Blood Infusion

[Medic7714]

Have a quick question.

I had a patient the other day that I was transferring 2hrs from a community hospital to a regional medical center. Pt. was receiving a unit of blood that was to infuse during the transfer through a central line. My plan was to have the blood remain on the sending facilities IV pump to make life easier and just return the pump after the transfer.

The sending RN would not allow us to take the pump and removed the blood so that it infused by gravity via the pump tubing. Long story short, we get down to the ambulance and blood is not infusing. I troubleshooted the line... all clamps open, flushed the central line, tried pressure on the bag, and tried to aspirate blood from the line. Nothing worked.

My question is... can blood flow by gravity through pump tubing or is actual gravity flow blood tubing required? The blood only filled the drip chamber and it seemed like the cassette within the pump tubing was the culprit.

I called the sending doc who had me discontinue the blood and run NSS. Any help is much appreciated!

[Altra, BSN, RN]

The brands of blood tubing I have worked with do allow for gravity infusion. The troubleshooting interventions you describe sound like what I would have tried. If the line flushed fine but even applying pressure to the bag didn't get it to infuse ... not sure what the problem was.

I agree -- it would have been much easier to simply take the pump with you. When I worked in a small community ED we had a "loaner pump" dedicated for just this purpose.

[skylark, BSN, RN]

My 2c worth . . .

blood can infuse by gravity, its commonplace to do that many places where pumps aren't available. How do you think the blood is collected in the first place? By connecting up a line and putting it below the patient so the blood runs out the line and down into the bag.

I've worked on ships where we transfuse from other crew and just run it the best we can, no pumps there : )

Pumps have really only been around a couple of decades, and some of us were running blood infusions long before then!

But it sounds like there was a problem with the line and even if you had gotten a pump it most likely would have stopped and alarmed anyway. If the line is not patent, forcing fluid of any sort thru it with a pump can cause vascular damage, etc, and the fact the infusion doesn't run by gravity tells me there was a problem.

[Medic7714]

I'm aware that blood can infuse by gravity without any problem and it is common practice at places to run blood this way. That isn't my question. My question is the practice of infusing blood by gavity with PUMP TUBING. The pump tubing has a cassette or cartridge in the line which is what has me wondering about common issues if this type of tubing is used for gravity flow of blood.

Do you guys run the NSS at the same time as the blood or turn the NSS off after the tubing is primed? I've learned to turn the NSS off until the blood finishes but some say that running the NSS with the blood reduces viscosity and allows the blood to flow through the line better.

[Altra, BSN, RN]

Even when I've worked in facilities which utilized tubing specifically made for that brand/pump manufacture, I've never had a problem still infusing by gravity.

Your situation may have been very specific to that particular tubing brand. Coincidentally - what gauge was the IV? 22# lines do typically need the *oomph* of the pump - although I would think that would have been rectified if you tried putting a pressure bag on the blood.

[nurse2033, MSN, RN]

Most pump tubing I've seen has a little stopcock on the cassette that stops the flow. This prevents the fluid from free flowing if disconnected from the pump. You just give it pull to open it.

[Dixielee, BSN, RN]

Most pumps have an automatic locking device that engages when you take it off the pump. This is a safety device to prevent free flowing if someone accidentally pulls the cassette off the pump. Many times this is not immediately evident unless you know it is there. Sometimes it is just a little lever that gets triggered but is not obvious.

As far as I know, all pumps allow for free flow via gravity if not on the pump, but my guess is that the pump you had was equipped with that little automatic locking clamp. If the line flushed well, I can't think of any other reason for it not to flow. The only other thing that comes to mind is that some of the blood tubing is pretty long, and if the IV pole used for transport is fairly short, and most are, and the patient BP was up for some reason, there may have been too much back pressure so the gravity flow was not working.

Those are my guesses :)

[rgroyer1RNBSN, BSN, RN]

No it was the clamp on the cassette especially of it was one of those stupid plum pumps, its happened to me on the chopper before.Rod Rn

[Medic7714]

The automatic locking mechanism on the pump tubing wasn't the issue. I use IV pumps all the time and that is a basic in the troubleshooting process. Fluids not on a pump get taken off the stretcher IV pole and hung on the ceiling of the ambulance which is where the blood was so that wasn't an issue. The blood was infusing through a dual-luman central line.

If I had an extra set of blood tubing I would have switched it out all together. I appreciate every ones feedback and insight. I think the line became clotted somewhere high either within the cassette or above it.

[thelema13]

250cc bag of NS to KVO when not running blood or in between units, also used for flush if needed. I use pump tubing on my blood products. I'll make sure the blood goes in on time, and if there is a kink in the line due to a patient repositioning, it will alarm so no blood is wasted, it's precious enough.

We just got those dumb plum pumps at my hospital, everyone loves them, I don't know why. They are so finicky, loud and annoying. I prefer to infuse by gravity if at all possible.