Blood Transfusion

[Elena88]

Hi guys,

I've been overthinking a simple issue and was hoping someone here could help. If you're putting up back to back bags of packed red cells in a manual pressure bag (emergency situation where back to back units are being given as fast as possible)... do you use the same giving set between the units or do you have to change the giving set in between units? Also do blood bags have any significant amount of air in them that needs "burping" the same way as saline bags do when being given under pressure? I've just always been told you shouldn't actively squeeze blood bags as that can cause haemolysis so wasn't sure "burping" a blood bag was correct or necessary.

[Been there,done that, ASN, RN]

Blood administration is never a simple issue. Transfusing blood is as serious as it gets.

Review your policy and procedures STAT.

[Elena88]

I am aware of our local procedures, what I was asking isn't mentioned in any procedure notes hence why I've asked here. Regarding the giving set, depending on hospital the recommendation is changing sets every 2nd unit but I'm sure some hospitals say change after every unit so again I wanted to see what everyone else tends to do.

[RNAC92]

Hello,

I agree with btdt. It depends on facilities. Everywhere I've been, there is no air in the blood bag but you need to make sure your infusion set doesnt run dry. At my facility we can hang 2 prbcs back to back until we throw out the set. We also use pressure bags in special circumstances, otherwise it's the pump, which gives better volume control. Everywhere is different.

[Elena88]

2 minutes ago, RNAC92 said:

Hello,

I agree with btdt. It depends on facilities. Everywhere I've been, there is no air in the blood bag but you need to make sure your infusion set doesnt run dry. At my facility we can hang 2 prbcs back to back until we throw out the set. We also use pressure bags in special circumstances, otherwise it's the pump, which gives better volume control. Everywhere is different.

Thanks for that. yes we also only use pressure bags in an emergency otherwise it will be pumped

[Rose_Queen, BSN, MSN, RN]

In emergency situations with multiple back to back units, we are using a rapid infuser with a filter expected to handle up to 150 units. Is this not an option where you work? It also eliminates the need for pressure bags and has an air filter to deal with any air that may get into the line.

[Been there,done that, ASN, RN]

29 minutes ago, Elena88 said:

I am aware of our local procedures, what I was asking isn't mentioned in any procedure notes hence why I've asked here. Regarding the giving set, depending on hospital the recommendation is changing sets every 2nd unit but I'm sure some hospitals say change after every unit so again I wanted to see what everyone else tends to do.

It IS addressed in your policy and procedures. You just need to find it. Strangers on the internet... will not cover your practice.

[Daisy4RN]

1 hour ago, Been there,done that said:

It IS addressed in your policy and procedures. You just need to find it. Strangers on the internet... will not cover your practice.

Agree with this. Most p/p are very similar but you need to find out what exactly yours says. I have always seen 1 tubing for up to 2 consecutive units given within a specified time frame but have seen different time frames. If it is not specified then I would f/u with management or blood bank (if in house). You need to know to CYA and for appropriate pt care.

[Elena88]

5 hours ago, Daisy4RN said:

Agree with this. Most p/p are very similar but you need to find out what exactly yours says. I have always seen 1 tubing for up to 2 consecutive units given within a specified time frame but have seen different time frames. If it is not specified then I would f/u with management or blood bank (if in house). You need to know to CYA and for appropriate pt care.

Thanks, yes I know the giving set is mentioned in local procedures and I’m happy with what that says, I just wondered what other places tend to do. My main question was regarding pressure bags and red cells, again the ideal pressure setting and all that is clear from procedures, the question was about “burping” or not of the blood bag when being given under pressure which is not mentioned in the procedures

[K+MgSO4, BSN]

11 hours ago, Rose_Queen said:

In emergency situations with multiple back to back units, we are using a rapid infuser with a filter expected to handle up to 150 units. Is this not an option where you work? It also eliminates the need for pressure bags and has an air filter to deal with any air that may get into the line.

Not everyone works in a high level hospital as you appear to...

I work at a quanternary hospital in Australia (i.e. major trauma hospital) and we don't have that blood line and I work in one of highest usage areas for blood outside ED / periop.

[Elena88]

2 hours ago, K+MgSO4 said:

Not everyone works in a high level hospital as you appear to...

I work at a quanternary hospital in Australia (i.e. major trauma hospital) and we don't have that blood line and I work in one of highest usage areas for blood outside ED / periop.

Yeah Rapid infusers aren’t available everywhere, also in a prehospital setting you’d prob have a pressure bag not a rapid infuser

[murseman24, MSN, CRNA]

On 2/25/2019 at 6:26 PM, Been there,done that said:

It IS addressed in your policy and procedures. You just need to find it. Strangers on the internet... will not cover your practice.

If everyone did everything exactly according to policy, NOTHING would get done. Bedside reports would take 30 min/patient, doctors would go NUTS with never ending phone calls for a written order for every little thing. You can't tell me you do everything according to "policy". Some policies are just stupid, and they're all made up to cover the hospital's *** in case there is a lawsuit. It's impossible to follow everyone to a T and also take care of the patient in a way that makes sense.