How fast is too fast to transfuse blood? - page 4

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... Read More

  1. Visit  Anna Flaxis profile page
    0
    Quote from wtbcrna
    There is an old saying "loaded for bear hoping for squirrel". Using a 22g for adults is just the opposite and when you need a larger bore IV or the 22g doesn't work fast enough to transfuse the blood etc. someone will be scrambling for a larger IV, and the patient is the one that suffers in the end. With the problems with aged blood and possible increased risk mortality with blood transfusions using a 22g IV adult patients for blood transfusions just adds another variable that doesn't need to be there IMO.
    Clearly, the largest bore you can possibly get is the best, not just from a blood transfusion standpoint, but from any practical standpoint. However, it's not always possible to get a 20 or larger, and not every patient is a candidate for a central line.

    Now obviously, if you're infusing blood through a 22, you're going to go slowly so you don't blow your site, let alone cause hemolysis from excessive pressure. My understanding, though, is that the 20g. or larger for blood transfusions is a myth, and that 22g. catheters are perfectly acceptable, both by the INS and the AABB.
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  3. Visit  Anna Flaxis profile page
    0
    Anyway, as far as how fast is too fast, I found a resource that gave some info on infusion rates, and it was something like 40mL/min. was getting dangerous, and 100mL/min. causes cardiac arrest. It also mentioned 200mmHg being max. pressure, and 300mmHg too high. I wish I could find it again! Does any of this sound familiar, wtbcrna?
  4. Visit  wtbcrna profile page
    0
    Quote from ~*Stargazer*~
    Clearly, the largest bore you can possibly get is the best, not just from a blood transfusion standpoint, but from any practical standpoint. However, it's not always possible to get a 20 or larger, and not every patient is a candidate for a central line.

    Now obviously, if you're infusing blood through a 22, you're going to go slowly so you don't blow your site, let alone cause hemolysis from excessive pressure. My understanding, though, is that the 20g. or larger for blood transfusions is a myth, and that 22g. catheters are perfectly acceptable, both by the INS and the AABB.
    I have yet to see anything that says it is okay to use a 22g, especially on a pump, for adult blood transfusions, but I could be wrong. A 22g in an adult will not work for my practice when I am doing blood transfusions.

    I do realize it is hard to get IVs in some patients, but I also realize it is rare occurrence to only be able to put a 22g in adult patients. Most of the time it is due to inexperience of the person starting the IV. I have went to med-surg on several occasions and started an 18 or 16g where the floor couldn't get an IV or just had one 22g. Normally, if you can get a 22g in a vein you could have got a 20g in instead.

    I would like to be proved wrong though and have someone post an article that shows it is safe to use a 22g on a IV pump for adult blood transfusions and still give a unit of blood in the normal 2-4hr time.
  5. Visit  wtbcrna profile page
    0
    Quote from ~*Stargazer*~
    Anyway, as far as how fast is too fast, I found a resource that gave some info on infusion rates, and it was something like 40mL/min. was getting dangerous, and 100mL/min. causes cardiac arrest. It also mentioned 200mmHg being max. pressure, and 300mmHg too high. I wish I could find it again! Does any of this sound familiar, wtbcrna?
    I wish it did, but all my transfusion patients would be dead if that was true. I usually transfuse a unit of PRBCs in about 3min in the OR.

    I like the reference to max pressure. That is actually very helpful, and can be verified through the IV pumps information sheet. I am not sure if the max pressure is right since in the ICU and OR we often put blood in a pressure bag with a pressure of 200-300mmhg(at least I think that is the unit of measure).
  6. Visit  Anna Flaxis profile page
    0
    Those numbers might not be accurate, since I was trying to remember what it was I read, and couldn't find the reference again.

    In my ED, we use a Level 1 rapid infuser. I've never timed it, but the blood infuses in a matter of minutes.

    I don't know how much pressure the Level 1 exerts, either. The reference I read was referring to pressure bags.
  7. Visit  carolmaccas66 profile page
    0
    Quote from grntea
    it's less an issue of iv catheter size (they give blood transfusions to newborns and premies and small kids and you're sure not gonna get a 20ga into some of them) and more an issue of need and baseline physiology.
    someone young and otherwise healthy who has recently had an unpleasant encounter with a sharp object and lost a lot of his own blood as a result (remember: surgery is just expensive trauma) needs replacement fast.
    the little old lady with chest pain from anemia who acquired her anemia slowly may not do well if you pump her poor old vascular system full of extra volume rapidly (think chf), so more slowly is better for her.
    see, it's not just a one-size-fits-all task, it's a nursing intervention that needs a thoughtful assessment before proceeding.
    what a great answer and a fantastic example of critical thinking!
  8. Visit  wtbcrna profile page
    0
    Quote from ~*Stargazer*~
    Those numbers might not be accurate, since I was trying to remember what it was I read, and couldn't find the reference again.

    In my ED, we use a Level 1 rapid infuser. I've never timed it, but the blood infuses in a matter of minutes.
    Good point...http://www.anesthesia-analgesia.org/.../1064.full.pdf

    They have a maximum infusion rate of around 500ml/min. You can do a unit of blood in under a minute with the level 1 or belmont.
  9. Visit  Fribblet profile page
    1
    I infuse as fast as possible. Every patient; every time. No exceptions.










    Seriously.





    For real.






    Good thread, y'all.
    wtbcrna likes this.
  10. Visit  Anna Flaxis profile page
    0
    Quote from wtbcrna
    I would like to be proved wrong though and have someone post an article that shows it is safe to use a 22g on a IV pump for adult blood transfusions and still give a unit of blood in the normal 2-4hr time.
    Check with the American Association of Blood Banks.
  11. Visit  misswoosie profile page
    0
    Quote from NeoPediRN
    Drawing blood is to gravity, when you've got the added pressure of a pump is when you're really at risk for hemolysis. However, you can get hemolysis when drawing blood out of a 22 gauge, especially if the tourniquet is on too long.

    Yes, gravity (because usually the venepucture site is lower than the heart) and also venous pressure too.

    It's a widely known fact that having the torniquet on for too long when taking blood can lead to an artificially high serum potassium result.
  12. Visit  misswoosie profile page
    0
    Quote from wtbcrna
    I have yet to see anything that says it is okay to use a 22g, especially on a pump, for adult blood transfusions, but I could be wrong. A 22g in an adult will not work for my practice when I am doing blood transfusions.

    I do realize it is hard to get IVs in some patients, but I also realize it is rare occurrence to only be able to put a 22g in adult patients. Most of the time it is due to inexperience of the person starting the IV. I have went to med-surg on several occasions and started an 18 or 16g where the floor couldn't get an IV or just had one 22g. Normally, if you can get a 22g in a vein you could have got a 20g in instead.

    I would like to be proved wrong though and have someone post an article that shows it is safe to use a 22g on a IV pump for adult blood transfusions and still give a unit of blood in the normal 2-4hr time.
    I agree. I'm only used to seeing 22gS (in adults) used for induction of anesthesia in OR- only 2 be replaced by 1 or 2 14 or 16gs, and that was in low risk patients with good venous access

    I mean, if the only IV access you have is a sh--- little 22 g and the patient suffers an anaphylactic reaction to the blood and needs the works, the Docs are gonna love you!

    Our standard practice on floors was an 18g even for running regular IV fluids.
  13. Visit  subee profile page
    0
    If you're sick enough for a transfusion, you're gonna buy at least a 20 gauge from me. If you can't get a 20 in, call for someone who can. I'm perfectly fine with running up to the floor to start an IV, especially if that patient is coming to me in the OR. In my experience, most of the floor or holding area nurses, don't push themselves hard enough to become more expert in IV starts. As a previous poster said, if you can get a 22 in, you can get a 20. Let's exclude neonates - that' in another parallel universe.
  14. Visit  wtbcrna profile page
    0
    Quote from misswoosie
    Yes, gravity (because usually the venepucture site is lower than the heart) and also venous pressure too.

    It's a widely known fact that having the torniquet on for too long when taking blood can lead to an artificially high serum potassium result.
    It is only to gravity if you are letting it drip out using venous pressure. It is not by gravity if you are using a syringe or vacuum tube to gather the sample. We usually use negative pressure to obtain a blood specimen. A heel stick specimen in a newborn would be an example of a gravity obtained specimen.


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