blood products

[luckycat]

I had a patient who came in with an INR of 15 (due to Coumadin use). I gave Vitamin K sub-q. Besides an AV fistula that was scantly oozing, there were no apparent signs of hemorrhaging. The patient had an ischemic bowel and needed to undergo necessary surgery timed for 3 hours later. At the doctor's request, the patient needed several units of FFP transfused before surgery.

Because the blood bank took a while to prepare the blood, it was nearly 1.5 hours later until I could get ahold of a couple units of FFP; and just my luck, the FFP was going in slower than I thought. The doc said I can just run them in fast, and was okay with me transfusing 2 units simultaneously.

However, my charge nurse later checked in and said we really shouldn't be transfusing 2 units of FFP at the same time (because of transfusion reactions). My patient was fine before, during, and after the transfusions and after surgery. But I do now realize the risks had a reaction had occurred.

In my ICU, I've seen 2 blood products given simultaneously when patients are "crashing"; mine wasn't "crashing" but she did need the FFP.

Does anyone know the recommendations for transfusing blood products simultaneously?

[meandragonbrett]

We transfuse multiple products at the same time on a routine basis. No, your patient might not have been crashing but there was an urgent need to get the FFP in so that they could go to the OR before they died.

[WSU_Ally_RN, BSN, RN]

Could you have placed each unit on a pressure bag?? When I was in the adult world, I routinely did this to get my FFP's in quick!

[detroitdano]

You run the same risk of a reaction no matter if it's one or two units going in. Worst case you have to send both bags back to the blood bank for a reaction workup.

Someone that sick who needs urgent surgery can take on the risk of TRALI or similar. Benefit/risk definitely leans heavily on benefit.

[luckycat]

Thanks for the replies. I feel better knowing that transfusing units simultaneously is not completely out of standard practice. I did use a pressure bag for a couple of units as the time got closer to surgery. Luckily though the surgeon was late in finishing up a surgery before my patient was wheeled down the OR.

I remember one shift where a colleague's severely ill patient needed ~10 blood products (PRBCs, FFP, platelets) transfused, I called the MD for her, and the MD told me to literally squeeze the unit of blood as fast as I could, into the patient. I was fairly new to ICU at the time, but looking back, I could've used a pressure bag. Duh.

[divaRN*]

I think the issue behind this is if they have a reaction you do not know which unit caused it. But if they need it now, they need it now and the benefit is greater than the risk.

[Biffbradford]

All good advice. Oh yeah, squeezing in a few bags of PRBCs with your friends sure helps the night go by more quickly, eh?

[elk280]

we stray from transfusing blood products at the same time unless it is an emergency... normally we slam them in fast using pressure bags or level 1's (except you cant use those for platelets).