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?

[onarie]

I work on a med/surg telemetry floor. The majority of our patients are elderly and have CHF, CRF, COPD, or some other chronic condition. When we give blood, we use a pump and start it at 75cc/hr. Our policy states that we must stay with the patient for the first 15 minutes of each unit to watch for a reaction. After the first 15 minutes, the rate depends on the patient. I usually do not go over 125cc/hr. We have to be very careful to prevent fluid overload on many of our patients. Also, we don't want to blow that IV site that it took several attempts to start. We have to have the blood infused within 4 hours, and for many of our patient's this is pushing their limit.

My gripe about giving blood - is when I see co-workers go and hang blood and they start the 15 minutes from when they hang it. My 15 minutes starts from the time the blood actually starts going into the person.

[4theBetterGetter, RN]

At the hospital I work at it is policy to start the unit at 300 cc/hr for the first 15 min. Then decrease to run in over 1-4 hrs as the pt condition indicates. Always using caution with the frail, elderly, cardiac and pediatric patient.

[Binkey, BSN]

Wow...

Running a transfusion in at 300cc for the first hour, or 75cc for the first 15 minutes is way to fast according to published standards. Your hemolytic reactions will usually be detected during the first 15 minutes, therefore no more than 30 cc is usually run in during that short 15 minute period.

Diane

[4theBetterGetter, RN]

Binkey said:

Wow...

Running a transfusion in at 300cc for the first hour, or 75cc for the first 15 minutes is way to fast according to published standards. Your hemolytic reactions will usually be detected during the first 15 minutes, therefore no more than 30 cc is usually run in during that short 15 minute period.

Diane

Nooooo not 300 cc for an hour just for the first 15 min. Sorry I was unclear on that.

[Runningnurse]

I think it also depends on whether the patient is a first-time recipient or not. I do run first-timers blood a bit more slowly than our folks who come in and are getting their fifth unit in two days.

I know each unit of blood is different, but in my experience someone "experienced" with transfusions usually does not react as often as a first-timer. Even then the reaction frequency is very low.

Nobody on our unit does anything that isn't approved in our organization's policy and procedure manual (being a newish nurse I have -definitely- checked), so while our rates may go against published guidelines for other institutions, we're well within our bounds at our own hospital. :)

And I know the question wasn't whether the IV can handle the rate but whether the pt can handle the blood...but you might be amazed at what a puny little 20 gauge PIV can handle. Over the past few days I've been running in chemo pre-hydration at close to 500/hr and the IV held up beautifully. (Doesn't mean I was totally happy about running it in that fast, but chemo orders are chemo orders.)

[Danielle RN]

Runningnurse said:

I know each unit of blood is different, but in my experience someone "experienced" with transfusions usually does not react as often as a first-timer. Even then the reaction frequency is very low.

Funny you should mention that.

When I was 23 years old, I was a victim of one of the worst blood transfusion reactions around. I had a Transfusion-Related Acute Lung Injury (TRALI) and it put me on life support. My friend had donated the blood to me for the very first time, and she had a protein that my body didn't like very much. I ended up with non-cardiogenic pulmonary edema and an oxygen sat of 50, before I was intubated. That was March 2000, and it's a miracle that I'm alive today.

Before that time, I never had a transfusion reaction before, aside from the minor hives and low-grade fevers that are common. I had thousands of units of blood before that time, and never thought I would ever have a reaction like that. Ever since then, I treat every one of my (or my patient's) transfusions as if it is my first.

I understand what you mean, though. ?

As for needle gauges, I have used different ones at different times, and they all held up pretty well. I ended up getting two mediports (at seperate times) down the road, which made things easier, but I have since had them removed due to clotting.