Blood Transfusions: How fast do you go?

We get a lot of blood transfusion patients to our med/surg floor. Many are coming in just for the blood and then D/C. In fact, some are complaining that on our unit, we run the blood in too slow, as they get each unit over 2 hours at "the other outpatient clinic." Assuming a unit is about 300 ml, that's 150ml/hr! Most of the time the docs are not writing in how fast to give the blood, so it is at the RN's discretion.

I am uncomfortable with 150ml/hr, unless the MD says it's okay to run it in fast. Am I just old school or what?

I start out at 70ml/hr for 1st half hour, and if pt tol well and vitals okay, etc., bump up the rate after that. If they are elderly, I don't like to go above 100ml/hr.

For the younger folks, I will run at 125/hr if tol well. This is of course, a non issue for inpatient transfusions, as they are already staying the night. But I am getting grief from these outpatient type transfusion patients...who want to go home immediately!  Some are quite rude, too. Many are oncology patients. I am only trying to be safe and not dump in fluids too fast.

By the way, I checked our facilities P&P and they say to run it in under 4 hours. 3 hours seems about right to me. It can take a long time if they are getting 3 units. Just curious if I am being over-protective?

[Runningnurse]

I work in oncology, with many elderly patients. That said, we normally run our blood over 2 hours.

We run all PRBCs on a pump, same with plasma. Sometimes platelets are run straight in, but usually on a pump just for good measure.

We stay with the pt for the first 5 minutes, come back and check vitals at 15 minutes, then they're good to go.

We generally give 2 units at a time, so sometimes folks will run the first unit in over an hour and 45 minutes, then use the same tubing for the second unit, since tubing is good for 4 hours.

Depending on the patient and the IV, I'll sometimes run the saline in at 300 just to get the blood to the patient, then slow it back down to 175 or so.

[caroladybelle, BSN, RN]

As a hemo/onco traveler, it varies a great deal from place to place.

First, hemo/onco gives a lot of blood products, TPN, antibiotics, chemo and cardiac drips. When you have limited lines, multiple drugs and some meds that cannot be run within an hour or two of blood products, you have to work fast and efficient. Second, I am usually on a BMT and/or biologic unit, so it tends to be staffed better (hopefully, but not always!) than standard med surg units, with more monitoring.

Most places will run PRBCs on a pump. Some prefer that FFP and Platelets be run free by gravity, though a few permit pumps. Most want cryopricipitate run by gravity. And for the few places that transfuse granulocytes....they must ALWAYS be gravity hung, especially since you have to invert/agitate the bag and chamber every 5-15 minutes.

That said, PRBCs are run over 2-3hours, Platelets over 30-60 minutes, FFP 30-60 minutes, and Granulocytes (if well tolerated) over 1-2 hours. With CHFers/high risk for fluid overload patients, they will probably be getting lasix with the infusion, as they will be getting a lot of fluid from all their IVs, not just the blood products. They will also get blood premeds if records indicate the need.

[Danielle RN]

Hi all,

I'm one of those "lucky" ones to have experience on both sides of the fence, being a nurse and a patient.

I was born with Cooley's Anemia, so I've been getting blood transfusions every 2-3 weeks since I was 9 months old. I don't make my own hemoglobin, so I must get it from others.

I could never imagine getting a unit of blood over 4 hours. That would be agony for me, since I need to get two units each time I'm at the hospital. I understand as a nurse that blood shouldn't be pushed quickly but, trust me, two hours is more than enough for a unit of blood for a healthy person, unless the unit is abnormally large (400+ml).

This is a way of life for many people, like myself, and it's very hard to live a normal life when you spend so much time at the hospital. Therefore, I think it should be taken into consideration the amount of time you are giving the transfusions over. Not only is it time consuming when you give a unit of blood over 3 or 4 hours, but the blood is also in danger of going bad or developing clots.

This is only my opinion, and I'm giving it from both sides of the spectrum. A normal unit of blood is usually between 275 and 325 ml, and I wouldn't have a problem giving a patient a unit of that size over 2 hours. As a matter of fact, the hospital that I used to go to for blood always tried to push my units in an hour and a half, and I always made them put it over two hours instead. So, I'm actually giving it more time than many nurses do here in New York. I don't like getting blood over 1.5 hrs, unless it's a really small bag. Otherwise, I end up with tachycardia and tachypnea.

I don't mean to step on anyones toes. I just thought you might want to hear a patient's point of view on this. :)

[Genista, BSN, RN]

Thanks for the replies. Most of these folks are oncology patients age 70 and up. Very rare do we see young folks or those with few medical problems. I'm glad I'm not the only cautious RN on the planet! LOL. It's just that I have been hearing so many complaints from the actual patients lately, that I was beginning to question my own judgement.

[Chaya, ASN, RN]

One of the places I work at runs blood by pump only and over 4 hours.

The other never uses a pump for blood and runs it in 3 hours.

I'm not sure if you can run it faster with a PICC/central line or if a faster rate makes hemolysis more likely?

[Chaya, ASN, RN]

I'd like to know if blood is commonly run on an infusion pump at most places? Or do you just hang it to gravity and regulate the drip?

[Thunderwolf, MSN, RN]

We use pumps.

[JennInColumbus]

Good question, I find the different answers/policies & procedures interesting. I guess I expected more uniform answers since evidenced based practice is in our faces at every opportunity :)

At our hospital (I'm in the SICU) we do everything from 3 minutes per unit on a rapid infuser in emergencies to 20 minutes or so off pump with a pressure bag with unstable fresh hearts. For someone who is not critical but needs blood to correct labs, we run them in at less than four hours, as policy is that the blood must be disposed of at the four hour mark.

[rjflyn, ASN, RN]

As far as pump use goes it depends on the pumps the hospital uses. I have worked in a couple facilities that their pumps were not to be used for blood.

[Joni's Mom]

I'm new here. Just to let you know that when my mother was given blood the nurse on shift had squeezed the bag just to finish it up. My father and I felt that this was wrong but we never said anything to anyone about it. Now I wish I would have.

[grinnurse, RN]

One of the nurses on my floor will start out slow and then zip it up to 185 even if they are elderly as long as they don't have CHF problems. Myself, I start slow and don't go over 125 regardless and I always stay with my patients the 1st 15 minutes! I can't imagine not being right at the bedside while transfusing blood.

[Tweety, BSN, RN]

Chaya said:

One of the places I work at runs blood by pump only and over 4 hours.

The other never uses a pump for blood and runs it in 3 hours.

I'm not sure if you can run it faster with a PICC/central line or if a faster rate makes hemolysis more likely?

We used to never use pumps, it wasn't alllowed. They changed their policy and it's fun to hear new nurses look at me aghast "I WOULD NEVER RUN BLOOD WITHOUT A PUMP, HOW UNSAFE". This happened to me just the other day in fact. Well, I never have infilrations giving blood. wink. Actually, I like using pumps, gives you more control, but in our cheap unit we don't always have pumps available.