blood administration

[GeminiRNmom]

Someone told me recently that when infusing PRBC the blood has to be over the filter line in the holding chamber or the red blood cells will break up, has anyone else heard of this? I thought as long as you had a filter in place it does not matter what the level of the blood is.

[blondy2061h, MSN, RN]

I've heard this from other nurses on the unit, but not from our official policy or anything. I wonder what the official, current "validity" of this is also.

[miko014]

Next time you're giving blood, read the package the tubing comes in. That should tell you what you need to know.

[iluvivt, BSN, RN]

Most standard blood filters are a 170 micron filter. IV manufactures make the standard y-type administration set. In order for filters to work properly they need to be primed properly. The 170 micron filter can either be inverted or squeezed (depends upon the brand) until the saline wets the entire filter. In other words the drip chamber should be filled enough ,but not so much so that you cannot still see the drips. If the filter is not primed properly the blood on most designs has a long way to drop and also the filter does not function well to trap the clots and blood debris you are trying to trap.The blood can also be damaged limiting its usefulness. The INS does recommend that this tubing be used for only one unit and be used for no longer than 4 hours. A microaggregate 40-80 micron should be used when patients will receive multiple units of blood in a short time span.

[Babs0512]

Your talking about the drip chamber area, yes, that is what I was taught. The fluid needs to be above the filter line. If it isn't, as the blood drips into the drip chamber and strikes the filter, is causes hemolysis, which defeats the reason for giving the PRBC and can cause hyperkalemia as the red cells break apart.

Have a nice day everyone.

[iluvivt, BSN, RN]

yes I am and you are correct on both counts. The patient may get damaged cells as well as hyperkalemia since potassium is predominately an intracellular ion. Also,when monitoring your CBCs post infusion you can expect a 3% increase on the Hct and a 1% increase on the Hgb for one unit of cells transfused. Also older blood,close to its expiration date may also cause some hyperkalemia.