hanging blood with the wrong fluids

[newnurse012]

last night was a crazy night on a busy med-surg floor. i work 2nd shift and hung a unit of blood half an hour before my shift ended. they called me today to inform me that i hung the blood with the pt's ordered fluids of d51/2nss. i realize that this is an error as blood is only to be hung with nss. i am curious how serious of an error it is though. i hung the blood at 10:30pm, and the next shift came on at 11pm. the blood completed infusion at 1:30am the next morning. i am hoping they noticed and switched it to nss before the blood completed infusion. any input would be greatly appreciated.

[fiveofpeep]

I dont know exactly what would happen, but the reason we use NS is because it is isotonic. RBCs may lyse d/t extremes in osmolality such as with hypotonic or hypertonic solutions. RBC lysis can cause hyperkalemia and defeats the purpose of the transfusion.

not sure if all that actually happens with D51/2NS tho.

[brownbook]

Hi, sorry you had a busy crazy shift. Sounds awful.

However hanging blood incorrectly can be DEADLY. I know you were trying to get things done, not leave stuff for the next shift. Do not let yourself be rushed. If your giving a "dangerous" IV drug, digitalis, insulin, potassium, blood, etc., you have to slow down, or even say to yourself or charge nurse. I can't do this, I am way to busy and don't have time to do this safely!!! This is why nursing in a hospital is a 24/7 shift. Let the next shift do it!

There will be times when doing nothing for the patient is the better treatment than doing something rushed or you are not sure of.

My quick Google search came up with, 5% dextrose can hemolyze the cells, and solutions with calcium, (lactated ringers), can cause clots to form in the blood.

[Reno1978, BSN, RN]

Although it isn't required, part of the 2 RN double-check to make sure you're giving the right blood product to the right patient should also include whether or not it's being hung with the right fluid. If I'm cosigning someone's blood transfusion, I make sure it's going up with NS.

[Emergency RN]

the problem you're facing here is one of degrees. sure it is bad, but not as bad as hanging blood with d5 alone. will you get cell hemolysis? yes, but not to the degree that you would had there been no saline at all. that said, the amount of actually hemolyzed blood was probably small. here's why; generally, when blood is running, the regular ivf ns that runs with it is shut off. so, the blood likely only came in contact with the hypotonic solution at the very beginning and very end of the infusion. that is, the bulk of the unit was probably not affected by the mistake. also, any clots that may have formed in the line were probably trapped by the in line filter where the blood first came into contact with the wrong solution.

but make no mistake about it, this was a huge mistake.

there are times when you need to do what i call "personal time outs" to ensure that what you're doing is correct. just like when you get into a car, the first thing you check is make sure you have your seat belt on, adjust your mirrors, seat, and windows... all before you start the car. at least, that's the way it is with me. after a period, it becomes second nature to the point that you won't even think about it, you just do it. for transfusions, besides checking for the order, consent, and the five rights on the patient, you need to also check the entire iv, from infusion site back up to the bag before you even start to check the blood.

i'm sure that we don't need to berate you on this, as you're probably already pounding your head into a wall over this already. but, like they say, painful lessons are sometimes the best teachers. just be thankful that the patient didn't suffer any long term harm from it.

good luck.

[classicdame, MSN, EdD]

Dextrose is sugar. Sugar is what we put in water to make syrup. Dextrose can cause fatal reactions when hung with blood.

[pinkpig]

i know prbc lyses with D5W but what about platelets???

[merlee]

I don't understand how this happened. Don't you have special blood tubing, Y-shaped, for hanging both the blood and the NS together? One does not usually just piggy-back blood products into an existing line.

[ChristineN, BSN, RN]

Well I will say that for the first year I was a nurse I was oblivious to the fact that you were only supposed to hang blood with NS. See, the facility I worked at would routinely hang our PCA's and their carrying fluid with the blood product. I was shocked when I switched jobs and found out how dangerous such a practice could be. So that being said, I never had anything bad reactions while hanging D5 or even D5 1/2NS along with the blood, so my guess is it's probably a very, very, small risk.

[Zaphod, BSN, RN]

Not as bad as hanging blood with heparin:) Seen that one. Patient had no adverse reaction. It happens but do be extra vigilant when hanging blood.

[headinsandRN]

Sorry. This can't be watered down OP....you were aiming for a sentinel event with this one.

Learn from this and do not make that mistake again for any reason you can think of.

[newnurse012]

I don't understand how this happened. Don't you have special blood tubing, Y-shaped, for hanging both the blood and the NS together? One does not usually just piggy-back blood products into an existing line.

i suppose all facilities and their supplies differ. we do have special blood tubing, which was used... it is not y-shaped but it does enable the blood to be piggy-backed into an existing line of nss. unfortunately, nss was not the existing line in this particular case though. thankfully the patient's h&h came up after the transfusion and the patient is doing fine. i have learned from my mistake though, after pounding my head into a wall for a few hours. thanks for the input!