transfusion ??'s and other iv ??'s

  1. hi everyone, i hope some of the nurses with experience in transfusions can help me with some general questions. i always fell all-thumbs around transfusions and hope i can get more comfortable soon. i've been a nurse actively for 3 years, but not fully on medical-surgical so at times feel nervous. please give me some guidance...thank you!

    1) lets say there is only one iv in place for transfusion, can you use the same line for both blood and platelets (i mean, infusing one product and then the next once the line has been flushed with saline)? and say for example after these transfuse, and you get an order to give albumin, can you use that same iv site? i know this is theoretical but, could one use that same site for ivig??

    and what about, is it possible to run blood and platelets at the same time using the y tubing? so for example, instead of blood and n/s, blood and platelets would be infusing, and another bag of saline in a minibag hanging on it's own? i'm sorry if this sounds off the wall but i really don't know! and

    2) if you have only one line and a continous iv med going in (say for example pantoloc drip on penecillin G drip going slowly) and then get an order to give blood would you stop those infusions to use it for the blood and then restart those infusions later, or would you put in another line??

    3) continuing with question 2, say you have to give blood as well as other infusions, could you use the same iv site with a y-connector or with a 3-way connector (i have seen saline locks converted to these types). how do would i know i can safely infuse blood as well as another infusion Y-d into the same site?? for example, i just know you cant have blood contact any solution with calcium, but what about others?

    ------------

    i also wanted to know about heparin and what to do?? so for example if a person was on n/s at 100 cc/hr and then you are required to start heparin line but only have one iv site what is the best set up in this case and how best to set up the pump. for example i have noticed that heparin is usually always set as the SECONDARY at whatever rate, say 18cc/hr, and then n/s as the primary at say 30cc/hr (like a carrier); and then the n/s on its own pump at 100cc/hr into a separate iv site. is this the best way?? or would it be better just to have the heparin going at 18cc/hr and have the n/s going at 100cc/hr y'd into the lowest port? i am very confused about this.

    another burning question--what exactly is an i.v. loop connector and how do you use it?? ive never seen them used actually on my floor but theres tons in the supply area--they don't screw into the luer lock and both ends of the u-shape are female (one bigger, one smaller)

    thank you for any help you can give me to clear the confusion...it's like what you get in the book is totally different from the real world!
    •  
  2. 6 Comments

  3. by   ritarunningfeet
    check you hospital policies of course. But my experiance is that blood and blood products are dedicated lines as far as when infusing, you cannot y meds or other products in. Of course to run things one at a time with a saline flush in the middle is perfectly acceptable. If you have a continous drip running, you either stop it if it is something that you can, but if it is something like a pressor, sedative or something that you just can't stop for an infusion, you will need a 2nd iv. About the heparin and saline, the way I do it is the saline on one pump and the heparin on another pump, y'd in at the lowest port. I hope this is helpful, of course like I said check your hospital policies first.
  4. by   Binkey
    Dayshiftnurse,
    #1- As long as your not needing to infuse that blood in a short time frame, you can infuse it via a 22g 1" IV catheter over a three to four hour time frame. Then, that same line can be used to administer plts or albumin after line flushing. And, as long as that line is still patent, an IVIG infusion can be given after that. Running Blood and Plts at the same time into different lines can create a fluid overload problem for some (the very old and very young are most susceptible).
    #2 - If a medication was such that it could not be discontinued - ie Heparin gtt - then a second line should be placed to infuse the blood. If however, it is a maintenance fluid that can be stopped, stop it, disconnect the maintenance fluid and place a sterile end cap onto its tip, flush the line and then connect the IV catheter to your preprimed NS "Y" set and blood component.
    #3 - NS should be the only carrier to be used with blood. No other medication or solution is appropriate. (Dedicated line)
    In addition, there may be no right or wrong re. the primary or secondary scenario. Can a Heparin gtt infuse by itself without a mainline? Of course it can. If however, a heparin gtt is ordered as well as a liter of saline at its own rate, your main concern is compatibility. Then, do you have a pump that will allow you to infuse two medications simultaneously, or does one medication stop while the other infuses? If compatibility is not an issue, and your pump is a dual chamber (or allows for multiple infusions) they can both infuse at the same time.
    Can that IV catheter accept the flow rate of both infusions together? The answer to that is usually yes... A 22g IV catheter can handle a flow rate of approx. 2L an hour (35mls/min)

    As far as the slip-lock, or non-leur-lock ext set goes.. Don't use it!
    Yes, you always want an ext set on your IV catheters, but they need to be leur-lock in nature. ie. they need to be the kind that has a male fitting, which then goes into the female and screws into place.

    Hope this helps..DD
  5. by   dayshiftnurse
    thank you very much for the help...i am going to print out these responses and keep them with me on the floor, because that's when i get nervous about what to do and then just end up doing nothing and asking for help, or rather, asking that someone else do the set up for me. i end up feeling handicapped and really want to get past that. thank you!!
  6. by   truern
    Dayshiftnurse, I'm on a telemetry floor, and of course our policy may differ from some, but we always make heparin/cardizem/etc our primary infusion with maintenance fluids running secondary. Please check your facility's p/p.
  7. by   burn out
    Blood goes by itself...never another unit or blood product can go with it. If the pateint were to have a reaction you wouldn't know to which one. Also check with your hospital ..where I work you can not transfuse through anything less than a 20g. cath.

    DON'T BE AFRAID TO START NEW IV SITES.
  8. by   Daytonite
    yes, you can use the same iv site for blood and platelet transfusions. you shouldn't be mixing any blood products or infusing them through the same iv tubing at the same time because of potential incompatibilities. remember that these products are coming from different donors and you shouldn't ever be mixing blood products yourself. that's something for the blood bank to do! however, the blood bank shouldn't be giving you a unit of blood and a unit(s) of platelets at the same time anyway.

    if you have a patient that has a continuous iv med and you have an order for a blood transfusion, you should start a second peripheral iv site to run the blood. this also allows you to place a larger bore needle for the transfusion so the blood can infuse nicely without problems. that way, you can continue the infusion of the medication. once the blood transfusion is completed, heparin lock or saline lock the iv access you used for the transfusion.

    once blood or a blood product has completed it's infusion you should remove the iv tubing immediately and replace it with standard iv tubing to keep the vein open or saline lock it. that's just good nursing practice. old iv tubing with microscopic blood cells hanging out in it (that you can't see) is a medium for bacterial growth. i don't like the idea of 3-way connectors and stopcocks on iv tubings for the same reason. in addition to being harborers of bacteria, they create confusion as to what you have infusing and it's very easy to get iv lines crossed up and confused. iv infusions not in use should be disconnected from iv lines and capped off. you might want to talk to the other nurses on the unit and find out who sets these iv lines up like this and why they are doing it. i have no problem removing all that crap from an iv line if it's getting in my way.

    as always, if you are ever in doubt, call the doctor to clarify what he wants done. i worked on an iv team for many years and we frequently placed second iv lines in people for blood transfusions. in addition, you should be pulling out your policy and procedure manual and looking through the hospital policy on blood transfusions and ivs. always use your facility policy and procedures as a guide. if you find a policy there that tells you to change the iv tubing after each unit of blood transfused, then do it and document that you are doing it. you should also have a nursing educator, or another nurse fulfilling that role, available to ask questions of about these things if you are having trouble finding these resources. part of their job is making sure staff nurses know the hospital policies and procedures that relate to things like this. somebody tells new orienting nurses these things.

    the reason heparin is often set up as a piggyback into a main iv line is so it can be removed or stopped immediately if necessary. a large amount of heparin may be mixed in a small amount of fluid to reserve the amount of fluid the patient is receiving. meanwhile, the doctor may also have an order for the patient to be receiving a main iv fluid infusion of something else. to save the patient from having two iv sites, the heparin can be piggybacked into a flush line which is then piggybacked into the main iv fluid line. if for some reason the heparin needs to be stopped for a few hours, it can be done easily this way. as i mentioned above, the heparin flush line should be removed from the main iv and capped off when the heparin infusion is stopped.

    it sounds like the iv loop connectors you have on your floor are something for very specific use. call someone in central supply and ask them what these things are used for. they may be an older item that no longer have any useful value and should be considered removed from floor stock. this is something your nurse manager has control over. my guess: some doctor at one time had some special type of tubing he liked to use and wanted this particular item available. he's long gone, the staff has changed, and now no one knows what this piece of tubing is used for.

close