Saline flushes or Blood

  1. I am curious to know how widespread the practice of putting up 100 ml bags of saline between bags of blood during a transfusion.

    Where I work most A&E units don't do this nor do some ICU's but the medical and surgical wards do. In some places it has even become an "unofficial" policy not only to run this extra saline but to get the doctor to order lasix to remove the excess fluid. What is often happening is that the nurses are convincing the resident docs to do this so they continue the practice to reinforce it to nurses in a viscious cycle.

    I can find no research supporting not doing this but I can't find research supporting it either. Any suggestions/opinions factual information will be gratefully accepted.
    Last edit by gwenith on Apr 8, '03
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  2. 13 Comments

  3. by   KaroSnowQueen
    We do it at our facility but don't know if it's policy, most docs just order the saline and lasix.
  4. by   canoehead
    We hang the saline in case a reaction occurs, then we can maintain the line after stopping the blood. We also use the saline to flush through the blood in the tubing before changing tubings betweeen blood units.
  5. by   RNonsense
    Originally posted by canoehead
    We hang the saline in case a reaction occurs, then we can maintain the line after stopping the blood. We also use the saline to flush through the blood in the tubing before changing tubings betweeen blood units.
    And to prime the tubing. If the doc wants lasix after/inbetween it will be ordered.
  6. by   wv_nurse 2003
    We hang the saline to prime the tubing, and to flush the line between units so that if a reaction occurs we know which unit (particularly if they are running in quickly). Its used to maintain the line. The patient doesn't get the whole bag of saline--so it doesn't require a diuretic-- from the saline anyway
  7. by   ceecel.dee
    Originally posted by wv_nurse 2003
    We hang the saline to prime the tubing, and to flush the line between units so that if a reaction occurs we know which unit (particularly if they are running in quickly). Its used to maintain the line. The patient doesn't get the whole bag of saline--so it doesn't require a diuretic-- from the saline anyway
    Ditto here!
  8. by   OzNurse69
    The theory behind it is that the individual bags of blood are x-matched to the pt, but not to each other, so theoretically you can get a transfusion reaction if two bags of incompatible blood are run in one after the other - have never seen this happen though.
  9. by   New CCU RN
    We have two different kinds of tubing to hang PRBC in and it depends on the type. We have straight tubing that you just hang to gravity and it goes in as fast as possible. We use this with GIBers or anyone else that needs a quick infusion. We do not reuse this tubing.

    Then we also have the tubing that we prime with NS. We will use this tubing twice. (if transfusions are given back to back)

    So really depends on the situation.
  10. by   melbnurse
    We use the saline , to both prime the tubing, and flush same, we do not necssarily run the entire 100ml. It also is routine for our Docs to order Lasix between units
  11. by   WhyO
    our policy is to have saline between units of blood and it makes sense with the whole cross match however if I had a patient with a reaction I WOULD NOT run the saline in, I would stop the infusion immediately and flush the saline lock. I personally would not want the blood left in the entire line before the saline to run into the patient. So that part of the rationale seems dubious to me, but I certainly don't know everything and could be completely wrong... someone please straighten us out on this issue!!
    thanks
  12. by   ?burntout
    Originally posted by WhyO
    our policy is to have saline between units of blood and it makes sense with the whole cross match however if I had a patient with a reaction I WOULD NOT run the saline in, I would stop the infusion immediately and flush the saline lock. I personally would not want the blood left in the entire line before the saline to run into the patient.
    I agree with you on this...this was a question that was brought up when I was in school. I would disconnect and flush and have someone bring me a new set of tubing and run plain saline for a reaction, till I got a hold of the MD. We use saline on Y-sets and pump sets-prime and then run the saline between units. If the doc wants Lasix, they order it before, between or after the transfusion. We use 500 cc bags-100 cc bags are hard to come by at my hospital.
  13. by   nursemouse
    Yes, we use saline as a "back-up" between blood units, and to flush the blood tubing initially. Different places where I worked or rotated students have used 100cc, 250 cc or 500 cc bags. Wonder if this is one of those things that we "do because we've ALWAYS done it that way?" Great question! Nursemouse
  14. by   Rapheal
    New bag of 100 cc NS and new tubing between each unit of blood. NS to prime the tubing and to flush. New NS and tubing between units because after the first unit of blood has run the tubing may maybe contaminated by bacterial growth during the time it takes to start the second unit.

    Lasix between units to prevent fluid volume overload - especially with our CHF patients. We may also give the patient Benadryl and or Tylenol before or between units if they have had a reaction to blood transfusions in the past, or if they have been known to spike a temp during transfusions.

    PS. Rapheals tip for the day. I run the pump at about 200 cc an hour until the blood reaches the IV site and then turn it down to the ordered cc/hour. This way when I am in the room for the 15 minutes that policy dictates- I get more time with the patient when they are actually receiving the blood- versus the time it takes to actually go thru the tubing and reach the patient. Learned this tip from a seasoned nurse- and am passing it on.

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