blood transfusion

If you held the blood and notified the MD, what was the problem?

as far as I was concerned the MD said to hold the blood and I felt like it was the right decision, as far as for this nurse's concern who has been a nurse alot longer than me, the MD and I made the wrong decision.

If VS were a LITTLE out of whack, then I'd say give the blood. Ex: HR=105, T=100.5.

Then you just have to monitor how far the VS go from baseline.

But why did the patient have an elevated B/P and HR? It can't be hypovolemic shock.

My concern would be if the HR was already 130, how high would it go if the patient had a transfusion reaction.

Sounds like the other nurse just wanted to nitpick at something.

thank you

I don't think you made a "big mistake". You notified the MD and the MD made the decision to stop the blood. Hopefully the MD weighed the risks and benefits and considered a way to treat the hypertension/tachycardia and will address the underlying causes.

I've given blood with similar vital signs before, so it's not unheard of, or unsafe, which is probably what this nurse is saying.

thank you

But why did the patient have an elevated B/P and HR? It can't be hypovolemic shock.

My concern would be if the HR was already 130, how high would it go if the patient had a transfusion reaction.

Sounds like the other nurse just wanted to nitpick at something.

Elevated heart rate is common with anemia. Thus transfusing with tachycardia is actually often common and often eleviates it.

With the BP high, I would be calling the MD for BP meds, or possible lasix between units, after transfusion.

But it also depends on what the VS had been all along. If this was a big change, I would be more concerned.

If the MD held the blood, the nurse has nothing to complain about and is nitpicking. Chances are the MD may order lasix w/ blood (preferably in AM, to reduce fall risk), which means more work for him/her.

Elevated heart rate is common with anemia. Thus transfusing with tachycardia is actually often common and often eleviates it.

With the BP high, I would be calling the MD for BP meds, or possible lasix between units, after transfusion.

But it also depends on what the VS had been all along. If this was a big change, I would be more concerned.

If the MD held the blood, the nurse has nothing to complain about and is nitpicking. Chances are the MD may order lasix w/ blood (preferably in AM, to reduce fall risk), which means more work for him/her.

Yes, I have commonly given lasix with transfusions - If the MD ok'd holding the blood up (how low was the h/h/?) Then you were working under his/her direction.

I think the nurse is just annoyed she'll have to give the blood prob- so if she kept up the attitude I'd ask her if she wanted a meeting about it with the MD,nurse 1 & mgr.....you need clarification of whats the right protocol in this situation...:innerconf

How low was the pt's H&H? Did you do orthos on the patient? What was the patient's baseline BP and did they have a history of HTN? Were they in pain? If the patient normally takes BP meds: were they held due to surgery?

The patient's HR is of concern to me. Did they have an abnormal underlying rhythm (ie uncontrolled a.fib)?

It's good that you called the MD and in my opinion, the decision to hold the transfusion is dependent upon what the H&H was. I once had a pt with a Hgb of 2.4 and nothing would have stopped me from transfusing this guy - he wouldn't have a heart rate and blood pressure for much longer if his Hgb dropped further...but, that's just my irrational ED mindset !

Prior to calling the MD I would have probably done orthos, assessed if the patient was dizzy/nauseated, if they looked pale, what their urine output was, etc. It's sad to say, but I see many patients with BP's of 180/100 and higher each day, and that is their baseline; I no longer get freaked out if a BP is higher than 140/90.

I can understand where the AM nurse is coming from though. There are so many times I come to work and get report that my patient's Hgb is low and they are to be admitted to the floor - and that I should get them up to the floor ASAP so I won't have to transfuse in the ED. Or, the previous shift RN will be sitting down chatting, meanwhile the transfused blood is ready at the blood bank. My thought: if they need blood, then they need it; it is a priority and if it's ready, then transfuse it.

Just keep in mind that she didn't have the whole picture since she wasn't there.