Blood administration

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Specializes in Pediatric Neuroscience.

Hello, I'm a new nurse and gave blood today for the first time but am questioning whether I administered it correctly. An experienced nurse who was my second witness and did the double check with me helped me set up the infusion. From what I remember in school, I thought we were taught to prime the whole line with saline first. I asked the other nurse about this and she said that after filling the drip chamber with saline that one should prime the whole line with blood instead. Was this correct? Also, I set the pump VTBI for the ordered amount. However, once you run the flush bag at the end and flush the line aren't you then by default pushing whatever blood is in the line into the pt thus giving them more blood than ordered? I thought perhaps I should deduct the volume amount of the line from my VTBI so that it would equal out once the flush is run. I asked a nurse who has given blood often and she said that was not necessary and that giving the extra blood that is in the line (which adds up to about 30ml) is okay. Is this right? Am I overthinking this? I checked with 3 nurses to verify I was administering it correctly, but I'm kinda freaking out that I made an error if what I did was wrong.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

This video is how I setup blood infusion,- priming line with saline prior to attaching blood.:

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There are different ways of doing things. Chances are excellent that your hospital has a written policy/procedure.

In general, when seeking guidance from experienced nurses, you will get different answers. If the answer includes some variation of "I was always taught to do it like.....", take it with a grain of salt. Maybe they were taught wrong- plenty of nurses are. Focus on answers that include evidence and research and hospital policy.

Most important is to know the principles. I don't think it matters whether the line beyond the drip chamber has blood or saline first. (somebody correct me if I am wrong)

Either way, remember the transfusion starts when the patient starts getting blood, not when you tern your pump on or unclamp your lines.

Regarding volume: I have never seen an order for 275 ml or 310 ml. It is generally one or two units, and the volume will vary. Pediatrics are a different story. I can't think of any other population in which delivering a partial unit of blood makes a lot of sense.

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I always prime my line with saline. It reduces the possibility of losing any of that blood. I don’t even want to lose a drop. Second, I have never seen blood ordered any other way except by units. Your units all have differing amounts of mL in it, but it’s usually 325-330. You shouldn’t ever waste blood. Get it all in the patient.

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Specializes in Med/Surg, LTACH, LTC, Home Health.

Personally, I prime the line with saline and start the pump at a KVO rate to get as close of a guarantee that the IV is still patent while I go to retrieve the blood from the blood bank.

I did have a very cooperative patient (while fluids were infusing) who insisted on doing other things before being connected even though I had already set up the pump. I flushed her IV, the site was patent, I went to the bloodbank, and came back to a patient with a useless, occluded IV as a result of whatever incident that she described as occurring in the bathroom. I immediately returned the unit to the blood bank since I was well within the 30-minute window. (Some facilities do not all a unit to be returned at all).

Anyway, this incident caused me to develop a different approach: take care of the 5 Ps first, and when they’re done ‘running their errands’, connect the pump and start my KVO saline infusion WITH THE HOPES that the patient will behave themselves until I return with the blood.

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Specializes in Community Health, Med/Surg, ICU Stepdown.

Yes, get it all in the patient! I have also never seen an order for a specific amount of milliliters of blood, just units. If a patient is anemic it won't hurt them to get the full bag instead of part of it... it will help them ? I also like priming with saline; I know blood tubing has a filter but makes me feel like lower risk of air in the tubing and as stated above that they will get more of the blood ?

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Specializes in Pediatric Neuroscience.

Many of you have mentioned that you have never seen an order for ml only units. What about in pediatrics?

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Specializes in Med-Surg.

I agree with the others that I've always given blood in units and not ML.

I prime with saline because I asked about our policy a little while ago and the educator said that's the way to do it. But I also don't see anything wrong with priming the tube with the blood itself. I get impatient waiting on the blood to get to the patient after the saline.

I wouldn't fret about it.

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Specializes in OR, Nursing Professional Development.
1 hour ago, Serotonin2 said:

Many of you have mentioned that you have never seen an order for ml only units. What about in pediatrics?

Pediatrics is the only specialty I know of that would order mLs rather than units. You didn't specify pediatrics in your original post, but now that I looked at your experience, I see that you're in pediatric neuroscience.

Do you have a unit educator that you can reach out to? Also be sure to check the policy to know the right way to set up a transfusion.

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Specializes in Community Health, Med/Surg, ICU Stepdown.
3 hours ago, Tweety said:

I agree with the others that I've always given blood in units and not ML.

I prime with saline because I asked about our policy a little while ago and the educator said that's the way to do it. But I also don't see anything wrong with priming the tube with the blood itself. I get impatient waiting on the blood to get to the patient after the saline.

I wouldn't fret about it.

I have seen other people get impatient about waiting for the blood to go in and they set the rate at 999ml/hr like a bolus and wait for the blood to get close to the IV, then set the rate to whatever rate they're running the blood at. It works but you run the risk of running the blood in as a bolus if you don't change the rate in time...

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Specializes in Oncology, OCN.

I work oncology so I give blood and platelets all the time. We prime the tubing with saline first and our orders are always by the unit so no worries about volume. We do always want to get all the blood product to the patient, our infusion volumes are calculated in EPIC based on the start/stop times we put in EPIC along with the rates. Standard practice on my unit is to start the infusion at a somewhat higher rate and watch until the blood product reaches the patient then slow to 120ml/hr for the first 15 minutes of the infusion. Come back and take your vitals, check on the pt, then up the rate. New policy is to not infuse faster than 1 unit in under 2 hours, so in general a max rate of 180ml/hr. When the blood bag is empty switch over to the flush to get all the blood to the pt. Taking vitals at 15 minutes, 1 hour, and on completion as a general rule.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

Serotonin2:

Since you work in Pediatrics, you procedures will be different than the Adult population, info members have posted about. Difference between what you would do for a toddler compared to a teenager.

Peds patients do not get same volume of fluids or blood -much reduced so priming tubing with blood acceptable. Blood transfusion orders will be written in ml instead of "1 unit" given to an adult. Disease process/reason for blood transfusion/blood product also influences amount of blood to be administered.

Please review your facilities policy +procedure and discuss with Peds nurse educator as you will be held to facilities standards when unexpected event occurs.

Transfusions in the Critically Ill Pediatric ... - Medscape

Children are not little adults: blood transfusion in children with burn injury

Blood Component Transfusion: Indications and Dosage includes Adults and Pediatrics/ Univ. of Vermont

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