Blood comparability

I don't know the answer to your question (I'm a NICU nurse and we would *never* do this), but I wonder, if the patient were to have a transfusion reaction or adverse reaction during transfusion, how would you know which blood product was the culprit? Interested to read responses to this thread...

The same is true if I were to use 2 IV sites. You would not know which caused the reaction.

The same is true if I were to use 2 IV sites. You would not know which caused the reaction.

That is the point. We would never run them at the same time. There would be no way to determine which product was causing the reaction.

We never give more than one blood product at a time unless as part of a massive transfusion protocol in OR or ICU for severe hemorrhage due to risk of reaction and not being able to respond appropriately in the event of a reaction.

I should clarify "I have done it" as in mass transfusion in major traumas. And pts come from the CVOR with with it like that hanging. It finishes in CVICU but it's the CVICU nurse whose name is on the chart because OR doesn't scan anything. I know anathesiology kinda gets to do things a bit more liberally but it's something to bring up.

(I just reread my post. Sorry, I asked it while waiting on giving report.)

The answer is NO.

The problem is, each and every dose of FFP, platelets, PRBCs and any other blood products (yep, including human albumine) can contain trace amount of host antibodies. Once product is infused, the concentration falls to the level which can be safely eliminated by body's immune system. But all blood products are prepared separately, many of them pooled and neither of them are cross - matched with each other except in very rare situations such as planned massive transfusions. While being infused, the concentration of those trace antibodies can be enough to provoke lysis in situ. Patient will have lytic transfusion reaction as a result. Since there are more than one product being infused, you will never figure out what caused it - a particular blood product or their mix and cross - reaction.

In addition to this, infusing FFP with cellular components, especially as fragile as platelets, can cause lysis because of FFP high osmolar density, like if you were transfusing cellular products with D10.

In OR with massive transfusion, lysis in situ less likely to happen because everything is infused very quickly. The situation when massive transfusion of everything at once is required are obviously life threatening, so worries about slight posttransfusion reaction are clearly not priority. But the poor CVICU RN who gets this mess on her hands can be held responsible if patient develop such reaction and if things are not done according to facility's policies, although it wouldn't be her fault. I hope patient had TLC or something better than a PIV somewhere so the stuff can be at least switched to each other's own lumen.

That makes sense. I think it would make a good poster presentation talk for a critical care conference.

When I've raised the question with other RNs, they quickly say no. When I am why, well they just say "you just don't." I think as nurses we need to be able to articulate why we do things without responding "that's how we do it."

These types of questions are good to create critical thinking skills.

When I've raised the question with other RNs, they quickly say no. When I am why, well they just say "you just don't."

"because it is a POLICY!!!"

'because we ALWAYS do it this way here"

"because we NEVER do it this way here"

"because THEY do it but WE don't"

"because you ask too many questions"

:banghead:

i have done it. However, hospital policy says you have to have 2 different lines to do this, no y-siting. Although to clarify, i only do this when absolutely needed not because i just want to get this 1 RBC and 1 platelet hung.

i have done it. However, hospital policy says you have to have 2 different lines to do this, no y-siting. Although to clarify, i only do this when absolutely needed not because i just want to get this 1 RBC and 1 platelet hung.

Agreed. When you've got an upper GIB lightheaded with BP 80s/40s. You do what you can to keep people alive.

I wanted to see how the nation of nurses thinks about this. I know what Is done on Ohio, but my community is limited off the net.

When I've raised the question with other RNs, they quickly say no. When I am why, well they just say "you just don't." I think as nurses we need to be able to articulate why we do things without responding "that's how we do it."

These types of questions are good to create critical thinking skills.

I hate those types of responses. At one place I worked, RNs were not allowed to removed central venous lines - had to be a fellow. When I asked why, I was told, "I don't know, its just the policy." When I pressed for a rationale, I was told, "I guess maybe because you could cause a pneumothorax when you removed the line."

That is the point. We would never run them at the same time. There would be no way to determine which product was causing the reaction.

Babies are different -- you probably don't even run a whole unit into a baby because they can't take the volume.

Sometimes, in CVICU where the patient is bleeding liters/hour, you have no choice but to run multiple blood products at the same time. I can't say I've ever Y'd them into a peripheral IV, but I certainly have into central lines with a PA at the bedside squeezing both bags into the patient as rapidly as possible while an MD stands on the other side of the bed squeezing in two more bags and begging the surgeon to come take a look. I think the biggest danger would be to your peripheral line . . . but I'm sure you'd have more than one in a situation like that.