Leaking blood during transfusion - page 2

So the other day I hung blood for the first time ever, and the charge nurse was in the room with me to walk me through it. Very time consuming but she assured me that it gets easier the more you do... Read More

  1. Visit  iluvivt profile page
    2
    Yes..everything IVRUS is correct...you can give blood through a 22 gauge but expect that you may have to give it over a slower rate but not to exceed 4 hours, of course. What I have found is that if the dwell time is getting up there ( 2 days old or greater) it may leak around the site especially in the elderly or those with very thin skin. The blood or infusion can backtrack and leak from the insertion site.

    So in your case..I would have carefully assessed the site before beginning the infusion. When was it started? Does it flush with ease? Is it in a good location and not in an area of flexion? Is it without redness,swelling or pain?

    Blood is very viscous and if that site was sluggish I would have established another site or if the site was very old.If you could it would be great if you could get a 20 gauge in as well but if not a new 22 would also work.
    x4livin and Anna Flaxis like this.
  2. Visit  Esme12 profile page
    0
    I agree with IVRUS .......Sounds like the site was bad to begin with.... the pateint needed a new site. If the pateint refused a restart did they waste the rest of the unit??
  3. Visit  mappers profile page
    0
    You can use a 22G for CT scans, unless it is PE protocol. We use it all the time. We also use Intimas instead of Insytes. As long as you replace the cap that the needle is withdrawn through with a red cap, it works just fine.
  4. Visit  hiddencatRN profile page
    4
    Quote from traumaRUs
    Can't run a full unit of PRBCs thru a 22g - way too small. Should have placed a new IV or if not an option, central line would have been my second choice.
    It's done in peds all the time.
    x4livin, poppycat, KelRN215, and 1 other like this.
  5. Visit  CoffeeLoveRN profile page
    0
    Whenever I had an order to hang blood, I would go reassess the IV, flush it. Then I would go get my papers ready, find a nurse who will check the blood with me. Once all the ducks are in a row (good IV, papers and supplies ready, found someone to check it, other patients are ok since you will be in the room for a while).
    Then go get the blood and roll with it.
    And even then, when you had everything in order, IV's go bad. It's just the way it goes.

    You can then try to get another IV in, but remember your facility's policy/protocol on how long you have to infuse the blood once it leaves the bank. And document what happened before and after.

    At least a 22g means 22g, 20g, 18g, 16g etc. The smaller the gauge (the bigger the actual #) like a 24g, you increase the risk of RBC's lysing because you are trying to push RBC's through a smaller cannula and they will burst.
  6. Visit  fiveoclocksomewhere profile page
    0
    Well of course this had to happen right near shift change, so after telling the doc that the pt refused a new iv site, we removed her IV and put the blood in a red bag and the night nurse told me she would take it back down to blood bank since the whole thing put me so behind on meds. I was good when the transfusion started but the stopping and getting crags nurse/paging MD was an unexpected time crunch. Oh the joys of being a new grad! This was my third shift so idk the actual outcome, she was scheduled to be discharged the next day though..
  7. Visit  fiveoclocksomewhere profile page
    0
    charge* nurse
  8. Visit  squatmunkie_RN profile page
    2
    What I usually do is get my set up ready, prime the line with NS, start the pump with the NS going at around 30cc/hr then go to lab get my blood check it with another RN and then hang it. That way you know you're IV is good before starting. The pt maybe gets around 10-15 cc of NS before I'm ready to start...but at least it's a constant flow of NS keeping the vein open.

    And, you can give blood through a 22g (not the best situation, and it always seems like the hardest sitcks need some type of blood product). When I have a 20g I'm thrilled...an 18g and I'm downright EXCITED!
    jrbl77 and Hoozdo like this.
  9. Visit  squatmunkie_RN profile page
    0
    Quote from fiveoclocksomewhere
    charge* nurse
    You can go back and edit your posts.
  10. Visit  KelRN215 profile page
    1
    Quote from hiddencatRN
    It's done in peds all the time.
    Ditto. I rarely saw a peripheral larger than a 22 gauge (and many patients had 24s) working inpatient peds. The majority of our patients who needed blood transfusions had central lines (oncology) but occasionally there was a surgical patient who needed a post-op transfusion or an oncology patient whose line had been pulled because of an infection. They never had peripherals larger than a 22 unless they were teenagers. Have definitely given blood through a 22 and a 24 before with no problem. Blood transfusion volume in peds is based on weight anyway so it's not like we're infusing any crazy volumes through these small IVs.
    hiddencatRN likes this.
  11. Visit  Anna Flaxis profile page
    0
    Quote from iluvivt
    What I have found is that if the dwell time is getting up there ( 2 days old or greater) it may leak around the site especially in the elderly or those with very thin skin. The blood or infusion can backtrack and leak from the insertion site.
    This is what I thought of, too. I see this a lot with large bore field starts that have been in for a few days, especially in the elderly.
  12. Visit  tamadrummer profile page
    2
    Quote from squatmunkie_RN
    What I usually do is get my set up ready, prime the line with NS, start the pump with the NS going at around 30cc/hr then go to lab get my blood check it with another RN and then hang it. That way you know you're IV is good before starting. The pt maybe gets around 10-15 cc of NS before I'm ready to start...but at least it's a constant flow of NS keeping the vein open.

    And, you can give blood through a 22g (not the best situation, and it always seems like the hardest sitcks need some type of blood product). When I have a 20g I'm thrilled...an 18g and I'm downright EXCITED!
    I will begin to use this idea from now on. I usually go get my blood and run NS at 125 for about 5m while checking and signing and spiking to make sure the site is patent and not leaking but starting before I even go to the blood bank and and being ready to simply spike the bag, knowing full well I am safe to use without delay makes awesome sense.

    As far as that patient being d/c in the AM, who knows. If they only needed one unit, they probably were not too far off from their normal h&h and as long as they have decent blood making capacity, they will recover just fine. Not like my active GI bleed lady with an h&h of 6.5/20.7 and such high antibody containing blood that we had to go all over FL to find non-antigen containing blood. Took hours and hours and hours. Was an ugly night Friday night.
    x4livin and squatmunkie_RN like this.
  13. Visit  limaRN profile page
    0
    It seems to me that your IV had just infiltrated. I think it's important to point out, however, that once the patient reports any signs/symptoms of a transfusion reaction such as itching the you should immediately discontinue the transfusion, flush the IV, ad then notify the MD. I find it interested that the doctor wanted to continue the transfusion when the patient was reporting symptoms even if they were only relatively benign such as itching... Always remember to save the blood bag if you ever have a patient that develops s/s of a transfusion reaction (because the blood bank will want it)!! What do you guys think?

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