"Y" tubing and transfusion reaction

[NYNewGrad]

Maybe this was answered before, but I did a little search here and couldnt find anything.

With regards to using "Y" tubings with blood transfusions and having a bag of NS ready - Purpose of the Y tubing is so that if there's a transfusion reaction, you can quickly just clamp the blood line and open the NS wide. Isnt the pt going to be getting quite a bit more blood b/c the NS is going to first flush the whole existing line's worth of blood into the pt?

On the standard tubings we use, there's a very distal port approx 6 inches from the insertion site that can accomodate a secondary line. Wouldnt it make more sense to setup a secondary gravity set line with NS and attach it to this distal port, so that if there's a transfusion reaction you're only clearing a few cc of blood from the line, as opposed to 10x that amount with using the Y tubing? (I hope I'm making myself clear here...)

I asked some nurses on my unit and they kind of shrugged, saying I guess that would make sense... I guess my real question is whats the use of the special Y tubing if a secondary line primed with NS and attached to the distal port can work even better?

Thanks everyone.

[gitterbug]

When we hang blood, we do use the "Y" tubing but always have a bag of NSS primed and ready to hang in case of reaction. I and every other nurse I have ever worked with, stop the infusion and hang the NSS at the hub of the IV site. This means new tubing without blood is infusing NSS in a matter of seconds. Once or twice a physician has ordered a new IV site and everything, even the intercath, is sent to the lab for testing.

[Mulan]

Funny how this thread was revived...

Either way, my original question still stands. You write that you attach NS with primed tubing to the nearest port in case of reaction. Logically, thats how I agree it should be.

However,with the standard blood Y tubing that we use, the bag of NS and the blood come together at the top of the tubing, which means they share a several feet of common tubing. In case of reaction, when you open the bag of saline which is connected at the top, you'd still be infusing all that tubing with the blood inside.

I still think you'd be safer just piggybacking the NS to the port closest to the pt...

===========

[ZASHAGALKA, RN]

The y-tubing is essentially a filter and flush for a non-reaction, routine transfusion.

At the moment of suspected reaction, the whole deal should come down and a new bag of saline and tubing should go up. It's an easy matter to keep an unopened bag of NS and tubing handy for such an event.

Including the filter, there is something like 30 ml of blood in that line: using the saline upstream as a 'flush' is not appropriate for a reaction event.

In fact, you could have a new bag/tubing up and running in most cases long before the upstream NS from the y-tubing started to reach the pt.

Don't think of y-tubing as a practical solution for reactions: the device isn't designed for reactions and such reactions require immediate cessation of blood delivery.

~faith,

Timothy.

[Mulan]

Agree with the above, and maybe you should speak with the appropriate people at your facility to make sure that everyone understands and is doing it correctly.

[faygoc]

Thanks to all who've responded to this "revived" thread. I totally understand the rationale behind taking down all tubing, etc. in the event of a reaction...it's academic that you don't want ANY add'l blood infusing in this case.

The second part of my original question still remains, however. In the case of an UNEVENTFUL infusing (i.e. no untoward reactions whatsoever), what is the reason behind NOT having the infusion set up so that the NS AUTOMATICALLY starts as soon as the blood is finished? The only rationale I've been given for this has come from more than one practicing RN; they've said that that the reason is to specifically force the RN monitoring the infusion to be in the room at the exact moment the blood has finished running; i.e. a forced "safety" precaution. To me, this makes no sense whatsoever. While I recognize that it would be ideal for the RN to be in the room when the blood stops infusing so that he/she can personally flush with NS and DC the infusion, this seems highly unlikely in real practice when you have many patients. Rather than run the risk of the site clotting off because the RN isn't in the room when it stops, I don't understand why an NS piggyback can't automatically initiate at a KVO rate once the blood is infused.

Am I totally off-base??? HELP!!!

[rita359]

Maybe this was answered before, but I did a little search here and couldnt find anything.

With regards to using "Y" tubings with blood transfusions and having a bag of NS ready - Purpose of the Y tubing is so that if there's a transfusion reaction, you can quickly just clamp the blood line and open the NS wide. Isnt the pt going to be getting quite a bit more blood b/c the NS is going to first flush the whole existing line's worth of blood into the pt?

On the standard tubings we use, there's a very distal port approx 6 inches from the insertion site that can accomodate a secondary line. Wouldnt it make more sense to setup a secondary gravity set line with NS and attach it to this distal port, so that if there's a transfusion reaction you're only clearing a few cc of blood from the line, as opposed to 10x that amount with using the Y tubing? (I hope I'm making myself clear here...)

I asked some nurses on my unit and they kind of shrugged, saying I guess that would make sense... I guess my real question is whats the use of the special Y tubing if a secondary line primed with NS and attached to the distal port can work even better?

Thanks everyone.

Never use the ns on the blood set to administer for a transfusion reaction.

That ns is for priming the line prior to blood administration and to clear the line after the blood bag is empty so that the patient gets all the blood from the unit instead of throwing away all the blood in the line. If the patien has a transfusion reaction disconnect the transfusion line at the angiocath and set up new line with ns.

[PamRNC]

the second part of my original question still remains, however. in the case of an uneventful infusing (i.e. no untoward reactions whatsoever), what is the reason behind not having the infusion set up so that the ns automatically starts as soon as the blood is finished? .... rather than run the risk of the site clotting off because the rn isn't in the room when it stops, i don't understand why an ns piggyback can't automatically initiate at a kvo rate once the blood is infused.

physics & available technology...

the y tubing is roller clamped directly under the blood bag and ns bag, it also cannot be used with an iv pump which may lyse the rbcs. if you do need the blood to go through a rapid infuser or warming pump, i think that may require different tubing. to my knowledge at this time there are no iv pumps or contraptions that can automatically open a roller clamp.

also, if you are setting up the blood with the y tubing piggy-backed into the lowest port of a ns mainline, again that line will be roller clamped, and not running, so even if you did set it up on an iv pump the pump cannot turn itself on. the blood will back up in this kind of set-up to the point were the tubing is roller clamped, so you can't leave the roller clamp open or the iv pump running.

blood and iv fluid are going to take the path of least resistance, which usually means going up the tubing vs down into the vein.

nursing to do for s/p blood transfusion...

check iv site, auscultate lung sounds, assess patient's vital signs, color, breathing, mental status, pain level, etc. these really need to be done in person.

nursing considerations...

not all patients really need to have any extra fluids infused after receiving blood, especially chf, esrd and the confused.

[Mulan]

There is a lot of misinformation on this site, people posting "absolutes" about different things.

For instance, there are some iv pumps that it is safe to run blood through, it's done all the time.

[augigi, CNS]

That's why you take your advice from literature or official sources, and not the internet :)

[chenoaspirit, ASN, RN]

Ya know, I have ALWAYS wondered the EXACT SAME THING. I even asked nurses on our floor and they had no idea either.

[veronica butterfly, ADN, RN]

Graduated six months, working as a RN in med/surg. Wondered the same thing about that last amount of blood running through tubing.

Wondering.... and I realize not probably good infection control..... can you clamp the blood line, unhook the tubing from the patient's arm, open the saline and clear the blood out of the tubing, and then quickly rehook up tubing to patient with saline running.

I'm trying to think of ways to save time, and stay with patient. If I have to leave pt to go find new tubing, it's a long hallway, supplies may not be stocked, etc., etc., it may be 10 minutes before I get back to room.

[ZASHAGALKA, RN]

Graduated six months, working as a RN in med/surg. Wondered the same thing about that last amount of blood running through tubing.

Wondering.... and I realize not probably good infection control..... can you clamp the blood line, unhook the tubing from the patient's arm, open the saline and clear the blood out of the tubing, and then quickly rehook up tubing to patient with saline running.

I'm trying to think of ways to save time, and stay with patient. If I have to leave pt to go find new tubing, it's a long hallway, supplies may not be stocked, etc., etc., it may be 10 minutes before I get back to room.

A much better solution: gather those supplies together and keep them on hand just in case of just such an emergency. Have new saline/tubing on hand whenever you hang blood. You don't have to open them, unless needed.

All it requires is planning for the contingency in advance.

~faith,

Timothy.