Tranfusing blood products - procedures

Nurses General Nursing

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I've been taught different things by different preceptors and am wondering if there's a diffinitive answer.

Some say to spike a bag of NS on the other side of the Y tubing and prime the entire tubing with it. Then leave that side of the Y clamped throughout the transusion. If you were to have a reaction, they say clamp the blood, disconnect it from the pt, run the blood out of the tubing into the trash, prime with saline and reconnect to pt.

Others say to have a bag of NS and primary tubing at the bedside. On the blood tubing, leave the other side of the Y clamped. Carefully prime with blood right to the end of the tubing. If you have a reaction, clamp everything, disconnect from the patient, and save the blood and the tubing to be sent to the blood bank. Quickly set up the new bag of NS and tubing, connect to pt and go at 20 ml/hr.

Also, some people do and some don't prime the filter by holding it upside down. I don't know why or why not to do this.

Is there some organization that tells what the procedure should be and why? How do y'all do it?

NS goes to the other Y port on the blood set. It is a waste of $ to have a second setup with NS and tubing. You will also need the NS to get the rest of the blood out of the tubing - the pt needs all the blood they can get.

On the rare occasion that there is a true reaction you would disconnect from pt and flush his IV. If hospital policy requires a running IV then you can get NS and start it running.

Too many nurses run blood too fast and the coldness of the blood causes discomfort. So after the nurse scares the pt about a reaction, the pt interprets the discomfort of a cold IV running too fast as a reaction, then the nurse believes it is a reaction and then you have to start that whole mess of reaction paperwork,etc.

Sometimes the filters don't fill right if you don't turn them upside down. When you turn them upside down you allow them to fill completely before running out to the other side of the tubing so that you don't have air bubbles which can cause the blood to stop running. Think of it like when you spike a bag and squeeze the drip chamber to get fluid into it before you start the line running.

Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

I ditto RN1989, I've always used Y tubing, primed first w/ NS , I've never had to invert the chamber to prime, but our chambers are soft, I've seen some that are hard plastic, we don't use those, but they make need inverting, the soft ones squeeze easily, and fill like a reg drip chamber. I've never set up a second line, maybe that would be necessary in emergency situations when running the blood wide open or not cross-matched...

I was taught the same way your first preceptor described - NS to one y port, prime the whole tubing and invert the chamber to fill filter, clamp off. Connect tubing to pt then after 2 RNs check and sign blood and initial VS taken, spike other y port to blood bag. One RN advised me to run the blood in wide open until it reaches patient, just so you don't have to sit there for 10 minutes for it to reach pt (OK slight exaggeration but you get my point) then immediately put it down to the rate you should run it in.

Specializes in SICU.

You don't say in which department you work. In Peds we would have a primary line of NS going to the pt. The blood tubing would be primed with NS, that side of the Y clamped, the blood on the other side opened. The blood tubing would be connected to the pt and the nearest port to the pt on the primary line. Blood was put on another pump for rate control. Maybe if your not in Ped's the nurse that told you to do it that way was at one time?

Specializes in OB/GYN, NB Nursery.

Where I worked, we had policy and procedure guidelines for everything we did. If there was question about how to do something, we would look it up. Granted, you don't always have time for that; but I found that was a big help and you knew you were doing it the way your hospital wanted you to do it. In L&D, we did have a notebook with copies of guidelines pertaining to everything we did back there right at the nurses station, so it was accessable.

Where I worked, we had policy and procedure guidelines for everything we did. If there was question about how to do something, we would look it up. Granted, you don't always have time for that; but I found that was a big help and you knew you were doing it the way your hospital wanted you to do it. In L&D, we did have a notebook with copies of guidelines pertaining to everything we did back there right at the nurses station, so it was accessable.

We do have policies for everything - but not everything is spelled out in exact detail.

Since I'm in orientation, I just go along with how my preceptor does it. Then sometimes, I start thinking about the differences when I'm home - and don't have access to the policies.

NS goes to the other Y port on the blood set. It is a waste of $ to have a second setup with NS and tubing. How does it waste money if you don't actually open it or use it? You will also need the NS to get the rest of the blood out of the tubing - the pt needs all the blood they can get. I don't think that person actually flushes when the blood is finished. I hadn't thought about that.

On the rare occasion that there is a true reaction you would disconnect from pt and flush his IV. If hospital policy requires a running IV then you can get NS and start it running.

Too many nurses run blood too fast and the coldness of the blood causes discomfort. How fast is too fast? So after the nurse scares the pt about a reaction, the pt interprets the discomfort of a cold IV running too fast as a reaction, then the nurse believes it is a reaction and then you have to start that whole mess of reaction paperwork,etc.

Sometimes the filters don't fill right if you don't turn them upside down. When you turn them upside down you allow them to fill completely before running out to the other side of the tubing so that you don't have air bubbles which can cause the blood to stop running. Think of it like when you spike a bag and squeeze the drip chamber to get fluid into it before you start the line running.

Thank you for explaining about the filter. That makes total sense.

Specializes in Hem/Onc.

Per my old skills text: The filter and tubing should be flushed with saline prior to running the blood. RBCs are fragile and may hemolyse on the dry filter.

We use blood tubing on our Oncology floor. We prime with saline first, then run the blood through tubing before attaching to the pt.... many of our pts are getting mulitple transfusions and they don't need the excess fluid. **interesting point** while flushing the tubing "wide open" some sets take longer to flush, and to run on the pump... what's up wiht that?

We run the saline through to flush the last of the blood to the pt and then set to kvo until the next unit arrives (as long as both units complete wihtin 4 hours total-before the tubing outdates.)

It's interesting reading this thread and the rationals, because our facility does it quite differently.

We don't use the second Y spike, it stays clamped. When setting up for a transfusion, we spike a NS bag, prime a gravity line, and attach that to the patient. We then prepare the blood (no NS in first, straight blood through the tubing, per our policy). Then that is piggybacked into the NS line, and run through a pump. The NS gravity line is of course roller-clamped.

The reasoning is this: if the patient were to have a reaction, you can quickly shut off blood, quickly disconnect blood tubing (cap line, don't toss). Then you can also very quickly open up that gravity NS line, and flush the patient with NS. There's only a very short bit of tubing that has blood in it before flushing with fresh NS.

This way, there's no switching lines, no dumping out tubing, or anything else before QUICKLY getting fresh NS into that patient. The blood bag and tubing stays intact, capped, and sent back to the lab along with the reaction paperwork. Very simple, no mess, no fuss.

This has been the policy for years.

At the end of a normal transfusion in which no reaction has occured, we run the blood until the pump can't anymore, then run it by gravity to get the last out of the tubing. Once the empty blood line has been disconnected, we flush the HL with the gravity NS until the line is clear, and prepare for the next transfusion if needed. Or, after flushing, we disconnect NS gravity line, and HL or set up patient's normal IVFs. We'd never use the same blood tubing for a second transfusion, ever. One set of tubing per unit.

in the hospital where i work the sop is like this: after getting the properly typed/crossmatched blood from the blood bank, the blood is usually checked by three people, the nurse on duty, the doctor and the supervisor in that order. if it is the first time the patient will be receiving blood transfusion,the med tech on duty will check the blood type of the patient at the bedside. only after going through this routine we can transfuse the blood. transfusion must start 30 minutes after getting the blood from the blood bank. we use normal saline as main line and the blood as side drip. we take the vital signs 3 times, before the transfusion, 15 minutes later and right after the blood is consumed. if there is any untoward reaction, the doctor is informed, blood transfusion is discontinued and the blood is returned to the blood bank. img]file:///c:/docume%7e1/dianne/locals%7e1/temp/moz-screenshot-1.jpg[/img]

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