Running PRBC concurrently with NS?!

Nurses General Nursing

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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!

I 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.

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Specializes in PCU.

If 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.

Specializes in ICU/PACU.

NS & PRBC are compatible. You did nothing wrong.

I, 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!

I agree with the above poster. Doesn't matter how anyone has ever done it before. Your hospital's policy is what you should follow. Period.

Specializes in ICU / PCU / Telemetry / Oncology.
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. :/

I 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.

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.

I agree with iluvivit. Saline is the only thing to run "with" blood, and clearly, the MD did not want the pt to get fluid overload the pt, so she slowed the rate of the infusion while blood was running. You also could have started another line as well. So you are OK! And that night RN II should be chastized for demeaning a bright new nurse such as yourself!! Shame on HER!!!

Specializes in Med/Surg,Cardiac.

I think you did what you were supposed to do. Starting another iv would have been good, but running NS with blood is fine. If the provider specifically stated to decrease NS to 70 then I don't see where clarification is needed. Don't let other nurses pick on you. Nurses get uncomfortable when things are done differently than usual.

~ No One Can Make You Feel Inferior Without Your Consent -Eleanor Roosevelt ~

Specializes in ICU / PCU / Telemetry / Oncology.

Just wanted to throw this out there for answers ...

Knowing only NS is run through the same line as blood, if a patient is getting blood through one PIV, is it OK to run D5NS (or any other D5) through another PIV if there is an order for this continuous infusion? Or should we hold the D5 until the blood is done (assuming an order in place to hold)? Not sure if the D5 being infused simultaneously could affect the blood being transfused. If infusion OK, do we use a separate arm? I was just curious about this scenario (which is one I just made up, but somehow want to be prepared in the event it does come up).

Just wanted to throw this out there for answers ...

Knowing only NS is run through the same line as blood, if a patient is getting blood through one PIV, is it OK to run D5NS (or any other D5) through another PIV if there is an order for this continuous infusion? Or should we hold the D5 until the blood is done (assuming an order in place to hold)? Not sure if the D5 being infused simultaneously could affect the blood being transfused. If infusion OK, do we use a separate arm? I was just curious about this scenario (which is one I just made up, but somehow want to be prepared in the event it does come up).

The prohibition against D5W in any form in the same line as blood is because the solutions are in such close proximity for a comparatively long period of time; the water will rapidly enter the RBCs, make them swell up, and rupture. Bad idea. Not such an issue in an IV line running comparatively slowly in a fast-running vein elsewhere, which is why you can give IV D5W at all. If you have blood running in one line, say, in the left arm, and have to run a D5 solution in another line, in, say, the right arm, that's fine. Or if you have a multilumen catheter, you can run your blood/NS in one lumen and the D5-and-anything in another lumen.

So, in brief, it's not just the fact that blood is being given somewhere, it's that the D5 is bad for the blood cells when they are in high concentration (packed cells have a hct of 98-99%) and so close together. Different conditions than giving D5 in a vein where the hct is like 30-40. Yes, you can have one in one PIV and one in the other.

Did she said run it concurrently? I know when we give blood we always have another small bag of NS that will be using to flush after blood transfusion completed.

Did she said run it concurrently? I know when we give blood we always have another small bag of NS that will be using to flush after blood transfusion completed.

The OP's patient already had NS running as a maintenance IV. If all you hang is a blood bag, flushing it with NS when the bag is empty is a good idea. Waste not, want not.

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