risk for fluid volume overload...and just think, if the patient needs several units of blood, think of all the normal saline going with it. That's a lot of fluid!

cherrybreeze, ADN, RN · Jun 25, 2011

Let's say you have a bag of PRBC about 370cc. But receive not instructions from the doctor as to how long to infuse the blood. You know the tubing is 10gtts/min. Do you assume the infusion is about 2hrs to get the rate? Then you count the drops to exactly 31 in a minute. This bag is hung to gravity.
[(370cc/2hr)*10gtts)\]/60min = 31gtts/min

?? I am not sure what this has to do with the OP.

Also, where I work, all blood is put on a pump. We are not allowed to hang blood by gravity.

BabyLady, BSN, RN · Jun 25, 2011

?? I am not sure what this has to do with the OP.
Also, where I work, all blood is put on a pump. We are not allowed to hang blood by gravity.

I agree..a pump regulates it...to hang by gravity, can put the pt at risk for fluid overload.

jrodrig2 · Jul 7, 2011

sounds like you have a pretty important job. that must be a government agency. i am 41, healthcaring for 23 years. recently i have been hanging more blood than usuall. i like this site. i am thinking a lot of nursing sit beside the patient recieving transfusion for the first 5 to 15 minutes. i have not been doing that, but definetly within earshot (kinda hard sometimes). do most nurses reading this sit beside the patient for the first 5 minutes or not so much. my area infuses within 30 and before 4 hrs. start at 125 ml per hr and up to 300 ml per hour provided a good reason not to. i have a bsn and practice as a medic on side. thanks for your comments!!

jrodrig2 · Jul 7, 2011

my bad, LTAC (long term acute care). nice post!

TinyHineyRN · Jul 8, 2011

Let's say you have a bag of PRBC about 370cc. But receive not instructions from the doctor as to how long to infuse the blood. You know the tubing is 10gtts/min. Do you assume the infusion is about 2hrs to get the rate? Then you count the drops to exactly 31 in a minute. This bag is hung to gravity.

I think another issue is that there isn't a rate in the order, or at least a time frame to infuse!

Esme12, ASN, BSN, RN · Jul 8, 2011

Google's great and all but it's not exactly the go-to source for practice info without some serious filtering. The first result that gives time requirements says you have 6 hours to start the transfusion after it comes out of the fridge and another 6 hours to infuse it, which is 3 times the time limit given by the CDC as a category 2 recommendation.

If I wanted to filter it Iwouldn't use LMGTFY........ guidelines are guidelines that vary from facility to facility depending on condition and circumstances of storage, usage and infusion probability. NOw if there has beena natioal disaster and it's been 6 and a half hours out of the fridge....I would give it.....I did work at a facility that the ICU recovered the openhearts (non academic facility/about 210 patients) and they had their own blood fridge. The time limits were different than the "recommended" times because although they were signed out of the blood bank their storage was closely monitored.....and the infusion time was elongated from the BB sign out time and the infusion time when removed from the second fridge to be started on the patient to almost 24 hours post release blood bank so......many things need to be taken into consideration. Thanks:)

Esme12, ASN, BSN, RN · Jul 8, 2011

I am employed in the Quality department of an LTAC. We use contract dialysis nurses to come in and perform dialysis on our patients. I am reading through a chart today and I find out that she infused 2 units of blood in less than a half hour on a patient with a BNP of 1555! Clearly the patient was in CHF. The patient's H&H was 8/25 so there was no need to rush the transfusion. The patient also had 4+ pitting edema of the bilat lower extremities. I am researching the standard for transfusions during dialysis because I don't know what they are. I know as a floor nurse, the standard minimum time for a single unit to infuse is 2 hours but could go as long as 4 hours based on the patients' status. The reason Lasix is ordered between units is to prevent fluid overload. Because this patient is on dialysis, I am not sure how effective the loop diuretic was. . .the nurse did not document her outputs via dialysis or foley! Needless to say, the patient ended up in respiratory failure and fortunately made it through the code. Now she's sucking on a vent. Does anyone have legit info that I can further research? I would like to prevent this from happening in the future. Part of my job is to identify what went wrong and put processes in place that will correct this and keep it from happening again. Thanks. . .

Well......there are many drugs removed with dialysis and aren't worth giving until dialysis is over. If the patient is being dialysed the blood is given through the machine and can be given very quickly. The tech, if they know what they are doing, know how to adjust the flow rates to keep the patient form overload. One of the reasons a patient gets dialysis is to remove excess fluid, to have a total of fluid removed reguardless of fluid infused. While the usage of lasix ok because it is one of the drugs not influenced by dialysis the effectiveness of the drug is as impaired as the kidney function (simply put) but there are drugs that are removed by dialysis and therefore not given during Tx. As usual, again this all varies according to the whims of the MD.

http://www.clinicaldruguse.com/dialysisDrugs.php

http://www.ckdinsights.com/downloads/DialysisDrugs2010.pdf

http://www.medonline.com.br/med_ed/med9/drogas%20e%20rim.pdf

The cardiac status of a patient plays a HUGE part in the sucess or failure of the treatment itself. A very fragile cardiac patient cannot undergo conventional mechanical dialysis because the cardiac output will not support the removal of the blood (again simply put), resulting in an inability to maitain blood pressure and end organ perfusion causing cardiac arrythmias and the patient will suffer further cardiac failure and cardiac arrest. That is why fragile cardiac patients with poor cardiac output are given a gentler form of dialysis....CAVVH, CVVH

http://medconditions.net/continuous-arteriovenous-hemofiltration.html

CVVHD is an effective treatment of choice applicable to all critically ill unstable patients with CARF. It is a technique that offers clinical advantages. It is easily initiated. It offers good clearance. Its closed dialysate circuit offers accurate control of UF that is adaptable to the patient's needs. The use of a blood pump reduces the risks of heparin-induced bleeding and arterial cannulation. In all patients, the blood flow rate was maintained at 100 ml/min. or more regardless of systemic BP. The UF removed per hour was between 100-200 mls/hour. Fluid removal on overloaded patients was easily accomplished with stable hemodynamic status. Adequate parenteral nutrition was able to be maintained to meet the requirement of the patients. The accuracy of the UF pump, no large volume fluid replacement and the safeguard of a closed system facilitates the work of the ICU nurses who have few or no adjustments to perform. Experience with CVVHD has proven that nurses working in the ICU are willing to be trained to

take responsibility for this mode of treatment.

http://www.ccmtutorials.com/renal/rrt/pg/page3.htm

So I am not sure if the nurse did anything specifically wrong except not document....which is still a huge problem especially on a patient like this that is that fragile. The standards for a floor nurse are different than critical care. The resp failure could have been ineveitable due to the patients underlying condition nothing whatsoever to do with dialysis and the blood infusion.

On the other hand there is another condition that occurs with transfusion TRALI

http://medconditions.net/continuous-arteriovenous-hemofiltration.html

http://www.medscape.com/viewarticle/460253_2

http://en.wikipedia.org/wiki/Transfusion_related_acute_lung_injury (not a big wikipedia fan but this is good)

http://en.wikipedia.org/wiki/Transfusion_related_acute_lung_injury

or Transfusion Related Acute Lung Injury.............may have been the culprit.

http://www.signavitae.com/articles/review-articles/99-transfusion-related-acute-lung-injury-trali

I hope this helps even though the post is older......