Leaking blood during transfusion - page 3

by fiveoclocksomewhere

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


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    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.
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    Quote from fiveoclocksomewhere
    charge* nurse
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  3. 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.
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    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.
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    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.
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    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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    Quote from limaRN
    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?
    I've had patients who receive routine transfusions who are often premedicated with an antihistamine prior to transfusion because they get minor reactions such as itching. They still need the transfusion, so we deal with the itching.
    BluegrassRN and wooh like this.
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    Quote from hiddencatRN
    I've had patients who receive routine transfusions who are often premedicated with an antihistamine prior to transfusion because they get minor reactions such as itching. They still need the transfusion, so we deal with the itching.
    I agree hiddencat- I suppose it depends on how severe the reaction is. If it is just itching this particular patient may need to be pre-treated anti-histamines or corticosteroids with subsequent transfusions. I would just be wary that the reaction did not develop into anything worse! I hope that the patient would at least be monitored more closely for changes in vital signs or any signs of respiratory compromise
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    If my patient was itching I would stop transfusion, check site, and assess vitals. If site and VS were ok, I would call the doctor and ask for additional benadryl and continue transfusion. Make sure lines are patent before running anything, but especially blood, antibiotics, and vesicants such as chemo. You can easily check blood return on central lines usually if you're unsure.
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    Could have been DIC! Talk to the lab medical director for insight. Ours is very accessible and trains the nurses to look for the zebra not the horse


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