Administering PRBC's -alone or with NS?

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My hospital does not have a specific policy in regards to this aspect of blood administration. I have seen nurses here do both. How do you administer blood - alone or with Normal Saline?

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In hospitals that I've worked at blood products are always set up with Y tubing so that saline is available in case of a transfusion reaction and to sit in the drip chamber over the filter to prevent lysis of the blood products. The tubing and drip chamber are primed with normal saline, but it is clamped off while the blood runs.

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Do you mean with NS mixed into the PC's? I don't mix the two. Just run or squeeze them in as is. Some might argue that mixing in a little NS thins the blood out a little bit and makes transfusion a little easier, which may be so, I just don't do that because it adds more volume that I'd prefer the patient not get.

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I meant running the NS as primary and the blood as a secondary as opposed to running the blood alone as the primary. I have always ran the blood with NS, but the other day my transfusion was not going in, and another RN suggested I run the blood alone, as that was how she always did it.

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I meant running the NS as primary and the blood as a secondary as opposed to running the blood alone as the primary. I have always ran the blood with NS, but the other day my transfusion was not going in, and another RN suggested I run the blood alone, as that was how she always did it.

I cannot fathom a facility without a specific policy. PRBC's are administered with specific transfusion tubing. You would start the administration with the NS, clamp that off and administer the PRBC's. Running NS and PRBC's concurrently could increase the likelihood of volume overload.

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Specializes in PICU, Pediatrics, Trauma.

In PICU/Pediatrics, because of strict volume restrictions, we use the y tubing with filter specific for blood...NS on one side, blood on the other. But we.prime with the.blood itself, as opposed.to the NS. When the volume of blood has gone in, we flush the blood line with the NS, or stop there and just use a flush of NS for the line site. However, you do need the NS in line in the event there is a reaction. Wherever you are, you need to follow your hospital's policy.

I just added my 2 cents to show there are slightly different policies and methods depending upon the population you are working with.

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Specializes in PICU.

We use single tubing for blood, no y tubing with NS. If there was a transfusion reaction, you would then take down the entire line, then may need to run NS. If you have the NS connected, increased risk for volume overload, increased risk for infection. I don't think that there is evidence that currently supports having NS with PRBC

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Specializes in ED, OR, Oncology.

I have always used the Y tubing, and frequently hear that the NS is there in case of transfusion reaction, but that makes no sense- if there is a reaction, the whole set is coming down- it would make no sense to continue an infusion with tubing containing ANY of the blood product the patient is reacting to.

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Specializes in PICU, Pediatrics, Trauma.
I have always used the Y tubing, and frequently hear that the NS is there in case of transfusion reaction, but that makes no sense- if there is a reaction, the whole set is coming down- it would make no sense to continue an infusion with tubing containing ANY of the blood product the patient is reacting to.

I agree with how it makes no sense to have the NS side when you have to take down the whole thing. This is why it is important for hospitals to update policies according Evidenced Based practice.

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Specializes in ER, Med-surg.

I've worked at hospitals that mandated Y tubing with NS and hospitals that have no policy and provide both types of blood tubing (Y and single) or switch back and forth in terms of which tubing they supply.

In the case of having Y tubing available or mandated, I prime with NS, then run the blood with NS clamped but flush after the blood with NS to administer the entire blood volume. If only single tubing is available, obviously that's what I use, with no NS.

I have never seen anyone run the blood simultaneous with NS and would be concerned about volume overload in that situation, especially if the patient was getting many units of blood consecutively. If the blood isn't running well, checking the site or establishing better access seems like a better intervention than trying to thin the blood with NS.

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This post and the replies have me so confused? I feel like someone is reinventing the wheel! Hasn't the protocol for hanging PRBC's been pretty well established?

The poster said the transfusion wasn't going in and another nurse said run the blood alone (again confusing...the NS and PRBC were running together at the same time)? Well...anyway if the blood, or any IV fluid is not running, why would changing what you have hanging make the IV work better? Either an IV works or doesn't? The fluid, NS, blood, whatever???? goes in or it doesn't?

Oh...I am still so confused!

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This is the recommended procedure from the Infusion Nurses Society

Procedure

  1. Obtain blood product from the transfusion service.
  2. Perform patient and blood identification process at time of obtaining blood:
    • Verify recipient's 2 independent identifiers, ABO group, and Rh type, if required; donation identification number; crossmatch test interpretation if performed; special transfusion requirements; expiration date/time; and date/time of issue.
    • Inspect each blood component prior to transfusion; do not use if container is not intact or if the appearance is not normal (eg, excessive hemolysis, significant color change in blood bag compared to tubing, presence of floccular material, cloudy appearance), and return it to the transfusion service.

[*]Perform patient and blood identification process at patient bedside using an independent double check by 2 adults in the presence of the patient

  • Verify patient identity using 2 independent patient identifiers and ask the patient to state his or her name, if possible.
  • Verify the blood component
  • Review the LIP's order for transfusion
  • Patient blood-type compatibility with the unit to be transfused
  • Crossmatch test interpretation if performed
  • Donor identification number
  • Unit expiration date/time
  • Any product modification such as irradiation or cytomegalovirus (CMV) seronegative

[*]Prepare to transfuse.

  • Perform hand hygiene.
  • Don gloves.
  • Open blood administration set, and close all clamps.
  • Spike bag of 0.9% sodium chloride with one of the Y-administration set spikes.

  • Hang on IV pole and prime administration set according to manufacturer's directions for use.

  • Attach primed administration set to VAD either directly to catheter hub or to needleless connector after disinfection.

  • Initiate slow infusion of 0.9% sodium chloride solution.

[*]Initiate transfusion.

  • Spike blood component with the other Y-administration set spike; close clamp to sodium chloride container

  • Open clamp and initiate transfusion
  • Start the transfusion slowly at approximately 2 mL per minute for the first 15 minutes, and remain near the patient; increase the transfusion rate if there are no signs of a reaction and to ensure the completion of the unit within 4 hours.

[*]Monitor patient.

  • Check vital signs within 5 to 15 minutes after starting transfusion, after the transfusion, and as needed depending on patient condition.
  • Compare to baseline vital signs to identify any early signs of a transfusion reaction.
  • Observe VAD site.

[*]Stop the transfusion immediately if any signs and symptoms of a transfusion reaction are present; disconnect the blood administration set from the catheter hub. Start a 0.9% sodium chloride infusion with new primed administration set at a keep vein open rate.

  • Notify the LIP and transfusion service, administer emergency medications as prescribed, and obtain prescribed blood sample for additional lab tests as prescribed. Return blood container with remaining blood and set attached to the transfusion service.

[*]Complete red blood cell/platelet transfusion within 4 hours; plasma within 1 hour.

  • Close clamp to blood product upon completion.
  • Open clamp to 0.9% sodium chloride to clear the administration
  • set and VAD of blood.
  • Discard empty blood container and administration set in biohazard container.

[*]Continue to monitor patient as reactions may occur after the completion

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