Blood administration

[Serotonin2]

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.

[MommaBear2012]

There are just different ways to complete the same task, it doesn’t necessarily mean one way is wrong.

I always prime the whole line with saline. I don’t want to deal with air in the line with blood which could cause me to waste some blood to run it out. The saline first helps me ensure I can run a little out if any bubbles occur. After I prime the saline I prime the blood. This includes using a medicine cup to collect the saline that runs out while the blood gets to the end of the tubing. I want the blood to start right away not have the patient getting only the saline when I start the infusion. We run it at the same rate the entire infusion.

Blood is ordered per unit, whatever the amount in that unit is the whole amount the patient should receive. This includes the last little bit in the line, that’s what the flush is for. ?

[marienm, RN, CCRN]

My hospital specifies that the tubing may be primed with blood or saline. Personally, I prime with saline first to get the air out and then with blood, since I have to stay with the patient for 15 minutes after the blood hits their vein. We start transfusions at 100mL/hr for non-emergent situations so it would take about 25 minutes total if I waited for the blood to make its way down from the bag. My hospital also has a written procedure for everything...if yours does too, try to review it with your trainer.

I don't work peds but I am a little surprised your blood bank allows you to waste blood (like if the order was for 250mL, I'm surprised they'd send you a bag with 275!). Maybe this is more common than I realize in small transfusions for little kids? But I would think they would divide up units into aliquots so that the right amount would be transfused and none wasted.

[RNNPICU, BSN, RN]

I have never heard of priming the line with saline, I thought that practice was changed years ago. In Peds, I have definitely heard of blod given in terms of mls, sometimes it is factored by mls/kgs.

I would check your policy as there are specific guidelines per institutions.

[Nash]

When we are in school, we are taught one way. I have worked for several hospitals in the same state and some out of state. I found out it is not just one way of infusing the blood. It depends on the facility and their protocols. Now, in addition to that, you do need to adhear by safety precautions, know your math, do all of your checks, ect. It is okay to contact your clinical educator for your unit and she will varify how they give blood in their facility.