Blood administration policy

[nickola]

My husband was recently a patient in an east coast hospital and the RN was going to give him packed cells through a 22g IV. My husband's father (a CRNA) asked her to get anesthesia to insert an 18g IV - she refused, stating "they don't like to do that". She looked for another vein- w/out even applying a tourniquet- my husband ultimately refused the blood. She became very snippy & stated they gave blood via 22g IVs "all the time & never had a problem". (maybe b/c SHE wasn't the patient!) This nurse was the charge nurse & she clearly was not comfortble finding an IV on him. I live and work on the west coast & our policy at my facility is nothing smaller than a 20g IV for packed cells, but preferably an 18g. Occ. we do call anesthesia to start a large bore IV to facilitate this. I am wondering, what is the policy in other east coast hospitals? My understanding is that a small guage IV destroys cells.

[Really An Actress]

We recently had an inservice where we learned that 22 gauges were perfectly acceptable for administering blood, and in most cases so was a 24 gauge. Still, I can't resist the urge to start a larger bore IV just so I can infuse it faster.

[Tweety, BSN, RN]

Also noteworthy is that CRNA's,(and ER nurses, and paramedics) rarely, if every start 22 g IVs, so it's a very foreign concept to them that they are even in use, much less acceptable for a non-critical blood transfusion.

[sharann, BSN, RN]

In a non-trauma situation it is preferred to use a 20G or larger, BUT in the event of a hard stick or lack of resources to start a new one a 22G is just fine for PC's and FFP or plasma. We don't give whole blood in our area(never seen it in 4 years) but routinely give packed cells. We tend to get hung up on a number without empirical evidence to back it up. Sure an 18g runs faster, but when you have a 22 that works fine, use it.

[Burnt Out, ASN, RN]

Our policy states a 20 guage or less, but there is an exception clause for elderly and peds patients. We will look and try to insert a 20 guage, but we have used a 22 many times without problems.

[gobblers]

I have always worked in ICU so we wanted large bore lines to get blood through in rapidly; however, I have questioned the policy of all blood having to be placed in a 20ga or larger iv catheter. The rbc goes through the capillary bed single file and at times compressed.

[military spouse]

We can only use a 22g. with a physician's order. Anesthesia would never come start an IV for us:madface: I would be terrified to let one of our regular Docs try to start an IV........they probably haven't done it since med school. Usually if we absolutely can't get anything, the Docs will insert a CVL.

[homesteadlite]

Glad I was able to access this link at work, because someone just asked me if they could give blood thru a 20-gauge Huber needle, I told them yes, I thought so, used to use 22/24 g on neonates all the time without a 2nd thought, but could someone more experienced with Huber's than me reassure me I told her it was o.k.? Not sure why there would be a difference - maybe you could explain why, if there is. Thanks!