Leaking blood during transfusion

Nurses General Nursing

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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 gauge iv and my charge nurse told me that they need at least a 20 gauge, but she had given blood through an 18 and that it should be fine. So we started the blood at 90ml/hr and the pt complained of itching at the site. Called the MD and she said to keep it going and see how she does. After about 30mins, blood starts seeping out all around the iv site and around the tape. Stopped the infusion and the charge came in to see it, said it had infiltrated. Is this because of the 18gauge?? Or did some kind of reaction happen?

Specializes in CICU.

I 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.

Specializes in Infusion Nursing, Home Health Infusion.

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.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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??

Specializes in Med/Surg/Tele/Onc.

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.

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.

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.

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..

charge* nurse

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!

charge* nurse

You can go back and edit your posts. :)

Specializes in Pedi.
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.

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.

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