Leaking blood during transfusion - page 2
by fiveoclocksomewhere | 8,544 Views | 36 Comments
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 it. Anyway, the pt had an 18... Read More
- 7Nov 24, '12 by IVRUSINS standards of practice say that one should place the smallest gauge and length for the therapy. 99.9% of the time I give blood to my elderly patients with a 22 gauge. Now, If I were in a trauma situation, or I'm needing to push the unit in in a small time frame, then yes, I use a larger bore.
If I can draw labs with a 24 gauge butterfly and not lyse the cells, then why can't I give it using a 22?
Of course I can. What matters is the time frame you need to get in it. Most elderly people can't handle the unit but over a 3-4 hour time frame. A 22g works well.
In this case, It sounds as if there may have been a clot at the end of the lumen which caused a retrograde of the blood. Itching at the site could be from histamine release from the seepage in the SQ tissue.
- 2Nov 24, '12 by Do-over, ASN, RNI use 22s most of the time, and give blood through them without problems. Slowly, of course, as most of my patients are older. 22s are my default when starting a new IV (I am on a progressive care floor).
THe only time I go for an 18 is for CT with IV contrast.
- 2Nov 24, '12 by iluvivtYes..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.
- 0Nov 24, '12 by CoffeeLoveRNWhenever 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.
- 0Nov 24, '12 by fiveoclocksomewhereWell 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..