Blood Transfusion With Leaking AAA

[atimeforeveryseasonednurse]

Moments before my patient was leaving our ER to be transferred to the tertiary center for immediate repair of her leaking triple A, an RN cohort pulled my NS flush bag off my currently infusing bag of PRBC's and hung a second unit on the NS spike. She didn't ask me how I wanted to proceed with the second unit. I didn't see her check the blood. Both units were cross-matched. I had two large bores in both arms, one with dopamine running. I've been an emergency room nurse for 30+ years. She for about 9 years. I've never done that, hang two units on the same blood tubing spike without a flush. I am aware of my facility's protocol. The patient was critical, for sure, but is there any reason to hang blood that way?

[MunoRN, RN]

I wouldn't say the two spikes necessarily have to have one dedicated for use only as a flush when multiple products are to be transfused, particularly transfused at least semi-emergently. In my experience, typically you would alternate between the two spikes, then at the completion of the transfusions a flush bag would be hung on one of the two spikes and used to flush the tubing.

[canoehead, BSN, RN]

I looked up the manufacturers recommendations a long time ago. Tubing is good for two units or four hours. But the blood needs to be checked every time.

[NickiLaughs, ADN, BSN, RN]

We’ve done that on critical hypotensive bleeding patients. Have you ever used a level 1 transfuser or a Belmont? You basically spike blood on both tubing ends to save time to get it in them as fast as possible. Our MTP (massive transfusion protocol) standardly does this. But we still check every unit of blood as we hang it. That would be my only concern with the other RN.