Blood Transfusion Question

TazziRN, RN · Jul 30, 2006

Possibility of clogging the cath, or of the blood cells breaking.

PANurseRN1 · Jul 30, 2006

Contrary to what you hear in nursing school, you can infuse blood through an IV as small as a 24g with no problems. Think about it--blood cells get through tiny capillaries without being damaged.

Larger gauges are needed in situations such as trauma, when you need to infuse rapidly.

Long Term Care Columnist / Guide · Jul 30, 2006

Packed RBCs are more likely to be hemolyzed when being transfused through a 22-gauge catheter. Not only that, it can be uncomfortable for the patient if it's going in relatively fast, and it's more likely to infiltrate, particularly if the IV is in the hand.

A wee word to the wise: it's better to put in an 18 or 20 anytime there's even a possibility of surgery or a transfusion......I never used anything smaller than a 20 on the floor, unless the pt. was an elderly person with teensy veins who only needed a saline lock per telemetry protocol.

PANurseRN1 · Jul 30, 2006

We gave PRBCs to peds pts. through 24g with no problems. Again, if you're having to infuse rapidly, that's another issue.

Irishgirl · Jul 30, 2006

It was an outpatient and she only had a little bit of blood left to transfuse. I was just doing a favor for another nurse, but in hindsight I should have put in a 20. Can hemolyzed RBC's do any harm to a person, or do they just not carry oxygen like the non-hemolyzed cells?

begalli · Jul 30, 2006

Something else to remember to prevent hemolysis when using the Y-type IV blood tubing is to make sure the barrel of the tubing is FULL - above the filter within the barrell so that when the cells drip they do not drip onto the hard plastic surface of the top of the filter.

This drives me nuts when I see it. Whenever I see this, even if it's not my patient, I squeeze the barrel to fill it up. We take such care to make sure we have a large enough IV but then we allow the cells to burst by letting them crash down on that rigid plastic piece.

Irishgirl · Jul 30, 2006

Yeah, but will the hemolyzed cells pose any harm to the patient?

JaneyW · Jul 30, 2006

I was just discussing transfusing with a coworker yesterday--timely thread. Thanks for the tip about the filter! I have another question. In nursing school, it was drummed into my head to NEVER hang blood through a pump because it will lyse the rbcs. Then I graduate (4 years ago) and I always see blood hung on a pump and also see it as part of the protocol. Have pumps changed and schools not kept up? What do you all do at your facility?

Irishgirl · Jul 30, 2006

We hang blood on pumps in our facility, but we don't really hang platelets on pumps, because they can be crused. But I've seen it done.

begalli · Jul 30, 2006

Yeah, but will the hemolyzed cells pose any harm to the patient?

oops, sorry.

Yes, besides the change in O2 carrying capacity as you have pointed out, hemolyzed blood can cause an array of problems. One of the most common is hyperkalemia that can lead to renal and cardiac failure.

Let me see if I can find a website that explains.....

begalli · Jul 31, 2006

Have pumps changed and schools not kept up? What do you all do at your facility?

Unfortunately, pumps that blood should NOT be hung on are still out there and still used to infuse blood. BUT, the newer pumps that are being used now-a-days are made for running blood and do not hemolyze the delicate cells.

You're right, schools should probably do some catch-up.

In our ICU's we hang blood by gravity.

On every other floor blood is run in on a pump.