How fast is too fast to transfuse blood?

  1. 0
    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?

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  2. 53 Comments...

  3. 0
    I have always been taught that blood must be given in at least a 20 gauge...nothing smaller..
    I have seen blood transfused via a pressure infuser in emergency situations. In that case, the blood is in in a matter of minutes.
  4. 1
    Check your policy regarding gauge, some places 22 is okay if that's all you can get.
    blueheaven likes this.
  5. 9
    It depends on who your patient is. If you have a little old lady with CHF you're going to infuse that bad boy over as close to 4 hours as possible, and probably giving Lasix in between the first and second unit.

    If you have a trauma you may be rapidly infusing your blood in a matter of minutes.

    Blood goes in over 2-4 hours depending on the order and situation.

    A size #22 is harder to infuse blood with because it's viscous compared to a fluid like NS, but it can be done, slowly. If you infuse blood rapidly with a #22 you end up with hemolysis.
  6. 12
    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.
  7. 2
    I think the needle manufacturer should have a maximum flow rate for that brand of needle listed on their website. The inner diameter of the needle and viscosity of the infusion affect the flow rate. I'm sure the rate listed in the link below is for water not blood.
    http://www.bd.com/infusion/pdfs/D16131.pdf

    Here's an article that may be of interest http://www.gdmedical.ch/media/DIR_23...73ffffffe7.pdf
    outrunningzombies and GGT1 like this.
  8. 0
    Our hospital policy is it must go through a 20 gauge or larger IV. I did run blood through a 22g once (got an order from the MD for that) when I was a new nurse and it took forever to go through and I think someone said there's a chance of hemolysis of the RBCs.

    My goal is usually to run the blood in over 3 hours. If it's a patient's first time getting blood i'll run it in a little slower, but never faster than 2 hours. However this was on a med/surg floor. I'm guessing the ER is different.

    My one tip for you as a new nurse is to make sure you get the vitals right before you go down to blood bank to pick up the blood. There have been a few times I got the blood first and then got the patient's initial vitals and they had a fever so I had to return the blood..ugh!! That can be time consuming!
  9. 0
    um, i usually run it at 100ml/hr for the first 15-20 minutes. Do my 15 minute check, as per policy requirment. then if everything looks fine i run it at 125ml/hr. There is approx. 300mL per unit of blood, so total it takes like 2 hours maybe?
    Bags are only good to hang for 4 hours, so really you shouldn't go too much slower than that.
  10. 1
    Quote from Jenni811
    um, i usually run it at 100ml/hr for the first 15-20 minutes. Do my 15 minute check, as per policy requirment. then if everything looks fine i run it at 125ml/hr. There is approx. 300mL per unit of blood, so total it takes like 2 hours maybe?
    Bags are only good to hang for 4 hours, so really you shouldn't go too much slower than that.

    I take that back. You can go quite a bit slower, cause the way i do it only takes about 2 hours. So really, you COULD do half what i do. my math was just a little off.
    So really, you could keep them running at 100/hr and it will be done in 3 hours. (Approx.)
    nola1202 likes this.
  11. 3
    A unit of blood at times in the OR and the ER can be infused as fast as five minutes, that is why they make the Belmont and also Level I infusers. Also, the smaller the radius of the catheter will result in slower flow as flow is proportional to 1/radius (to the 4th power), which is derived from puiosselles law (8nl/Pi*r^4).

    In an emergent scenario, 16g if possible and get the blood in as fast as possible.

    Hope that helps.
    nola1202, NRSKarenRN, and GGT1 like this.


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