Priming blood tubing with...blood??

Nurses General Nursing

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Specializes in Emergency Nursing, Cardiology.

My facility is doing away with priming blood tubing with saline. The policy basically says to prime the tubing with the blood, infuse the blood and then we have the option of following the blood with saline to flush remaining blood out of the tubing into the patient.

I tried this for the first time the other night. I let the PRBC's flow slowly into the tubing, through the filter and through the rest of the tubing. I had air bubbles, lots of air bubbles. I ended up wasting (and cringing) at least 20 ml of blood into the sink to get rid of the air.

What could possibly be the rationale for this change? I was told many facilities are doing away with using saline at all for priming or following the blood.

Also, any hints on how to prime with blood without getting all the air bubbles.

Thanks,

Robinbird

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We are still priming the tubing with blood; so I have no advice for you. I'll be interested to see how others respond.

Did they give you any rationale for discontinuing the priming with saline? Besides the cost, what could it possibly hurt? A 100cc bag of saline doesn't cost that much, and to me, it seems like being able to not waste any blood at the beginning of the infusion, as well as being able to flush with saline after the infusion ultimately is better. You pay for 100mL of saline, but you get virtually every possible drop of blood.

Keep us posted.

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Specializes in ED, Trauma.

Never heard of such!

Anyway, try priming very slowly. You could also try pinching off the lower part of the tubing while the larger drip chamber on the bottom of the blood tubing is filling up and has plenty of blood in it before letting the blood flow into the rest of the tubing.

Good luck!

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We've never primed the tubing with saline, only with the blood that is to be transfused. Not sure what the reasoning would be for priming with saline, actually. Didn't learn it this way in school, and have never seen anyone do it like that. Obviously you do, just saying that it's not at all odd to do it the "new" way your facility is going. There is no waste of blood, not even a drop, providing you prime the tubing correctly.

You might avoid bubbles by turning the drip chamber upside down (much like primary pump tubing) and flipping it back after you get it about halfway filled. I usually flip the "hourglass" chamber too; I find if I don't flip the other drip chamber, I will get bubbles.

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Specializes in Surgical Telemetry.

At our facility we do not hang blood, nurses on our IV team do we just do a double-check with them, but I've watched it done both ways. To me it seems easier to prime with saline first. For me the problem is always switching over the saline in time to flush the blood in. I never seem to catch it in time no matter what I do.

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Specializes in Emergency Nursing, Cardiology.
We've never primed the tubing with saline, only with the blood that is to be transfused. Not sure what the reasoning would be for priming with saline, actually. Didn't learn it this way in school, and have never seen anyone do it like that. Obviously you do, just saying that it's not at all odd to do it the "new" way your facility is going. There is no waste of blood, not even a drop, providing you prime the tubing correctly.

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What about the blood that is left in the tubing when you are finished?

Its so interesting to hear about these different methods of practice. In nursing school (I graduated in 2006), we learned to use saline. Obviously there is some reason why we are moving away from saline, I just don't know what it is. I have not asked the people who wrote the policy why they changed the policy but I will ask my nurse educator on Monday.

Thanks for responding, it's good to know that with the proper technique there is a way to do it and not to waste valuable blood.

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Specializes in OB, HH, ADMIN, IC, ED, QI.
My facility is doing away with priming blood tubing with saline. The policy basically says to prime the tubing with the blood, infuse the blood and then we have the option of following the blood with saline to flush remaining blood out of the tubing into the patient.

I tried this for the first time the other night. I let the PRBC's flow slowly into the tubing, through the filter and through the rest of the tubing. I had air bubbles, lots of air bubbles. I ended up wasting (and cringing) at least 20 ml of blood into the sink to get rid of the air.

What could possibly be the rationale for this change? I was told many facilities are doing away with using saline at all for priming or following the blood.

Also, any hints on how to prime with blood without getting all the air bubbles.

Thanks,

Robinbird

Also, what do you hang to run in case of a transfusion reaction?

While we're on the topic of blood transfusions, I have a question about the now prevalent practise of giving Benadryl before transfusing patients - me! I've had transfusions for severe anemia in the past few years, and refused the Benadryl due to my stringent education regarding the "masking" of symptoms. My refusal caused all sorts of negative personnel reactions, which tried my stubbornness.

When and due to what, has this become standard of practice? :confused:

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Specializes in Cardiac Telemetry, ED.
Also, what do you hang to run in case of a transfusion reaction?

While we're on the topic of blood transfusions, I have a question about the now prevalent practise of giving Benadryl before transfusing patients - me! I've had transfusions for severe anemia in the past few years, and refused the Benadryl due to my stringent education regarding the "masking" of symptoms. My refusal caused all sorts of negative personnel reactions, which tried my stubbornness.

When and due to what, has this become standard of practice? :confused:

It's not common practice at my facility, unless a patient has a history of transfusion reactions. Febrile reactions are the most common, but the incidence is very low, I understand, when leukoreduced PRBCs are used, which is what we use at my facility. Perhaps this is why I never see the practice. Even so, since febrile or mild allergic reactions are not life threatening, just uncomfortable, sometimes the benefit of getting the blood outweighs the risk. Perhaps that is why they premedicate. I don't know, I'm just hazarding a guess here. My understanding is that premedicating has not been shown to actually prevent transfusion reactions anyway. Maybe it just decreases the severity of symptoms for the patient.

We do premedicate patients with known iodine allergies prior to cardiac catheterization, typically with Prednisone. In this case, the benefit of PCI outweighs the risk of a contrast reaction, which is minimized by premedicating.

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Specializes in M/S, Travel Nursing, Pulmonary.

I've always primed with saline also. I dont think the PO's workplace is thinking of costs when they say to do it with the blood. Did I read that the policy is to flush the remaining blood with saline. Seems her facility is just using the saline at the end of the transfusion instead of in the begining. Guess if you prime the tube well and dont lose any blood, its better.

I would be interested in hearing about it if you do find out why they made the change.

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Specializes in OB, HH, ADMIN, IC, ED, QI.

Quote from Virgo_RN's post: "We do premedicate patients with known iodine allergies prior to cardiac catheterization, typically with Prednisone. In this case, the benefit of PCI outweighs the risk of a contrast reaction, which is minimized by premedicating."

Oh, I refused that too a week ago, because I'd had a reaction while having an IVP, in 1968. Again I was afraid of "masking" another one. So I didn't get the CT scan to find the source of bleeding that could be causing my anemia. The upper and lower endoscopies didn't reveal it. Thanks for your post. I'll read up on the use of predisone with iodine dye........

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Specializes in Cardiac Telemetry, ED.

lamazeteacher,

I found this thread:

https://allnurses.com/radiology-nursing/premedicating-patients-contrast-144855.html

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Specializes in med-surg, LTC.

The facility I work at uses "Y" blood tubing that allows for a saline bag to be hung with the unit of blood to be transfused. Our practice is to prime the tubing with the saline first, to eliminate those pesky air bubbles. Then, just prior to administration, and before putting tubing into the pump, priming with it blood so that it has only blood in it when it is strung through the machine and then connected to the pt's IV access (after 2-person checks, of course). This is beneficial for 3 reasons:

1) There is no waste of precious blood product while trying to rid (prime) the tubing of bubbles

2) You can pinpoint the moment that the bood actually started infusing into the pt

which leads to 3) then you will know exactly when the blood product began to transfuse and can monitor for reactions within the "important ten minutes".

This saves you time and guess work. You have to stay by the pt's side and monitor (on my unit anyways, we don't have remote monitoring...) for the first 10 minutes (the amount of time research says that most blood reactions will take place in). It's a good idea to know exactly when that 10 minutes starts, so you can recognize a reaction as quickly as possible, which may not happen if you are infusing a mixture of blood and saline at the start.

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