blood products question

Elvish, BSN, DNP, RN, NP · Aug 15, 2007

Where we are we run blood in over 2-3 hours. We start the rate slow in case of a rxn but after 15-30 min we crank it up to about 150/hr, depending on the pt's condition (mostly otherwise healthy women).

It's been a LOOOONG time since I've given platelets, but as I recall, they had to go in pretty quickly, like 20 min or something.

FFP I have never given & am clueless about.

CritterLover, BSN, RN · Aug 15, 2007

for prbcs, it depends on patient condition: if they have cardiac compromise, i it give slowly, over 3-4 hrs. if they are exsanguinating as we speak (bad gi bleed, gsw), then i give it as fast as possible; possibly 3 or 4 units in a matter of minutes.

for the "average" person, over 1-2 hrs.

i've always given platelets and ffp wide open. i would reduce it some if the patient couldn't tolerate the rapid volume, but probably no longer than over 1/2 hr.

Larry77, RN · Aug 15, 2007

I sure hope there is a policy in place at your facility...this is important stuff and I would look into it further if I were you. Usually we start the product (PRBC's, FFP, Platelets) slow and after 15 min crank it up as high as the patient can tolerate but I work in the ED where we are usually in a hurry.

suanna · Aug 15, 2007

Every hospital has different rules- you need to know yours(your blood bank should know the policy). As a general rule of thumb- PRBCs at least 1 hr but no more that 4, FFP 15min with a bleeding issue (the same for CRYO) 1 hr if not in trouble with bleeding. Platelets very slowly for the first 15-20 min then over 1 hr. CHF pts double the min. time -This may mean "splitting" the units. Most blood products slower for the first 10-15 min. to monitor for reaction.

ICRN2008, BSN, RN · Aug 15, 2007

Our policy in peds is 5 mg/kg/hour maximum. We run all blood products on IV pumps.

Elvish, BSN, DNP, RN, NP · Aug 15, 2007

Oh yeah, we run all our blood on pumps too. Anything IV has to be on a pump unless it's something we're pushing in.

RachelRN25 · Aug 15, 2007

Thanks for all your help! :) I'm still curious about FFP and Platelets though...how fast do you usually run these in? Thanks :)

miko014 · Aug 15, 2007

We can't run blood products on our current pumps, but we're getting new ones "soon"...whatever that means. Anyway, then we will be able to have them on pumps. We give a lot of blood products. FFP and platelets we slam in, usually over 15 min or so...as fast as they will go.

For PRBC our policy is 2 - 4 hours, and it HAS to be done in 4 hours. Meaning, if it's not done, it comes down anyway.

Daytonite, BSN, RN · Aug 15, 2007

This information comes from Intravenous Therapy: Clinical Principles and Practice, by Judy Terry, Leslie Baranowski, Rose Anne Lonsway and Carolyn Hedrick, published by the Intravenous Nurses Society in 1995, page 173 and Portable RN: the All-in-One Nursing Reference, third edition, by Lippincott, Williams & Wilkins, published in 2007, pages 380--383.

Whole blood (includes RBCs, WBCs, plasma, platelets and some clotting factors) - infuse within a 4-hour period, infuse with NS only. Watch patient for signs of volume overload.
Packed RBCs (includes RBCs, WBCs, platelets and minimal plasma) - infuse within a 4-hour period, infuse with NS only
RBCs, saline washed and/or frozen (includes RBCs, minimal WBCs, no plasma, no platelets) - infuse within a 4-hour period, infuse with NS only
Fresh-frozen plasma (FFP) [includes all clotting factors] - infuse rapidly. Do not hang for longer than 6 hours. Can use a straight line IV set. Monitor for hypocalcemia because the citric acid in the FFP binds the patient's serum calcium.
Platelets (platelets, plasma, and a small number of RBCs and WBCs) - An individual unit can be administered over 15 minutes. If multiple units have been pooled together by the blood bank, then they need to be administered within a 6-hour period. May need to premedicate with antipyretics and antihistamines if there is a history of platelet transfusion reaction. Do not give if the patient has a fever. Platelet counts are usually drawn an hour after transfusion to determine platelet status and need for more transfusions.

I am thinking that the policies regarding blood transfusion may be in your hospital's laboratory policy manual, specifically under policies pertaining to the blood bank. You might put a call in to the hospital nurse educator, if your hospital has one, to see if they are aware of the policies on this. Someone in nursing administration is responsible for maintaining the nursing policy and procedure manual and will know if such a policy exists and where it is filed. There may also be some information on the actual blood bank form that comes with each unit of blood products. You might want to get your hands on a blank form (ask the blood bank for one).

Also, from this INS textbook (pages 172 and 173), and just FYI for anyone else reading this thread:

BASIC GUIDELINES FOR BLOOD ADMINISTRATION

Gloves should be worn when handling blood products.
Blood should not be out of controlled refrigeration for longer than 30 minutes without being initiated as a transfusion.
Blood should not be stored in nonblood bank refrigerators because they are subject to vast fluctuations in temperature.
No intravenous solution other than isotonic saline (0.9%) should be added to or administered simultaneously with blood.
A blood administration set should not be affixed ("piggybacked") into a main line that has been used for any solution other than isotonic saline.
All blood components must be filtered using in-line or add-on filters that are appropriate for the component or specifically requested by a physician's order.
A new administration set and filter should be used for each transfusion. A blood filter should not be used for more than 4 hours.

and

PROCEDURE TO FOLLOW IF HEMOLYTIC REACTION IS SUSPECTED

STOP TRANSFUSION.
Take down the blood and all tubing involved. Attach a new bag of saline using all new administration equipment all the way to the IV catheter hub and
keep the IV open
.
Notify the physician and the blood bank immediately.
Check the blood bag compatibility tag, label, and patient identification for clerical errors.
Send anticoagulated and clotted blood samples, a blood transfusion reaction form (if applicable), and blood bag to the blood bank. The blood bank may also request a freshly collected urine sample.
The physician may order blood urea nitrogen (BUN), creatinine, and coagulation studies.

Signs and symptoms of an immediate transfusion reaction:

fever, low back pain, pain at the IV site, hypotension, renal failure (due to ABO incompatibility)

fever, chills, rigor (WBC antigen-antibody reaction)
acute respiratory insufficiency, chills, fever, cyanosis, hypotension (anti-HLA antibodies)
flushing, dyspnea, hypotension (absent IgA and high-titer anti-IgA antibodies)
urticaria (allergic reaction, antibodies against foreign plasma protein)
The most severe: fever, shock, DIC, renal failure (bacterial contamination)

Hope that is helpful for you. I was trying to find some guidelines on the National Clearinghouse and on the American Association of Blood Banks website but wasn't having much success at it this morning.

CRNI-ICU20 · Aug 15, 2007

One way to "cover yourself" is to ask the doctor to write a parameter of time for blood infusion when ordering, such as:

Give slowly over four hours...or rapid infusion followed by lasix, or give one unit of PRBC's over two hours, then draw H&H one hour post infusion, call with results, monitorl lung sounds and urine output.".....

Then, you are following his/her orders....

crni

classicdame, MSN, EdD · Aug 15, 2007

May I respectfully recommend that you contact your clinical educator and/or the MD in charge of the blood bank to request adequate teaching? Probably a lot of people have the same questions as you. Educators like to respond to a need.