Administration of blood products

jmgrn65, RN · Feb 19, 2008

nativesundance said:
We had quite a debate about the administration of blood products the other night at work which became unusually heated. So I put the question out to all of you...
How fast do you run your prbc's? What type of tubing do you use? What size of angiocath do you run it through? This subject in particular was hotly debated. Stable patient in over 3-4, unstable as fast as you can. Special blood tubing that has it's on filter and so you can run ns with it. At least a 20 is recommended but can run safely 22
how fast do you run your ffp? What type of tubing do you use and through what size angiocath? Do you use a pump? Ffp can ran as fast as you want, still use blood tubing. Pump is optional, same size angio as above
How fast do you run your platelets? What type of tubing do you use and through what size angiocath? Do you use a pump? This subject was also hotly debated. Platelets can just be run in as fast as they will go often just by gravity. Still use blood tubing
Do you feel there is any difference in cell integrity when running your (trauma-emergent) blood in using a pressure bag as opposed to using a rapid infuser/warmer? As long as the vein is good, no problems
It will be interesting to see what some of your opinions might be!!

See my response in red.

crb613, BSN, RN · Feb 19, 2008

jmgrn65 I agree. #2 We usually run them in over 30 mins/pump/blood tubing.

S.T.A.C.E.Y, LPN · Feb 19, 2008

I was told to not use a pump with blood products as most work by squeezing the tube forward which can cause damage to the cells in the tube. Our blood tubing doesn't fit the standard pumps anyways so that point is mute. Our rapid infuser/warmer works under a pressure bag type system. All blood products are run through blood tubing, with NS to flush the line, unless trauma then we can go back to back blood on each port. Best to have an 18g to infuse blood products, but was told it will work with a 22 if needed, 24 if desperate....after all they give blood to neonates with small IVs don't they? (I could be wrong here....) Rationale I was explained is that you can see through a 24g, but RBC are smaller than the eye can see, so it really shouldn't be a problem, unless the line isn't really great any-who. Stable blood goes in usually over 3-4 hours, unless otherwise ordered by the doc. I've heard of some people running it uber-slow to start just in case of allergic rxn, but I've also heard that if you run it so slow the body doesn't have time to react during that first period when you're checking them q15 then you're going to miss the rxn once you speed up the blood and space out your checks.

CritterLover, BSN, RN · Feb 19, 2008

nativesundance said:
We had quite a debate about the administration of blood products the other night at work which became unusually heated. So I put the question out to all of you...
How fast do you run your prbc's? What type of tubing do you use? What size of angiocath do you run it through? This subject in particular was hotly debated. Stable patient in over 3-4, unstable as fast as you can. Special blood tubing that has it's on filter and so you can run ns with it. At least a 20 is recommended but can run safely 22
how fast do you run your ffp? What type of tubing do you use and through what size angiocath? Do you use a pump? Ffp can ran as fast as you want, still use blood tubing. Pump is optional, same size angio as above
How fast do you run your platelets? What type of tubing do you use and through what size angiocath? Do you use a pump? This subject was also hotly debated. Platelets can just be run in as fast as they will go often just by gravity. Still use blood tubing
Do you feel there is any difference in cell integrity when running your (trauma-emergent) blood in using a pressure bag as opposed to using a rapid infuser/warmer? As long as the vein is good, no problems
It will be interesting to see what some of your opinions might be!!

1. Depends on why they are getting the blood, what their vs are, and any pmh. Anything from as fast as possible, to 3+ hours. Preferably use an 18g, though a 20 can be used. Some hospital policies allow use of a 22g. The smaller the angiocath, the slower the blood needs to be infused to avoid hemolysis.

2. Ffp is infused wide open (unless there are potential fluid-overload issues), on a pressure bag if needed. It is infused with the tubing provided by the blood bank ("blood component tubing," not the same as prbc tubing). Angiocath size doesn't matter. The tubing provided by our blood bank can't be used on a pump.

3. Platelets -- same as ffp

4. No. And many facilities don't have a blood warmer/rapid infuser.

Some pumps (old ones) can't be used to infuse prbcs. They crush the cells.

Much of this stuff is very facility-specific, depending on their policy. I worked in one place where is was considered a med error if blood was hung to gravity, rather than on a pump. I left and went to another facility where it was impossible to run blood on a pump, since the tubing wasn't compatible with a pump. Some of it depends on particular equipment, or even the theories/desires/ideas of the medical director over the blood bank.

BrnEyedGirl, BSN, MSN, RN, APRN · Feb 19, 2008

I agree with most of the other posts,..anything larger than a 22,..we usually use 18 or 16g in ER,..depends on why I'm giving PRC's,...for instance a CHF'er might have the unit split in 1/2 in blood bank,.get 1/2 unit over 4 hrs, 40 of lasix then the next half,...most other instances they go as fast as I can get them in,..we use The level I warmer/infuser w/o problems,.our blood tubing does fit in our pumps and we do use it if we need to be careful about how fast it infuses! Platelets come from blood bank with their own filter.

jayne109, RN · Feb 19, 2008

I completely agree with jmgrn65. In the ER we don't have the blood-pump tubing but on the floors they do and it works great.

SDS_RN, RN · Feb 19, 2008

We had quite a debate about the administration of blood products the other night at work which became unusually heated. So I put the question out to all of you...

How fast do you run your prbc's? What type of tubing do you use? What size of angiocath do you run it through? This subject in particular was hotly debated. Stable patient in over 3-4, unstable as fast as you can. Special blood tubing that has it's on filter and so you can run ns with it. At least a 20 is recommended but can run safely 22

how fast do you run your ffp? What type of tubing do you use and through what size angiocath? Do you use a pump? Ffp can ran as fast as you want, still use blood tubing. Pump is optional, same size angio as above

How fast do you run your platelets? What type of tubing do you use and through what size angiocath? Do you use a pump? This subject was also hotly debated. Platelets can just be run in as fast as they will go often just by gravity. Still use blood tubing

Do you feel there is any difference in cell integrity when running your (trauma-emergent) blood in using a pressure bag as opposed to using a rapid infuser/warmer? As long as the vein is good, no problems.

In our facility it is the same as listed above.

We have a specific policy r/t giving blood. We use pumps & blood tubing for delivery and we are to use at least a 20g but preferably an 18g.

mianders, RN · Feb 19, 2008

According to the Infusion Nurses Society and "Core Curriculum for Infusion Nursing" PRBC's may infused over 1-2 hours but must be infused within 4 hours. FFP should be administered at 200 mL/hr or slower if potential for overload. Platelets as fast as tolerated by patient. They recommend that each be transfused through an 20-18 gauge catheter. Blood warmer temperature should be 32-37 degrees Celsius, hemolysis may occur if temp greater than 42 degrees Celsius. There suggestion is to follow manufacturer directions for use of infusion devices with blood components.

Mobeeb, RN · Feb 20, 2008

mianders said:
According to the Infusion Nurses Society and "Core Curriculum for Infusion Nursing" PRBC's may infused over 1-2 hours but must be infused within 4 hours. FFP should be administered at 200 mL/hr or slower if potential for overload. Platelets as fast as tolerated by patient. They recommend that each be transfused through an 20-18 gauge catheter. Blood warmer temperature should be 32-37 degrees Celsius, hemolysis may occur if temp greater than 42 degrees Celsius. There suggestion is to follow manufacturer directions for use of infusion devices with blood components.

In our Level 1 Trauma Center ED, we follow the above guidelines with the exception of those trauma patients needing to be aggressively resuscitated with blood/FFP/Platelets. Then we use the Level 1 Infuser attached to a central line (8.5fr) and infuse each unit over 45 seconds.

Altra, BSN, RN · Feb 20, 2008

We use blood tubing for all blood products.

18# strongly preferred.

We nearly always run blood products wide open on the vast majority of ER patients except those who absolutely cannot tolerate the volume. The only time I've used a pump recently was to give some "oomph" to PRBCs that had to be infused through a 22# because there was no way we were going to get anything larger on that patient. Otherwise, even one unit would take forever to infuse through the 22#.

elizabells, BSN, RN · Feb 20, 2008

Since someone mentioned babies I'll add my 0.02, although we don't give a lot of emergency blood - you absolutely can give blood through a 24g, as that's all we have, but we run it over 4 hours - 3 if there are volume issues and the blood is going through the only access we have. That's partly because of the size of the IV, but also because the babies are wee, and you can flood their lungs with even just a little fluid overload. The blood for the babies is pre-filtered in the blood bank - they draw it into a syringe from the main bag and send it to us that way, so we run it through regular medication tubing on a syringe pump.

The only times I've seen blood just poured into a kid in an emergency was for ECMO, and in that instance we had the pump circuit to take the volume, so we don't run it over 4 hours in that case.