Blood products question

[TigerGalLE, BSN, RN]

Do NICUs and PICUs routinely transfuse blood products via 24g IVs or must the patient have some type of central line? They say you must have a 20g IV or larger to transfuse blood products at my hospital. I work with adults in an MICU. I am just curious what gauge IVs are used for all the little patients out there receiving blood products.

Any ideas?

[labordude, BSN, RN]

We will transfuse through our 24g IVs or through our umbilical venous lines. Very rarely will we infuse through our PICC lines, though this has varied among different facilities upon the size of the PICC line and the current status of the patient.

[NicuGal, MSN, RN]

We use 24 or 26 angios, our UA or UVC (UA if we have not other access), and our PICCs if they are 3fr.

We took 24 and 26 angios and pushed blood thru them in to crit tubes once and there was no difference in the hct, we thought for sure it would lyse going thru the 26.

[TiffyRN, BSN, PhD]

One thing to remember is that our transfusion volumes are smaller and generally the rates are much slower than one would be used to using with an adult. I know at times the blood is pushed (as mentioned in a previous post), however, most transfusions run so much slower that the risk of hemolysis is minimal.

Infants are often transfused at 15mls/kg so we are talking volumes less than 50mls, so those rates of infusion are going to be very slow. I remember with adults needing to run those at 125ml-150mls/hr to get that whole bag infused in 2 hrs.

Infants will get much larger volumes when they are getting exchange transfusions but the infant should have an umbilical line at that point. I've seen blood or platelets given through PICC lines and I've seen many of those clotting off after that.

[NICU_babyRN, BSN, RN]

just like the other posters, we infuse via 24 too! UVC if available and not in use by other IVF and UAC is last resort. We only infuse via PICC if the picc is dedicated for Blood products and we prefer to do it with larger PICCS like 3fr.

[prmenrs, RN]

Just thinking about how to go about getting a 20 ga in a 500 gm baby kinda gives me a headache! And, as previously mentioned, we don't have to give 500 mls in

24ga works just fine for us. But on an adult, it'll take forever. A 22 might be a better choice if you can't get a bigger one.

[Imafloat, BSN, RN]

We give blood through 24 g PIV and UVC. Our PICCs aren't big enough for blood. I gave blood yesterday, 35 cc over 2 hours.

[MegNeoNurse]

In the NICU I work in you must have atleast a 24ga PIV in, otherwise the lumen is too small and will break down the blood cells. So, if your baby has a 1.9fr (26ga) PICC in, you must start a PIV to transfuse. Pain in the butt, right! In the PICU I'm in most of our kids are C-Lines so it's no issue.

[littleneoRN]

We don't transfuse through our PICCs because they are 1.9 fr, but we routinely transfuse via 24 g IVs. We rarely use 26 g, so I can't comment on that. It's true though that we transfuse MUCH slower. My transfusion is often running at something like 6 mL/hour. It will take you a while in peds or adults at that rate. :)