Blood Filters and Lasix

Gompers, BSN, RN · Feb 15, 2006

Well, we give Lasix slow push over a few minutes, but if you have mini-bags of it to hang, all the better. We often give two units of blood back to back, and in those cases, yes, we do give the Lasix in between the two transfusions. However, after the first dose of blood, we disconnect the tubing and toss it. Then we completely flush the heplock with saline to clear the line, then give the med, flush again, then start the second transfusion using all new tubing. Of course, this is in the NICU, but I can't imagine why it should be different for adults.

allnurses Guide · Feb 15, 2006

Drugs should never be introduced into blood tubing. Lasix can be given push as long as it is never faster than 10 mg a minute (risk of ototoxicity). Did your facility have an incident in the past that led to using only bags? That is the usual reason for that type of policy IMO.

It would be best in my opinion to disconnect the blood tubing, or to access a port close to the site only after thoroughly flushing with saline. Never go through the filter, that is just for the blood product.

tanner1334 · Feb 15, 2006

In the hospital I work in you are to never add anything to blood products. We give Lasix IVP in between units of blood after flushing the line. We also are also not aloud using the same tubing for both units of blood. You have to get a whole new set of tubing for the other transfusion. If you are an RN there should be no reason you can not give Lasix IVP unless there is a specific restriction in your facility. :nurse:

subee, MSN, CRNA · Feb 15, 2006

tanner1334 said:
In the hospital I work in you are to never add anything to blood products. We give Lasix IVP in between units of blood after flushing the line. We also are also not aloud using the same tubing for both units of blood. You have to get a whole new set of tubing for the other transfusion. If you are an RN there should be no reason you can not give Lasix IVP unless there is a specific restriction in your facility.

What is the rationale for changing tubing between units? We give multiple units in the OR through the same tubing. The filters can easily handle two units of PRC's.

steelcityrn, RN · Feb 15, 2006

I have always changed the tubing with each unit, and never any meds through that filter. I would say if you hang anything it is below the filter. I would say the rationale for the tubing change is any delays in starting the next unit could cause clots in the tubing. In the OR, thats different when you are slapping on one after the other.

bonesrn · Feb 15, 2006

Since the units of blood you are giving are different you must use different tubing. What if the patient had a reaction and you were using the same tubing from the first unit...how could you tell which unit caused the reaction? Granted, most reactions occur in the first 15 min but they can occur anytime. As stated above, you also risk clot formation in the tubing if there is any delay. As for the lasix, don't know why, if you are an RN that you can't give it IVP. How long do you run the piggyback for? If I had to do it that way, I would trash the blood tubing, flush the IV and then hang the lasix with its own tubing, flush again and then hang the second unit with new tubing. Hope that helps!

HappyNurse2005, RN · Feb 15, 2006

Quote
However, after the first dose of blood, we disconnect the tubing and toss it. Then we completely flush the heplock with saline to clear the line, then give the med, flush again, then start the second transfusion using all new tubing. Of course, this is in the NICU, but I can't imagine why it should be different for adults.

Same way on my floor. and we IVP the Lasix

hrtprncss · Feb 15, 2006

We are allowed to reuse the blood tubing for a second unit IF the second unit is to be infused within 4 hours. So 2 hours per unit. So if you can infuse a unit in two hours, and u need to give a second unit, then we're allowed to use that same tubing as long as it's within the time frame. In regards to the lasix, there's usually multiple heplocks anyways, so u wouldn't have to disconnect the blood tubing.

Aneroo, LPN · Feb 15, 2006

My tubing for blood is always dedicated tubing.

I disconnect the tubing, flush with saline, give lasix SIVP, then flush with saline again.

Then for the next set I get more tubing. I agree with the rationale about the reaction- how do you know which unit of blood caused it?

hrtprncss · Feb 15, 2006

I'm just thinking this out in regards to changing of blood tubing per blood tx.

Changing the tubing won't really tell you DEFINITELY which blood product gave u that reaction, if we're being technical. Let's say that it's a delayed reaction. If you hang a new tubing for the second unit, and the reaction happens during the second unit infusion, how are you able to tell that it is the first unit's delayed reaction that's the culprit. Meaning, you would either assume that it is the second unit, and it's a rapid onset reaction during the first 15 minutes of the second infusion or the first unit which would be a delayed reaction. You still won't know definitively which unit caused it. I for one would assume that if it happens in the first 15 minutes of the second unit, then that would be the offending unit. Changing the tubing if you're giving multiple infusions wouldn't give u a precise answer if a reaction happens. Once you give multiple units, then you would have to rely on the time frame that the reaction happens and your astute clinical observation. So as long as the 2 units of blood runs in within 4 hours, then it doesn't make a difference. Of course if a third unit is to be infused then I use a new tubing because usually it goes over the maximum amount of time our blood tubing is allowed to be hanging, which is 4 hours. IMHO

Pepper The Cat, BSN, RN · Feb 15, 2006

Wow - thanks to everyone for their responses. Interesting how every hospital has different policies in regards to blood.