How fast is too fast to transfuse blood? - page 5

by RNdiva505

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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... Read More


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    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?
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    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.
  3. 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).
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    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.
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    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!
  6. 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.
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    I infuse as fast as possible. Every patient; every time. No exceptions.










    Seriously.





    For real.






    Good thread, y'all.
    wtbcrna likes this.
  8. 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.
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    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.
  10. 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.


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