Running PRBC concurrently with NS?! - page 3
by nurseap 9,590 Views | 53 Comments
Hi, I'm a new RN working on a medical oncology unit and went off of orientation last week. Today a Dr came in and told me she'd like me to administer 2 units of PRBC's. She added that she'd like the patient's fluids, normal... Read More
- 8Feb 21, '13 by ♪♫ in my ♥Quote from GrnTeaKind of like the myth that you can only run blood through a 20 or bigger.The people who are getting in a fluff about it don't know the physiology involved (including the ones with the idea that you just stop the IV fluids and give the blood at 125) and are ritualistically relying on inappropriate transfer of incomplete information that no IV fluids may run c blood products.
Had a nurse at work belittling me for saying it can be done through a 22. Finally, I copied a page out of the BB book which explicitly states that a 22 is acceptable. Next time she went off, I said "that's your opinion..." and handed her the copy. Pretty much ended that one.
- 0Feb 21, '13 by DesireeRN2011At both places I worked at as a floor RN - we had pumps with settings for blood administration. Both systems had specific "blood" tubing that if we didn't have it, we had to run it by gravity/calculating drip rates. With both pumps I used it wasn't the pumps but the tubing that cause hemolysis. (Not all pumps are created equal though, friends working elsewhere have told me stories about their pumps' limitations).
That being said, I always ran blood in alone without anything else. I liked having another IV access point peripherally just in case and would prefer to run maintenance fluid through there. Not always possible, so there is that consideration too.
I would definitely check policies/procedures. Another thing is, if policy doesn't prohibit it, you could ask whoever (physician, PA, NP) who insisted you run them together (blood products and NaCl) to write an order as such. I would definitely follow my policies but if the policy doesn't say or is vague, this would be something I might consider.
- 5Feb 21, '13 by PMFB-RNQuote from nurseap*** The night nurse doesn't know what she is talking about. It is perfectly OK to run PRBCs with NS. It's done in every ICU I have ever worked in. She is wrong, and she is a bully. Don't let anyone "ream" you like that for any reason. If she feels you made a mistake (and now you know she doesn't know much herself) she can take it up with the charge nurse or nurse manager.Hi,
I'm a new RN working on a medical oncology unit and went off of orientation last week. Today a Dr came in and told me she'd like me to administer 2 units of PRBC's. She added that she'd like the patient's fluids, normal saline, to be reduced to 70 ml/hr during the infusion and returned to 125 ml/hr (the current running rate) after the transfusion was complete. I know you're typically not supposed to mix anything with blood, but being that it was normal saline and that's what we prime the transfusion line with I went to ask my trusted past preceptor what he thought. Together we agreed that I would get a second pump to run the blood through using the Y-port tubing, which is standard on our unit, and then connect it to the line running the NS. I connected the blood line to the lowest port, closest to the insertion site, on the fluids line. When the night shift came on I got reamed for making such a mistake. I don't know if what I did was truly wrong or if I was just being bullied. The RN II on nights is very mean to new nurses, but my colleagues have stated she's especially rough on me. Spending my ride home in tears is pretty commonplace. Anyway, I've spent the last 3 hours googling and haven't found a concrete answer. Though some sites indicate it's ok to run PRBC’s concurrently with NS. My old preceptor pulled me aside before he left and told me it was fine and that they're compatible. The RN II said I read the order wrong. The Dr had not written the words “run concurrently”. The order just read reduce rate to 70 and then return to 125. But when she verbalized it to me I took it to mean run together. I'm exhausted with anxiety. Besides answering regarding this issue, can you also tell me if things get better... Right now I feel like a failure, because no matter how many times I'm told I'm doing well, this woman (RN II) makes sure I go home feeling incompetent nightly. :/
Thanks in advance fellow nurses!
Don't take her crap, don't let her rent space in your head. YOU need to bring her inappropiate treatment of you to the attention of her nurse manager in writing. Use words like "hostile work enviroment" and "bully" and "abuse".
- 4Feb 21, '13 by NurseKittenIf you can't run blood with NS, then I have been doing it wrong in every open heart I have ever provided anesthesia in. Just sayin. Does your hospital have Up To Date or another clinical resource database. I paid the $$ to have UpToDate on my phone and iPad with me in the OR, cause I always have a current evidence-based database with me to answer what I don't know.Last edit by NurseKitten on Feb 21, '13 : Reason: Autocorrect is going to be the death of me yet...
- 2Feb 21, '13 by DoeRNI would have run the NS through another IV. If they had a port, the blood would go through the port and the NS through a peripheral. Of course making sure the patient didn't have heart failure.
As far as the night nurse learn to be assertive and she/he will back down. I'm a float nurse and I don't usually talk to people unless necessary. People see this as a weakness and attempt to talk down to me or question me about every little thing. I change to my assertive voice/demeanor and pull up the policy along with my charting and tell them to have a look. This 100% stops them in their temper tantrums. You may have to be like this to that night nurse next time she/he tries to go off on you.
Sent from my iPhone using allnurses.comLast edit by DoeRN on Feb 21, '13
- 2Feb 21, '13 by maelstrom143If NS is IVF ordered, then it is ok to run w/PRBC, but the preferred method is to have dedicated IV site for blood and another for IVF, meds, etc. Also, if your primary IV site goes bad (i.e. infiltration, pain, leakage) you already have a site in place. Nothing worse than losing your only site when giving blood.
- 1Feb 21, '13 by Karen SouthadI, personally, have never run any IV fluid concurrently while infusing PRBCS, even if normal saline is used to prime the blood tubing with. Rule of thumb: Start a second iv access to infuse the PRBCS thru while decreasing the NS line down to 70cc/hr. Yes I have done this several times and I am an 18 yrs nurse. Remember that that nurse dresses just as you do every day, one leg at a time. some will always try to cowl the new nurses but do not let them get away with it! Always ask questions of older nurses, charge nurses, or even the nursing superviser when you have any questions you are not sure or confiedent about carrying out. Remember the 3 little letters ""CYA" Cover Your Ass" because no one else will do it for you!
- 0Feb 22, '13 by Paco-RNQuote from nurseapI will leave the NS/blood question up to the more experienced nurses to answer, because my small level of experience requires me to defer to them as well. I have hung blood before but never concurrent with such a high NS rate.Besides answering regarding this issue, can you also tell me if things get better... Right now I feel like a failure, because no matter how many times I'm told I'm doing well, this woman (RN II) makes sure I go home feeling incompetent nightly. :/
But I can tell you that I have had the same experience with my CNS as you have with the RN II on your end. Some people are never going to change. At some point a newer nurse will come around and she will start picking on them. You will have to wait it out unfortunately, this will get better for you. I am still in the waiting game but I can see this will end soon too as more new nurses join the fold this summer ... start to believe in your instincts that you are doing well. I know it's hard to ignore the browbeating, but you have to try to keep moving forward. With experience, it will be easier to do.