Blood transfusions-how fast do you go?

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    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??? That's my usual tendency, by the way (not always a bad thing). ;-)
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    I usually run it over 3 hours. Most of the time, I start it at 100ml/hr, then bump it up to 125/hr if tol well after first 15 minutes. If the pt is a CHFer or renal compromised, I usually don't go much more than 100/hr. Take it easy on the elderly and frail. I have run it at 150/hr for surgery pt's who don't have additional med probs. Those people your talking about can either be patient, or they can just go to "the clinic" everytime they need blood. You are right on the money! Transfusions are nothing to take lightly.
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    I am a bit paranoid about running blood. I start out at 50cc/hr for 15 min, then bump to 75, then 100, then 125. I don't go above 125 unless they are young and healthy. Then I go to 150. It usually takes me 3.5 hours to get in one unit. Not really a problem though since it is night shift that I work and the patients aren't in a hurry to go anywhere at that time.
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    I usually started transfusions at 75ml/hr for the first 15 minutes, then bumped it up to 100-125 if the patient's vital signs were stable and their lungs remained clear (or didn't worsen if they'd had some crackles to start with). A lot depended on the patient's age, weight, and general health---I'd transfuse a unit in a younger patient with few other medical problems over 2 hours, while a unit going a frail elderly pt. with CHF history would take the full 4 hours. I was also very anal about staying with the patient for those first 15 minutes or so---I caught more than one transfusion reaction that way, and was able to stop it before things got out of hand.

    I just don't think you can be too conservative with blood transfusions, unless of course it's an emergency situation where it's pouring out faster than you can run it in, and that's not something you deal with on med/surg very often (thank Heavens!).
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    It depends on the situation. I have run it in on a trauma patient at 250/hr-- but that is not common
    Sometinmes we will go 4/hr sometimes 2/hr---just depends on the patient and the dituation.
  8. 0
    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. :spin: 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.
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    I usually start all transfusions at 100ml/hr for 15-30 min. If patient is tolerating well or if they already have orders for pre-treatment or lasix between units i usually wont go over 125ml/hr. If they are young, they can usually tolerate 150ml/hr without difficulty.
    I used to have a patient that would come in for transfusion on a regular basis. He dictated how fast he wanted it to go and thats how i gave it. He knew exactly how long he had to "waste" in there getting transfused and he wanted OUT when he wanted out. He used to like me because i didnt make the wait between units a big deal, i usually had the second up and ready to hang when the first one was done. Very picky, but he liked me so always asked for me to give his transfusions. I kind a miss him.
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    Personally I have ran a unit in as fast as it could be squeezed in, a matter of 2-3 minutes on trauma patients. I have heard as long as several hours when a unit is split by the blood bank and each portion over the maximum 4 hour out time.

    Rj
  11. 0
    Quote from kona2
    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??? That's my usual tendency, by the way (not always a bad thing). ;-)

    Hi Kona. 150 ml/hr is not that fast even for a blood transfusion. I used to run blood transfusions in 2 hours, that is perfectly acceptable. I wouldn't be too put out by the patients' being rude, especially as they are oncology patients they probably spend a lot of time at doctors' offices and in hospitals and they probably get pretty sick of it. Now the real reason is why are they admitting patients to the floor for the sole purpose of getting blood transfusions, that sounds mighty inefficient to me.
  12. 0
    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?


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