How fast is too fast to transfuse blood?

[RNdiva505]

I have been trying to find a clearer answer to my question. I am a new nurse and new to transfusing blood. I know to get the blood in within four hour time period, vitals, priming, etc... My question has to do with rate and size of the patient's IV. I know that preferably we want and 18 or 16 gauge but unfortunately I end up with 22 gauges. I know about watching for first 15 minute blood reactions also. Just safe rate and patient IV size.

1. Patient IV #18, #20, #22?

2. How fast is too fast?

[RNdiva505]

wow great info...thank u

[merlee]

I have never understood the hemolysis issue with 22 ga catheters. Has anyone seen the how tiny the hollow fibers are in an artificial kidney??!! MUCH tinier than a 22 ga.

I suppose I should look at the most recent research!

But each unit needs to be run very slowly for at least 15 minutes, and then per your unit protocol or the doc's orders.

[Anna Flaxis, BSN, RN]

I have never understood the hemolysis issue with 22 ga catheters. Has anyone seen the how tiny the hollow fibers are in an artificial kidney??!! MUCH tinier than a 22 ga.

And considering that we do blood draws with 23g. butterfly needles without hemolysis.

[wtbcrna, MSN, DNP, CRNA]

:sstrs::sstrs:

In other words a 2mm radius IV catheter compared 4mm radius IV catheter is going infuse 16x slower assuming that the length of the catheters are the same. The difference in the radius of the IV catheter cubed will give the approximate difference in flow rates between two IV catheters.

[Orange Tree]

I have never understood the hemolysis issue with 22 ga catheters. Has anyone seen the how tiny the hollow fibers are in an artificial kidney??!! MUCH tinier than a 22 ga.

I suppose I should look at the most recent research!

But each unit needs to be run very slowly for at least 15 minutes, and then per your unit protocol or the doc's orders.

I don't understand it either. On my unit, we give blood through 22s all the time. I was taught that the need for a larger gauge catheter to transfuse blood is a myth, so I'm surprised to see so many people agree that's it's the correct way to do things.

[wtbcrna, MSN, DNP, CRNA]

I don't understand it either. On my unit, we give blood through 22s all the time. I was taught that needing a larger gauge catheter to transfuse blood is a myth, so I'm surprised to see so many people agree that's it's the correct way to do things.

The potential problem is when you put it on a pump (too much pressure through a small gauge catheter can cause hemolysis) or if you ever wanted to give it faster than 2-4hours. In some cases with a 22g it maybe hard to get a bag of PRBCs in over 4 hrs with a 22g, but if you want to talk about myths and blood it is also a myth that only NS is compatible with blood. LR use with PRBCs is only a theoretical problem.

http://www.dtic.mil/cgi-bin/GetTRDoc?Location=U2&doc=GetTRDoc.pdf&AD=ADA421564

http://www.springerlink.com/content/9hv712j8j2612v87/

[Orange Tree]

The potential problem is when you put it on a pump (too much pressure through a small gauge catheter can cause hemolysis) or if you ever wanted to give it faster than 2-4hours. In some cases with a 22g it maybe hard to get a bag of PRBCs in over 4 hrs with a 22g, but if you want to talk about myths and blood it is also a myth that only NS is compatible with blood. LR use with PRBCs is only a theoretical problem.

http://www.dtic.mil/cgi-bin/GetTRDoc?Location=U2&doc=GetTRDoc.pdf&AD=ADA421564

http://www.springerlink.com/content/9hv712j8j2612v87/

OK, well the gauge with too high of a pressure makes sense. The LR thing is pretty interesting. I thought blood+LR= dead (or at least harmed).

[canoehead, BSN, RN]

How fast the blood goes in depends on how fast it's coming out.

Ahhhhh, the weekly catheter size vrs blood discussion...IMO. put the blood through the best access you can get, but don't delay a transfusion because the catheter is the wrong color.

[applewhitern, BSN, RN]

When I worked at a large university teaching hospital, they didn't care what size IV you used for blood. The kids always had 24 g or smaller; not all of the children had central lines. (The smallest amount of blood I ever had an order to infuse was 7 cc's! On a baby, of course.) They held the philosophy that the need for a large gauge was a myth, also, because a red blood cell is only 4 microns. Now I work in a hospital that requires a 20g or larger; they expect you to get a doctor's order if you use a 22g. Also, we have to get a doctor's order to give blood in less than one hour. And yes, it really depends on the particular patient and the situation.

[applewhitern, BSN, RN]

Orange Tree, I was taught that fluids with dextrose was not to be used, because the dextrose will lyse the cells. But in every facility that I have worked, the policy was to always use normal saline.

[nurseprnRN, BSN, RN]

"i have never understood the hemolysis issue with 22 ga catheters. has anyone seen the how tiny the hollow fibers are in an artificial kidney??!! much tinier than a 22 ga.

i suppose i should look at the most recent research!"

now, is anyone watching? there's critical thinking for you.

the "only use catheters of > xga" is a holdover from the old-wives'-tale school of nursing. thanks for sharing a good bit of reasoning.

[wtbcrna, MSN, DNP, CRNA]

Orange Tree, I was taught that fluids with dextrose was not to be used, because the dextrose will lyse the cells. But in every facility that I have worked, the policy was to always use normal saline.

Arch Dis Child Fetal Neonatal Ed. 2011 Aug 16. [Epub ahead of print]

Effect of co-infusion of dextrose-containing solutions on red blood cell haemolysis during packed red cell transfusion.

Stark MJ, Story C, Andersen C.

Source

1Department of Perinatal Medicine, Women's and Children's Hospital, Adelaide, Australia.

Abstract

Aim Transfusion guidelines prohibit co-infusion of maintenance intravenous fluid solutions, with significant consequences for neonatal clinical care. This study investigated co-infusion-related haemolysis in an in vitro model closely resembling clinical practice. Methods Packed red blood cells (PRBCs, n=8) were co-infused at 5 and 10 ml/h with dextrose 5%, 10% and intravenous amino acid solution (synthamin). Free haemoglobin (fHb), as a measure of haemolysis, was measured by spectrophotometry and presented as % haemolysis and total fHb content (µmol/l). Results Following co-infusion, there was no significant increase in PRBC haemolysis with either type of solution co-infused (p=0.82) or infusion rate (p=0.5). Neither macroscopic nor microscopic agglutination was observed during co-infusion for any type of solution co-infused. Conclusions Co-infusion does not result in increased haemolysis, with total fHb significantly lower than currently accepted safe thresholds for fHb. Adherence to current guidelines may place undue restrictions on current transfusion practice in neonatal intensive care.

PMID: 21849305 [PubMed - as supplied by publisher]