Most blood products in one shift, ethics

  1. Related to another thread I just read on blood transfusions, what is the most blood you have transfused in one shift?

    My record, is forty plus units or so (this includes some FFP cryo, and platlets) over 70 minutes while in Angio taking care of an unstable pelvis with a grade 5 liver lac. That patient died within two hours.

    Also, what are your thoughts on using large amounts of blood like that on clearly unsalvagable patients?

    A funny note, is one of the things new hires from the floors have the hardest time getting used to, is giving a unit of blood over the space of a few minutes. Freaks them right out. Ummm,, shouldn't that go in over say four hours, with frequent temp checks? Answer, sure, you just start forty IV's and we will get right on that. grin.........

    Craig
    •  
  2. Poll: What is the most blood product you have ever given in a shift?

    • zero

      0% 0
    • 1 to 20 units PRBC's

      77.59% 45
    • 21 to 30 units PRBC's

      8.62% 5
    • 31 to 40 units PRBC's

      0% 0
    • 41 to 50 units PRBC's

      6.90% 4
    • 51 plus units PRBC's

      6.90% 4
    58 Votes
  3. 14 Comments

  4. by   wildtime88
    send them to the ER, I have on occasion flooded in 2 separate units at the same time. A new nurse asked me what would happen if there was a transfusion rxn. My answer, deal with it and send both empty bags to the Blood bank.

    Most for me so far is 16 units during the same shift.

    Ethics, there is a time to give up and usually no matter what you do the patient will make that very clear.
  5. by   hoolahan
    I can't remember, but I think it is in the 40 unit range, like you Craig, that includes all types of blood products. I remember one post open heart crashing and the bed was so crowded, that I was checking the units with one nurse at the foot of the bed where the ID braclet is, on the foot, and then tossing them to the nurse at the head of the bed, who was hanging then 2 at a time. We also use those super cool "pumpers", it's a blood set-up with a ball in the middle, which you can pump the unit in, in about 5 minutes or less if you are strong and fast. There have been many occassions that I thought at some point we should stop "wasting" blood when a pt was clearly not going to make it. We had one cardiac surgeon who would let the hgb go to 7 and crit of 21 before he would order blood, unless, the pt were over 80. I had one woman who was 85, who had HIV from multiple blood transfusions in the early 80's. What a way to go at 85, huh? But, I have to say, I think the surgeon did help to preserve the blood supply, even if only to prevent the risk of hep and HIV in his pt's. And, I have seen a lot of post-op hearts walk out of the hospital after they had multiple blood transfusions, so in those cases, you just have to do it, and pray the outcome is good.

    One time, we had a young man, a leukemia pt, who was a DNR. He had a very low platelet count, and not only that, he was unresponsive now. I felt very sad infusing those 20 units of platelets that night.
  6. by   P_RN
    Hey you said PRBC! Platelets and FFP don't count do they?
    How about pheresis packs. Gad they came up with them, rolling all those little bags was terrible.

    OK if you count them I guess I'm up to a bit over 20-25.

    ONE patient I think 4u PRBC and 2 pheresis packs.
    Next day got FFP but I forget how many.
    And we had one doc who LOVED to give "salt poor albumin" for just about every patient who had a little serum leaking from an incision.
    P
  7. by   Marijke
    Although I am now working in an OR and handle a lot of blood products on occasions, the worst cases I encountered where while I was working working critical care obstetrics. Fortunately the bloodbank was next door and I never lost a patient (just lucky I think (patients where also healthy young women before they started to bleed)).
  8. by   CelticNurse
    I own up to being the individual in the poll who had the dubious honour of giving 51+ units of blood products in one sitting. In point of fact this was a recent situation where we had a very serious GSW to an 18 y.o. male. It was an abdominal wound that passed primarily through the right iliac artery.

    After being kinda patched up in the OR as best as they possibly could, he was sent to us in the ICU, whereupon we spent the next 4 hours trying desperately to stabilize this young man. Essentially, he was hosing from various bleeding points and we proceeded to give him approxiamtely 61 PRC's, 20 cryo's, 8 platelets and about 18 FFP's. We also gave him 2 boluses of Factor 7A. We actually went with two dedicated lines just for blood products and had them on pressure bags!!

    On top of this we had him on industrial-strength inotropes running at ridiculous rates.

    Never got his systolic beyond 90.....

    As to whether we should have done what we did? Well, on reflection, I would have to say a resounding NO! In point of fact, I did repeatedly ask the ICU registrar if he would get a surgical review to this young man because we were clearly up a creek in a BIG way! In fairness to him, he was new to the environment so he was doin' his level best in a very tense and tenous scenario.

    Ultimately, the outcome was the same: The young man died.

    The one resounding question that came to haunt me for a while was this: Just 'cos we think we can change the world sometimes, should we go for it in such a pell-mell fashion without thought to the blindingly obvious?

    Any thoughts on this would be gratefully received.....

    Keep smilin', people....
  9. by   Jenny P
    I had a situation recently where I can't remember how much blood I gave. I think I gave 30+ units of FFP, >15units PRBCs, plus cryo and Plts. Can't go into details (too many nightmares on this even now); but I do think in this case it was necessary but I hope that I never have another shift like that again.
    I do believe that many times that we are doing things that are totally futile because the doc can't understand that death is just another part of life.
  10. by   jeezlawheeze
    I am the other person who gave >51 blood products in one shift and have on many occasions. My first experience was a young man with a stab wound to his left ventricle. Post-op DIC, we were flooding him with PRBC's, FFP, Cryo, and platelets. There were at least 3 RNs and 3 residents in there at all times. I asked "What kind of chance are we looking at here?" A 1% chance of survival I was told. I thought to myself, what are we doing? I was off for a couple of days after that, and when I returned I was walking to the unit and I saw that young man WALKING in the lobby! No MOF, no ARDS, but walking. By the way, the total for 8 hours was 180 units of blood products.
  11. by   teeituptom
    Had one case just 2 months ago,young kid in his early twenties,was shot in the chest at close range with .45 caliber pistol,breaking into a house. came in via fire dept.,asystole.
    the ER doctor opened him up saw a large hole going through his right ventricle and out the back, placed a 24 french foley catheter into the right ventricle,,cross clamped and hooked him up to blood tubing.
    sutured the catheter into place. Got a rythm back,shipped him to OR with a cardiovascular doc.
    He survived and was discharged 3 weeks later,ambulatory,into the hands of the police department. Interesting.
    Thank god for the level one infuser, and a foley catheter, we gave him almost 30 units in the er,before he went to surgery. this all took place in about 45 minutes. I dont how much he got in the OR. You sure can give blood fast with that LEVEL one infuser, particularly when you give it through a 24 french foley inserted into the heart.
    HAPPY TRAILS TO YOU
    TEEITUPTOM
  12. by   sikevin
    I work at an institution where the motto seems to be "because we can", and I find myself asking "should we", anyways motorcyclist versus tree, post op DIC 40+ PRBC's with two level ones over 45 minutes.........big shock patient still expired
  13. by   nurs4kids
    Hmmm, I think my max is like 4 units a shift. 'course we're talkin babies here.

    Ethics: Well, if it's MY kid; MY family, then you damn well better give it your all. If not, then it becomes an issue of ethics...
  14. by   CEN35
    screw ethics............if your reffering to wasting blood?

    i had a 17yo female gunshot victim secondary to being the cashier, of a store being robbed. the initial 4 liters of saline and 11 units of o-, were not enough. then the type and crossed stuff came down, and used ffp, about 30 units and much more saline through the level one infuser.

    if thats your kid.....you want it all done.....

    i then had an 11yo male with a liver lac, after being tagged out at second during the summer, he took a lot also. again you have too......

    unless they are a dnr.......if they are needing it to keep them going, wouldn't witholding it be the same as not doing cpr, not defibrillating, not giving meds, on a full code patient?

    remember.......we see it everyday, we can pretty much tell anybody the outcome.....although there are those rare occasions when the unexpected occurs.....we all hate to see the 97 yo with cancer, or chronically dehabilitated from a stoke having a code run on them. just accept the fact that if that is what the family or patient wants, thats what we have to do?


    this was in no way to intended to offend anybody......hope i didn't!

    me
  15. by   Q.
    Most I've ever given in one shift is 8, and I think that is including one neonate as well as one mother who was bleeding out after severing the uterine artery during a crash C-section.

    As far as "wasting" blood on a "clearly" hopeless cause, I guess I don't see anyone as hopeless, especially neonates. Neonates and infants are typically the most resilient. As far as adults, well, we've had several cases of severe hemmorhage in Labor and Delivery that I guess by all practical purposes shouldn't have made it, but they did.

    It's never over until the fat lady sings.

close