Blood products simultaneously

MunoRN, RN · Aug 31, 2018

Ideally they are administered one at a time, although for life-threatening active bleeding the downside to simultaneously administering multiple products doesn't outweigh the benefit of having a patient who's not dead.

jinpepito · Aug 31, 2018

Have you ever experienced giving 2 blood products at a time? True. He is alive and Im glad he didnt have any reaction. But I hope to know more in case it does happen again. Thank you for responding.

Editorial Team / Admin · Aug 31, 2018

It's a weighing of the risks/benefits. If the patient is unstable and becoming more so, then the prudent thing to do would administer the treatment (blood products). I'd be willing to bet that at some point you will experience the use of a rapid infuser, where you may end up mixing multiple units in a reservoir in a very short time. I've seen over 30 units given in less than an hour. Even if there were somehow miraculously hung one by one, there's still no way to know which of those units would have caused the issue given that close together.

JKL33 · Aug 31, 2018

Have you ever experienced giving 2 blood products at a time? True. He is alive and Im glad he didnt have any reaction. But I hope to know more in case it does happen again. Thank you for responding.

Giving more than one blood product at the same time isn't too rare. I agree with the above comments.

One thing you could do is review your hospital's related policies to help you feel more comfortable with what is expected in your environment when this situation arises. These are great types of topics to discuss in more detail with your preceptor, too. :)

Triddin · Sep 1, 2018

I've given 3 at a time, but we were also using rapid transfused so a unit of blood is in under 10 seconds.

Yes, worry about transfusion reactions, but generally on these situations, the fact that the patient is bleeding out and will continue to do so until they've had their FFP, cryo and platelets means that we are prioritizing the hemorrhage and stopping it first

offlabel · Sep 1, 2018

Hello! I'm new to nursing and Im starting in ICU. I had a patient who was bleeding heavily. He needed FFP and PRBC. His blood pressure at the time was already dropping and his HR was increasing. At the time the patient was already receiving FFP when the doctor ordered PRBC. I wanted to know how many blood products can we administer at a time. He still needed more FFP and PRBC. could we administer 2 blood products at the same time because I wouldnt be able to tell which one caused a reaction if administered it simultaneously. Thank you!

Which is more likely in aggressive transfusion therapy in the setting of catastrophic bleeding? Cardiovascular collapse with all of the attendant sequelae or *serious* transfusion reaction from cross matched blood products? The risk isn't even close. Besides, even if you gave the products in series, how long would you wait in between? A minute? Five minutes? 20 minutes? The patient would bleed to death while you were waiting to see of there would be a transfusion reaction. There's no telling how long a transfusion reaction would take to occur in an individual patient, nor would you have any guarantee that you'd be able to pick it up in one that was tachy and hypotensive anyway.

Any medical treatment carries a risk/benefit ratio and the benefit of simultaneous blood product massive transfusion far outweighs the potential risk of an unmanageable transfusion reaction.

Don't over think it.

/username, BSN, RN · Sep 2, 2018

After you give over 50 units of PRBCs in just as many minutes, the policies seem a bit silly.

Creamsoda, ASN, RN · Sep 2, 2018

When you have to do it, you have to do it. When the blood is pouring out of them so fast you must give it back as fast as you can. At this point life is more important than potential reaction. Every patient and situation is different. But if their vital signs indicate hemodynamic instability, you need to give the blood products. If this helps ease your mind any about reactions, you said there was already FFP going, well most serious reactions occur within that first 15 min anyway which is why we stay at the bedside. So if it had already been infusing for 15 min, you good to go on hanging the blood anyway.

Ive seen women post partum hemorrhage in minutes, GSW's hemorrhage out, GIB's hemorrhage out. Ive seen it all. Ive given 50+ products in 1-2 hrs with the Level 1 rapid infusor.

Night__Owl, BSN, RN · Sep 2, 2018

In an emergency you could justify it, but for me it would have to be a "we need this blood in now, or we'll be coding this patient in 20 minutes." I've given one unit at a time to plenty of pts with some tachycardia, or some low BP, so long as it was pretty stable on one pressor. That still means that it was 1 at a time in rapid succession, putting the next one up as the previous one comes down.

MunoRN, RN · Sep 2, 2018

Have you ever experienced giving 2 blood products at a time? True. He is alive and Im glad he didnt have any reaction. But I hope to know more in case it does happen again. Thank you for responding.

First we should clarify the difference between giving blood products simultaneously where you are forgoing the ability to isolate the cause of a reaction due to emergent transfusion needs, and situations where the timing is less urgent and you're assessing for a reaction with each product separately since you can do that and still be running them simultaneously.

Keep in mind that for the types of reactions you would see signs of during the transfusion, they will occur within the first 20 minutes or 50mls of product. Once you're past that window there is no need to wait until the entire amount has transfused, you've already screened that product for a reaction and there's no reason not to go ahead and hang the next product.

I would the majority of transfusions I do are emergent multi-product transfusions, there used to be a time where we routinely gave blood products with the belief that "it couldn't hurt" and by far the majority if transfusions were not emergent, but there's been a shift towards more conservative use of blood products and as a general rule if they don't need blood products as fast as they can go in, they it's possible they don't need them at all.