Running PRBC concurrently with NS?! - page 4

by nurseap

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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... Read More


  1. 0
    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!!!
  2. 2
    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 ~
    NurseKitten and carolinapooh like this.
  3. 0
    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).
  4. 5
    Quote from Paco-RN
    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.
    canoehead, NurseKitten, Altra, and 2 others like this.
  5. 0
    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.
  6. 1
    Quote from Born_2BRN
    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.
    NurseKitten likes this.
  7. 1
    Not arguing with anyone else's ideas, just describing me and my buds and our policies. Figured I'd mention them to present alternate POVs and stimulate more conversation.

    I use an IV pump (by policy). I use the transfusion set made specifically for the IV pump. Policy limit is 125 ml/H. Rationale is that the pump works by "massaging" the fluid downstream. Over 150 ml/H and the pump starts to crush RBCs, increasing risk of hemolytic reaction and rhabdo.

    I give no fluids at all during transfusion except PRBCs (policy). Besides the bag of PRBCs, there is a bag of NS attached to the transfusion set that is there to prime and flush the set, but just a tiny bit, and not concurrently given.

    Fluid overload can come fast. I don't want it to come any faster than it does. It was hard for me to understand just how fast until my patient went from asymptomatic to horribly dyspneic (flash pulmonary edema) in 5 minutes running PRBCs at 125 ml/H, and we had to call a rapid response.

    I assess before transfusion, and not just breath sounds, BNP, vss, whether they feel even slightly SOB, etc. Whatever's in the chart and in report, I get a fresh transfusion history from them and family with details of adverse reactions. I ask if they ever have swelling, get SOB, were ever told they have or might have CHF, or have renal issues. And I ask if they have ever been treated with Lasix.

    If it even vaguely smells like they're prone to fluid overload, I call that history in along with my request for a PRN order for IV Lasix between multiple units, maybe even with one unit if they've been on fluids. Sometimes the cardio will say to just give it, or to give a higher than normal dose.

    And then, of course, I give pt ed about adverse reactions and what to report, and repeat with each set of vss.

    Just my two cents.
    NurseKitten likes this.
  8. 3
    OP, I read most of the responses but I'm not sure if anyone addressed this..... it does get better. You will get more confident, even in situations you might not be familiar. Even just learning where to look for answers or trusting your gut even if you aren't sure why. And when you do get more experience and confidence you will remember this feeling and treat other new people and coworkers with respect. Every person we come across teaches us how we want to be and you don't want to be that person that sends someone else home crying and doubting their ability to be a nurse. Remember how she made you feel and promise not to do it to someone else. Even in the face of errors you can speak to someone in a way that helps them learn versus belittles them. Once you get that experience and confidence you will be able to see where their comments are coming from. Maybe they got yelled at in their beginnigs and it forever put them on the defensive, finding mistakes in others. There are a few people that I know when they get report they always question things. Usually it's their personality or they are just voicing things they wonder out loud but really don't mean they are questioning me (though it can feel like that sometimes). I hope you are feeling better since your experience. Hang in there and good luck!
    NRSKarenRN, NurseKitten, and GrnTea like this.
  9. 0
    Where I worked our policy was to ALWAYS run the blood by itself.
  10. 0
    I am not a new grad, and I was recently in a "sort of" similar situation. My pt had 2 IVs, one running a cardiac med that could not be stopped, y-ed into NS running at 100. Because there had been a suspected problem with a previous PRBC transfusion (nurse stopped after 90ml), the doctor told me to run one unit of PRBC over 8 hours. Now clearly, that was not an acceptable order. I told her I would run it over 4, she agreed. As the pt was in hospital, for dehydration and anemia, I did not want to stop the NS for 4 hours. I ran the blood into one IV at 75ml hour, ran the NS with the cardiac med at 100 in the other IV. Monitored the pt very closely for fluid overload, no problem.
    My shift manager leaves for the day, and the oncoming shift manager calls me into the office to tell me that we "never" run fluids during a transfusion, even in another IV.

    I have tried to find documentation that I screwed up, I havent found it yet.

    Dear OP, things will get better, and somedays things will be worse. Keep learning and improving your skills. Do the best you can for your patients. Dont let the bad days trip you up too much. Nursing is an adventure.
    Last edit by qaqueen on Jun 3, '13 : Reason: grammar


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