How fast is too fast to transfuse blood?

Nurses General Nursing

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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.:confused:

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

2. How fast is too fast?

Specializes in ICU,ANTICOAG,ACUTE STROKE,EDU,RESEARCH.
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.

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Specializes in ICU,ANTICOAG,ACUTE STROKE,EDU,RESEARCH.
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.

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Specializes in CRNA, Finally retired.

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.

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Specializes in Anesthesia.
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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Specializes in ICU,ANTICOAG,ACUTE STROKE,EDU,RESEARCH.

Provides some useful information

Interesting to see the differences in the recommendations from BD/INH and UK for catheter sizes.

http://www.sarb.be/fr/journal/artikels_acta_2007/acta_58_1/05-Rivera%20et%20al.pdf

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Specializes in ER, progressive care.

I have been taught to have AT LEAST a 20 gauge to transfuse blood. Any smaller will cause damage/hemolysis of the RBCs. Last night I had to transfuse some blood to a patient, and the patient had 2 IV's - a 22G and a 20G. I flushed the 20G prior without problems, but then when it was time for me to hang blood, the IV was no good :uhoh3: Luckily we were able to get a brand new 20G in the patient and I was still able to start my blood within 30 minutes :) Last night I was also told that if a 22 gauge is all you have, then you use it to transfuse blood...you will just have to run the blood at a slower rate.

I usually start at 75mL/hr, see how the patient does, then up it to 125mL/hr. If the patient has CHF, I slow it down to around 100. Be diligent with monitoring and teach the patient which signs and symptoms to look out for and to report to you immediately, if something happens in between the last time you checked on the patient and the time you check on them again.

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