Rate to run blood?

Nurses General Nursing

Published

Hi! I am a graduate nurse that just got hired to a post-surgical floor. No one has EVER been able to give me a straight answer to the question; how fast do I run blood after the initial 15 minutes? The protocol at my hospital is 120ml/hr for the first 15, then "run over 4 hours" which would be fine, if I knew how many mls are in a unit of blood, but it never has mls on the bag and everyone that I've asked has said they just kind of leave it at 120. Is there a way to know exactly how many mls are in a unit so I can do out the math to be sure i'm running it at the right rate to go in over 4 hours? What do you guys do?

LynnLRN

192 Posts

I feel like the ml's in blood are never the same. However, I think it typically ranged from 350ml-400. Are you sure your policy is over 4hrs? not 2-4hrs? I do not think I ever ran blood over 4 hours besides maybe on a CHF, elderly patient. Plus, we are not allowed to run the blood longer than 4 hours because then its no longer good. So lets say you miscalculated your rate and still had some blood in the bag if it had been 4 hours you'd have to toss it. I usually started blood at 110ml/hr and typically ran it at 125ml. Unless concern of fluid overload I would sometimes run it at like 90ml/hr.

KelRN215, BSN, RN

1 Article; 7,349 Posts

Specializes in Pedi.

When I worked in the hospital, the blood was always labeled with how many mL were in the bag. This was pediatrics and a "unit" was weight based (10-15 mL/kg) so there was no standard unit of blood. We always ran red blood cells over 4 hours.

flyingchange

291 Posts

Specializes in MPH Student Fall/14, Emergency, Research.
if I knew how many mls are in a unit of blood, but it never has mls on the bag and everyone that I've asked has said they just kind of leave it at 120.

Hi Kaeli, all of our blood products have the exact mL on the bag, which varies from unit to unit. It is in small print and not very obvious, so maybe you just didn't notice it before?

Asystole RN

2,352 Posts

I don't think anyone can give you a solid rate, there are recommendations but I do not think there are hard numbers.

At my facility we run it at 100ml/hr for 15 minutes and then routinely run it at 200ml/hr after that. Most units of PRBCs that I have seen from UBS are about 300-350ml. I guess the answer is, "what can your patient tolerate and what is safe?" I run blood much slower for smaller people, CHF, history of reactions, or when I think there is some other factor.

I have glanced at studies related to blood transfusion rates in the past but I was mostly concerned with IV size and rate, check out PubMed.

KaeliF

50 Posts

Oh yea I meant WITHIN four hours.Thanks, I've hung blood before in my clinical rotations but was never actually was there to see it finish, I didn't realize there was so little in the bag! I guess keeping it at 120mls WOULD work. The reason that I had understood for the 120ml/hr in the first 15 rule was to "run it slower at first in case of a transfusion reaction"

so I had just assumed you were supposed to run it faster after that. Thanks for the help!

Do-over, ASN, RN

1,085 Posts

Specializes in CICU.

I work with a lot of elderly CHF patients, so usually 100/hr is what I would go for, maybe 125 if I give Lasix between units.

If there are no concerns about fluid overload, then I will speed it up, but I don't start it faster then 125.

Like others have said, it needs to be used within 4 hours of getting from blood bank. And, I do not like wasting precious blood.

Our bags always say 350mLs. I usually set the pump's VTBI at 250 so my tubing doesn't run dry before the line flushes.

MN-Nurse, ASN, RN

1,398 Posts

Specializes in Med Surg - Renal.
What do you guys do?

It really depends on the patient and the situation. I generally try to run it as fast as feasible for that particular patient. Today, that was 125 an hour.

msjellybean

277 Posts

Specializes in Emergency.

As always, check your facilities P&P, they will likely have a max that you can run it at.

At my hospital, on the floors, blood can be run as fast as 300cc/hr, once you're past the initial 15 minutes, assuming no problems there. Of course, patient factors & IV size also play into this. If my patients aren't fluid overloaded/CHFers, I typically will run it at 150-175, depending on my access.

Our blood bank doesn't label the volume, so it's kind of a guessing game. They seem to average about 375 though. So I set my pumps for about 350 & then frequently check on it when the unit is nearing empty. Our blood infusion sets have a double drip chamber and I always totally fill the bottom one & partially fill the top one as well. This has saved me many a time, when I haven't gotten back fast enough and/or I've grossly mis-estimated the volume. That way, there's still some blood in the line & I can salvage the rest when I start the NS flush. Nothing worse than discovering your line is almost dry & you can't get that last bit of blood in.

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

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

welcome to an! the largest online nursing community.

it is very important to check and follow your facilities policy and procedure for the administration of blood and blood products. your blood bank probably knows how much is in the unit but it is usually 350 to 375 cc's. the rate of transfusion will vary patient to patient but it must be infused well within 4 hours.

transfusion basics

http://www.resourcenurse.com/feature_transfusion.html

Anna Flaxis, BSN, RN

1 Article; 2,816 Posts

I'll echo the others; about 350mL to one unit, rate will vary according to patient condition, run within 4 hours, check your facility's P&P.

RockinChick66

151 Posts

Specializes in LTC, medsurg.

At my facility, the blood bank gives us a paper that contains pt identifiers, blood unit #, this paper has the weight in mL. I see blood range any where from 280-375 or so. I start my blood off slow like at 100, then I increase to usually 125 and will go up to 150 depending on the pt. It's all about nursing judgement.

+ Add a Comment