Blood transfusion

Just wanted to get your opinions on this. I currently work in the medsurg unit. We have this patient for transfusion of half of fresh whole blood. Her hgb levels were in the 90s mark. She had cancer as well and her weight was estimated at 70kg. Her transfusion was ordered for four hours, so by protocol i identified the patient correctly, i infused the blood slowly at first to monitor for reactions. At the second hour mark, i saw that my blood was still 3/4 despite constantly regulating. The blood as consumed at the 5th hour. At the end of the bt, patient's vs increased and dob was noted. Dr were informed and they gave furosemide and neb after. Bt rate was decreased to 6hours. My questions are: what is the safe rate of blood transfusion per volume? For example, was it safe to infuse it longer than 4 hours and or lesser than 4 hours?

[ChristineN, BSN, RN]

This is something you really need to go by what your facilities policy and procedure manual says. That being said, I have never worked someplace that allowed blood to be infused over 4 hrs

[vintage_RN, BSN, RN]

We always infuse over 3 hrs unless the order specifies otherwise. We use the alaris pump so I just program it in at 100ml/hr for 300ml and never have a problem.

[edimo]

We always infuse over 3 hrs unless the order specifies otherwise. We use the alaris pump so I just program it in at 100ml/hr for 300ml and never have a problem.

We also usually infuse over 3 hours typically and always use an alaris pump as well. Anything over 4 hours and there's an increased risk of lysis or bacterial proliferation.

[NewlyGradBSN]

In the 100ml per hour no complications were noted? Like dob or congestion? Or im thinking too much, the patient might have an underlying problem. Because after the dob and the neb she was relieved. But after 1 day, i remembered the pt being brought to the ccu.

[annie.rn]

Check your hospital's protocol but everywhere I've ever worked the blood cannot hang for more than four hours. I always aim for 3 hours (unless trauma or acute blood loss). That way if I run into issues (bad I.V. site, etc.) I have a little cushion to get it in by the 4 hr. mark.

[NewlyGradBSN]

Yup its 2-4 hours by protocol but sometimes ordered otherwise

[NewlyGradBSN]

In that rate arent patient at risk for congestion?

[SoldierNurse22, BSN, RN]

I've run it in in about an hour before on patients who were severely low in their counts. They didn't have any adverse affects.

At my facility, blood that is hung for longer than 4 hours is expired due to the risk of clotting in the bag. There are no exceptions. You need to check your policy as this is typically the case across the board.

[ChristineN, BSN, RN]

Yup its 2-4 hours by protocol but sometimes ordered otherwise

You can run blood as fast as you can get it in if the pt is sick enough. I have given blood with each unit going in over 10 minutes via a rapid infuser in a pt that was bleeding out during a cardiac arrest.

[jallen326]

In that rate arent patient at risk for congestion?

As a former oncology nurse, I can tell you that you have 4 hours to transfuse a unit of blood and if you are worried about congestion then get an order for lasix from the prescribing doctor. Most of the time I am giving 2-3 units of blood with lasix in between each unit.

[KelRN215, BSN, RN]

When I worked in the hospital (pediatrics), standard rate for blood transfusions was over 3-4 hrs. 4 hours was the absolute max and the blood expired at the 4 hr mark.