Blood transfusion and heart failure

[Darknights]

Hi,

We frequently have extremely elderly patients with heart failure and multiple co-morbidities who require blood transfusions. The physician wants the 350ml Packed Cells administered over an hour and doesn't provide an order for frusemide. Is this volume enough to overload an already compromised patient? IF so, what is your standard over in the U.S for duration of transfusion of Packed Cells for such patients.

And, I'd be extremely grateful if someone could tell me why vaccines, heparin, Enoxaparin etc are given via DEEP subcutaneous injection. I can't find the rationale for it to be deep, less pain receptors in the deep tissue????

[Ashley_RN]

We give lasix between infusions for those at risk of being fluid overloaded. If necessary we split the 1u of PRBC to allow the adminsitration of lasix in between. Have you tried asking them their rationale for not doing so? Is this scenerio happening with all your CHF pt's needing transfusions or are you speaking of a specific case?

[Darknights]

This is for every patient, including those with heart failure. The rationale is that there is no reason not to administer the packed cells over one hour. However, when the pt has been admitted with heart failure and were overloaded we are reluctant to give a unit so quickly.

[larniegrl]

I would be very cautious about giving a unit of blood that quickly unless it was in a massive transfusion situation. It is just too much, too fast. I've seen a few older patients go into respiratory distress from a unit of blood transfused faster than 2 hours. I've slowed the transfusion to 2.5 to 4 hours before with a chronically ill/fragile patient. I don't think MD's always look at the whole picture for specific patients.

[Matilda91]

What would be the time frame of the blood transfusion when the blooded is pumped in warm instead of cold on a 91 year old with CHF? How many units would be given?

[Rose_Queen, BSN, MSN, RN]

What would be the time frame of the blood transfusion when the blooded is pumped in warm instead of cold on a 91 year old with CHF?

What is the facility policy/provider order?

How many units would be given?

How many were ordered?