Blood products

[pepitojp]

Im new to ICU and I have had multiple preceptors tell me different things which now Im not sure I understood them well. There are alot of things I dont know. My pt the other day was AMS, hypotensive 80/60s and had a low H&H. But was a little bit stable. Asymptomatic. VS stable. I was told we could give FFP and blood together as long as it is not hung together at the same time to make sure there is no reaction with in the 15 min in which I did before with another nurse. But then again I was told by another nurse not to because we wouldnt be able to tell which caused a reaction and we can only do these during live saving situations. Some say dont. Some say its a routine they do in larger hospitals. But Id rather not have a reaction and I believe in the safety of my pts. Im just kinda confused now. Thank you!

[KeepinitrealCCRN]

I would not hang them together due to the reason that you mentioned. Also, the scenario you are describing is not an emergency. If they ordered 1 unit of each I would hang the FFP first since it goes in faster and then the PRBC after the FFP is finished. In an MTP (massive transfusion protocol) situation where you are using a level 1 the blood is going in so rapidly that there is still no reason to hang them at the same time. You can get a unit of PRBC in the patient in 2 minutes if you needed to. I have hung 30 blood products on a patient in a single shift and still it was one after the next. You can also look at your hospitals protocols on blood transfusions and see what it says.

[MunoRN, RN]

I would not hang them together due to the reason that you mentioned. Also, the scenario you are describing is not an emergency. If they ordered 1 unit of each I would hang the FFP first since it goes in faster and then the PRBC after the FFP is finished. In an MTP (massive transfusion protocol) situation where you are using a level 1 the blood is going in so rapidly that there is still no reason to hang them at the same time. You can get a unit of PRBC in the patient in 2 minutes if you needed to. I have hung 30 blood products on a patient in a single shift and still it was one after the next. You can also look at your hospitals protocols on blood transfusions and see what it says.

The benefits of running products separately don't always outweigh the risks, but if you're giving each product over a couple of minutes then it's not really any different than giving multiple products simultaneously over a longer period of time in terms of being able to identify which product may have caused a reaction if a reaction were to occur.

[AceOfHearts<3]

I've only hung multiple blood products at the same in an emergency. We had people running to the blood bank for coolers of blood and used pressure bags to get them in fast (we didn't have access to the rapid infuser at that point in time). The patient had appeared stable in the ED, but we knew something was going on. They vomited a bunch of bright red blood within a few minutes of arriving to the unit. They had an emergent bedside EGD done and were fine. They had blood coming out of both ends and I was scooping it out of the bed once they were stabilized and I could finally clean them up.

[Rosie_one]

Hang separately as what everyone else has said regarding possible reactions.

Easy to remember is stop signs, amber before red so I'd give FFP first, then blood. Your country should have a blood administration protocol in acute care, massive bleed etc.

You could always use noradrenaline if has central access or metaraminol if only peripheral access if blood pressure was that labile until blood products were in.