"Y" tubing and transfusion reaction

[NYNewGrad]

Maybe this was answered before, but I did a little search here and couldnt find anything.

With regards to using "Y" tubings with blood transfusions and having a bag of NS ready - Purpose of the Y tubing is so that if there's a transfusion reaction, you can quickly just clamp the blood line and open the NS wide. Isnt the pt going to be getting quite a bit more blood b/c the NS is going to first flush the whole existing line's worth of blood into the pt?

On the standard tubings we use, there's a very distal port approx 6 inches from the insertion site that can accomodate a secondary line. Wouldnt it make more sense to setup a secondary gravity set line with NS and attach it to this distal port, so that if there's a transfusion reaction you're only clearing a few cc of blood from the line, as opposed to 10x that amount with using the Y tubing? (I hope I'm making myself clear here...)

I asked some nurses on my unit and they kind of shrugged, saying I guess that would make sense... I guess my real question is whats the use of the special Y tubing if a secondary line primed with NS and attached to the distal port can work even better?

Thanks everyone.

[veronica butterfly, ADN, RN]

A much better solution: gather those supplies together and keep them on hand just in case of just such an emergency. Have new saline/tubing on hand whenever you hang blood. You don't have to open them, unless needed.

All it requires is planning for the contingency in advance.

~faith,

Timothy.

I knew someone would say that! haha

[ZASHAGALKA, RN]

I knew someone would say that! haha

Well think it through: infection control aside, do you know how MUCH blood you would have to be spurting into a trashcan, or wherever? Think about standard precautions.

In addition, IF a patient has an allergic reaction to that blood, you could run an entire liter of NS through the line and still be introducing particles of blood that would continue to stoke a reaction. Once that reaction is lit off, ANY amount of continued exposure is going to continue to elicit a reaction response.

So, your idea probably would have infection control implications, standard precaution implications and efficacy implications. A new setup is a better idea.

~faith,

Timothy.

[epiphany]

Someone should call the company making the Y tubing and asked them exactly what they are for.

[veronica butterfly, ADN, RN]

Well think it through: infection control aside, do you know how MUCH blood you would have to be spurting into a trashcan, or wherever? Think about standard precautions.

In addition, IF a patient has an allergic reaction to that blood, you could run an entire liter of NS through the line and still be introducing particles of blood that would continue to stoke a reaction. Once that reaction is lit off, ANY amount of continued exposure is going to continue to elicit a reaction response.

So, your idea probably would have infection control implications, standard precaution implications and efficacy implications. A new setup is a better idea.

~faith,

Timothy.

Thank you! Your advice is awesome, as a fairly new nurse, I so appreciate it.

Shelly

[Jaysie1]

That ns is for priming the line prior to blood administration and to clear the line after the blood bag is empty so that the patient gets all the blood from the unit instead of throwing away all the blood in the line.

Finally, the answer I was looking for! Thanks, I was scratching my head trying to figure out why a Y-tubing was necessary. I'm still not clear on why you couldn't attach a small bag of NSS as a secondary to flush the tubing (especially if NSS is not required to prime the tubing), but I suppose this saves the step later.

Thank you.

[sameasalways, ASN, RN]

At our hospital we don't use Y tubing..I graduated 2 years ago and since this is the only hospital I have worked out I can honestly say I have never used "Y-tubing" to give blood... we use our IV pumps and a PALL filter. The blood is hung as secondary with a 250 cc bag of NS as the primary. We set the IV pumps to do 120 cc/hr for 30 cc as the volume. That takes about 15 minutes. We take the vitals. If the patient has a slight elevation in temp, we give tylenol. Then continue the transfusion at 180 cc/hr to 185/cc hr if no history of CHF. We set the primary bag of NS to flush at the same rate for 30 cc after the blood runs through so that the pt gets all the blood in the tubing. Then we take a final set of vitals. Almost everyone I have given blood to starts to get a slight temperature. If the temperature has a rise of over 2 degrees at our facility it is considered a transfusion reaction.