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.

[LovingLife123]

I have never “burped” blood when transfusing with a pressure bag. I thought a line was good for four hours, but maybe that is just my facility.

[murseman24, MSN, CRNA]

Current recommendations vary with regard to the frequency of change of a red blood cell (RBC) administration set. A full review was undertaken to evaluate the recommendations for how often a RBC administration set should be changed while a patient is being transfused. Comprehensive searches of Medline, Embase, Cinahl, the Cochrane Library, handsearching of transfusion journals, guidelines and websites and contact with administration set manufacturers identified 32 relevant papers: 11 clinical updates; 11 guidelines; 5 manufacturer data sheets; 3 standards; 1 Department of Health report and 1 expert opinion. Recommendations varied widely across papers. There was no pattern in recommendation by paper type, date or country of origin. Recommendations were based on change of RBC administration set either after a given number of hours or number of RBC units. The recommendations varied widely and ranged from 4 to 48 h and from 'every unit' to 'several units'. The most frequent recommendations were change of RBC administration set after 12 h or 4 units. Methodological quality of the included papers is poor. There is no formal evidence base on which to support current recommendations or challenge the current British Committee for Standards in Haematology guideline. Targeted research aimed at establishing an evidence base may be warranted and would need to document other variables that can impact frequency of change, including type of filter, age of blood and duration of RBC transfusion......

From a quick google search, this is an abstract from pub med. Because I got curious.

[marienm, RN, CCRN]

At my hospital we're supposed to change bags every 2 units. In an emergency I suspect it's more like every 4 to 6 units or whenever the current cooler is empty. (Assuming we're not using the rapid infuser.) I have also never burped a bag of anything before pressure bagging it into anyone, and I've never bolused the patient with air. The worst that's happened was I got air in my tubing and had to replace or re-prime it. (The bag needs to be higher than the patient for this to work, so if that's not possible it's probably worth getting the air out.)

[Been there,done that, ASN, RN]

13 hours ago, murseman24 said:

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.

I certainly agree ALL policies and procedures cannot possibly be followed to the "t". However, you can bet your sweet tookas that blood administration is being closely monitored... and errors will come back to bite that sweet tookas.

[Ruby Vee, BSN]

Every hospital has a different policy as I'm sure you know. Different blood sets can handle different things, also. One manufacturer recommends no more than two units of blood through their tubing and another says that their filter allows you to infuse four units. There are special blood filters that you can add and use the set for more units of blood as well. You have to find out what your particular blood tubing is rated for. And yes, follow your policy unless you have very clear data indicating that a different practice is better.