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.

[JentheRN05, RN]

Well - I'm trying to rationalize this myself. I don't remember any reading on this in nursing school. But to me it makes perfect sense that you wouldn't want less than a 20g to infuse blood (see how often I've done this myself?) because PRBC's are cells that if squished through a smaller IV could get damaged. SO it makes good sense to me. (Actually I do believe it's policy in most hospitals to get an 18-20g going if one isn't started already)

[hrtprncss]

20 gauge or less only in my hospital.

[neneRN, BSN, RN]

Our policy is also to use nothing smaller than a 20 to infuse PRBCs, and I never have. However, I have seen it done through a 22 without adverse reaction. And I'm sure with pediatric pts it is probably done as well. If you think about it, some of the butterfly needles we draw blood with are 23 guage, and the blood makes it through all right without getting hemolyzed.

[Dixielee, BSN, RN]

Please don't indict the whole east coast based on this one bad experience. I have never started blood on anything smaller than a #20. I have also not worked at a place where anesthesia started IV's on hard to stick patients. I am in ER and we start all of our own or have the ER doc put in a central line. Even when I worked ICU, the anesthesia never left the OR/OB areas, never graces us with their presence. Attendings or residents would insert central lines, otherwise it was up to the nurses. Even in most operating rooms I have been familiar with, the pre op RN started the lines if they didn't already have one.

As far as hemolysis, I am sure peds patients get blood via a smaller needle, but they require smaller volumes, so maybe the issue is how long does that bag have to hang to make it thru a #22?

I would prefer a competant RN than a physician who rarely started lines. Sounds like you may not have had a competant RN, at least in the IV placement department.

[truern]

I'm on the east coast, and the two times I went to surgery the anesthesiologist started my IVs...thank goodness, because they numb it first and I'm a HARD stick

Oh yeah, this thread is about administering blood and needle gauge...hmm...I don't know nothin about no stinkin blood :imbar

[VickyRN, MSN, DNP, RN]

At the hospital in which I work part-time, we use the ACUVANCE system:

http://www.allmed.net/catalog/item/141/2535

Several of the nurses here have stated that it is safe to give blood to adults through the 22 gauge ACUVANCE. Since I have yet to see this in writing (or have documentation from the manufacturer of this), I only give blood through a 20 gauge or larger.

[spidermonkey]

Policy at the hospital I work is minimum of 20g for packed cells, and min. 18g for whole blood. I've worked hospitals on both coasts and in between and this seems standard.

[Tweety, BSN, RN]

The anesthesia dept. has made it loud and clear they are not the IV team for the floor, even when administering blood. End of discussion there. Besides floor nurses are just as good as they are at getting IVs.

I've had patients with existing 22 g needles, and I and others have unsuccessfully tried to get a larger needle in and were unsuccessful. Under these circumstances I've administered blood successfully raising their H&H with a 22 g. I don't have any sources to document this, but learned from oncology nurses that it was o.k. So I hope I'm not wrong.

I don't think this nurse handled the situation correctly. However, having a CRNA in the room didn't help with her confidence/communication skills and she might have been a bit nervous, so please don't be so judgemental.

[Gompers, BSN, RN]

While I agree that the larger the bore, the better for infusing blood...

We always use 24 gauge IVs for blood in the NICU and it works just fine. We put it on a pump over 2-3 hours. The H&H increase as they should without any problems. So while I can see needing an 18 gauge for an adult that needs blood NOW, so that it goes in quickly...if all you have is a 22 gauge and the patient isn't actively bleeding out...I don't understand why it would be a problem.

[UM Review RN, ASN, RN]

We routinely use 22s to give PRBCs.

Never had a problem.

[RN5000]

I also work on a floor where we have a very elderly population with fragile veins who often require transfusions. Rarely do we insert an 18G into these folks. 22-24, usually not a problem. Sometimes the pump is what inhibits the flow. I have found that running it by gravity, closely observed, as long as the pt isnt a CHFer, etc, works well. Agreed if they needed it fast, 24 would not be ideal, but our older pts rarely require that.

PS.... Well know that we in the medical field are by far the worst patients at times. I guess we know too much!!