blood transfusion

Stop time should be stated in your facility's policy. In my experience with the "real world", stop time is when the bag is empty even if there's still blood in the line and hasn't been flushed out with NS. Especially if the busy nurse is there to check the infusion and has too much going on to come back again to check. As far as the lasix in the clearing/pink tubing flush goes... ask that busy nurse. I know, that's what you're doing here!

My busy nurse answer to that is in my real world, in my real time, I gotta do what I gotta do. There's black, there's white.... and there's pink. There's also a lot of other things that need my attention NOW. Like getting that second unit started before shift change or giving that pain pill that's been waiting or changing that beeping PCA over or rushing to answer the doc's return phone call to get orders for that critical lab value....

When a blood product is being administered it should remain a dedicated line , The rational is because the risk for bacterial contamination is much greater. So the best way to give the Lasix in between transfusions when you only have one VAD available is to do it one of two ways. Wait until the NS has significantly cleared the line((less risk for contamination) and then administer it at a Y site or directly at the site if you a T ext or port at the site. The second way is to add a double T ext directly at the site or a double extension set at the site and give it at the second site closest to the patient as the other one has the blood transfusion already attached. The intima is designed this way already.

I would count the blood finished when the bag is empty but a few minutes here or there is not going to make that much of a difference b/c there is such a small amt left in the tubing,as long as you do no exceed the 4 hour hang time on blood.

If I am giving more than one unit to a patient that requires Lasix in between then I am changing the entire set-up between units. My policy states that blood tubing is onlly good for 4 hours, and if the patient is a CHF'er or we are worried about fluid overload for whatever reason, I will not be running two units in that time frame.

So, when the first bag is finished I take down the tubing, flush the IV, push the lasix, flush the IV, then put up the fresh tubing and NS bag before going to the blood bank for the second unit.

As far as "time finished" it is either when I take down the whole set-up (after the line clears as much as it is going to clear), or when the line is clear enough to go get the next unit of blood.

But, that is just me.

Yes that is one way do do it as well though on occasion when you only have one access and cannot get another you can give an IVP push med that way. Ideally better to have another access but reality is that may not always happen. I too believe that for red cells it is best to hang a new tubing with a 170 micron filter each time but that may not be the case with other blood products that can be infused more quickly.

That is assuming your policies and procedures are up to date at to the level of specificity one might need in a given situation. A nurse in any given clinical situation will be held to the standard of care. let us just say a hospital has not updated policy in years ans the policy is lacking and does not meet the standard of care and the patient has a bad outcome. Can the hospital and RN get sued...YES they can. They will have to prove the current standard of care was not met and a prudent nurse with similar training would have done things differently.

So by all means look over the polices and procedures when you are employed..know them well but always make sure they make sense to you as well and bring anything that seems outdated to your managers attention for correction and updating.

People get educated in many different ways and almost every specialty in nursing has a set of standards of practice. So to rely on only policies and procedure where you are employed to guide your practice and keep your yourself relevant and current is not wise.

There will be many times when you are held to a standard of care that may not even be specifically addressed in a policy and procedure ,nonetheless you will be held to it should a bad outcome occur. So knowing all your P and Ps is not the ultimate solution.

that is a good point, iluvivt. what does it take to get policies and procedures updated anyways? Evidence-based practice is always coming up with proven best ways to do things. In real life, how does EBP affect hospital policies... anyone? (New nurse, starting a new job next week so I'm not sure how it goes....).