Blood Transfusions: How fast do you go?

We get a lot of blood transfusion patients to our med/surg floor. Many are coming in just for the blood and then D/C. In fact, some are complaining that on our unit, we run the blood in too slow, as they get each unit over 2 hours at "the other outpatient clinic." Assuming a unit is about 300 ml, that's 150ml/hr! Most of the time the docs are not writing in how fast to give the blood, so it is at the RN's discretion.

I am uncomfortable with 150ml/hr, unless the MD says it's okay to run it in fast. Am I just old school or what?

I start out at 70ml/hr for 1st half hour, and if pt tol well and vitals okay, etc., bump up the rate after that. If they are elderly, I don't like to go above 100ml/hr.

For the younger folks, I will run at 125/hr if tol well. This is of course, a non issue for inpatient transfusions, as they are already staying the night. But I am getting grief from these outpatient type transfusion patients...who want to go home immediately!  Some are quite rude, too. Many are oncology patients. I am only trying to be safe and not dump in fluids too fast.

By the way, I checked our facilities P&P and they say to run it in under 4 hours. 3 hours seems about right to me. It can take a long time if they are getting 3 units. Just curious if I am being over-protective?

30 Answers

Specializes in Med/Surg, Ortho.

I usually start all transfusions at 100ml/hr for 15-30 min. If patient is tolerating well or if they already have orders for pre-treatment or lasix between units i usually wont go over 125ml/hr. If they are young, they can usually tolerate 150ml/hr without difficulty.

I used to have a patient that would come in for transfusion on a regular basis. He dictated how fast he wanted it to go and thats how i gave it. He knew exactly how long he had to "waste" in there getting transfused and he wanted OUT when he wanted out. He used to like me because i didnt make the wait between units a big deal, i usually had the second up and ready to hang when the first one was done. Very picky, but he liked me so always asked for me to give his transfusions. I kind a miss him.

I usually run it over 3 hours. Most of the time, I start it at 100ml/hr, then bump it up to 125/hr if tol well after first 15 minutes. If the pt is a CHFer or renal compromised, I usually don't go much more than 100/hr. Take it easy on the elderly and frail. I have run it at 150/hr for surgery pt's who don't have additional med probs. Those people your talking about can either be patient, or they can just go to "the clinic" everytime they need blood. You are right on the money! Transfusions are nothing to take lightly.

Specializes in Psych, Med/Surg, LTC.

I am a bit paranoid about running blood. I start out at 50cc/hr for 15 min, then bump to 75, then 100, then 125. I don't go above 125 unless they are young and healthy. Then I go to 150. It usually takes me 3.5 hours to get in one unit. Not really a problem though since it is night shift that I work and the patients aren't in a hurry to go anywhere at that time.

Specializes in LTC, assisted living, med-surg, psych.

I usually started transfusions at 75ml/hr for the first 15 minutes, then bumped it up to 100-125 if the patient's vital signs were stable and their lungs remained clear (or didn't worsen if they'd had some crackles to start with). A lot depended on the patient's age, weight, and general health---I'd transfuse a unit in a younger patient with few other medical problems over 2 hours, while a unit going a frail elderly pt. with CHF history would take the full 4 hours. I was also very anal about staying with the patient for those first 15 minutes or so---I caught more than one transfusion reaction that way, and was able to stop it before things got out of hand.

I just don't think you can be too conservative with blood transfusions, unless of course it's an emergency situation where it's pouring out faster than you can run it in, and that's not something you deal with on med/surg very often (thank Heavens!).

Specializes in Inpatient Acute Rehab.

It depends on the situation. I have run it in on a trauma patient at 250/hr-- but that is not common

Sometinmes we will go 4/hr sometimes 2/hr---just depends on the patient and the dituation.

Specializes in Emergency.

Personally I have ran a unit in as fast as it could be squeezed in, a matter of 2-3 minutes on trauma patients. I have heard as long as several hours when a unit is split by the blood bank and each portion over the maximum 4 hour out time.

Specializes in Med/Surg, Geriatrics.
kona2 said:
We get a lot of blood transfusion patients to our med/surg floor. Many are coming in just for the blood and then D/C. In fact, some are complaining that on our unit, we run the blood in too slow, as they get each unit over 2 hours at "the other outpatient clinic." Assuming a unit is about 300 ml, that's 150ml/hr! Most of the time the docs are not writing in how fast to give the blood, so it is at the RN's discretion.I am uncomfortable with 150ml/hr, unless the MD says it's okay to run it in fast. Am I just old school or what? I start out at 70ml/hr for 1st half hour, and if pt tol well and vitals okay, etc., bump up the rate after that. If they are elderly, I don't like to go above 100ml/hr. For the younger folks, I will run at 125/hr if tol well. This is of course, a non issue for inpatient transfusions, as they are already staying the night. But I am getting grief from these outpatient type transfusion patients...who want to go home immediately! Some are quite rude, too. Many are oncology patients. I am only trying to be safe and not dump in fluids too fast. By the way, I checked our facilities P&P and they say to run it in under 4 hours. 3 hours seems about right to me. It can take a long time if they are getting 3 units. Just curious if I am being over-protective??? That's my usual tendency, by the way (not always a bad thing). ?

Hi Kona. 150 ml/hr is not that fast even for a blood transfusion. I used to run blood transfusions in 2 hours, that is perfectly acceptable. I wouldn't be too put out by the patients' being rude, especially as they are oncology patients they probably spend a lot of time at doctors' offices and in hospitals and they probably get pretty sick of it. Now the real reason is why are they admitting patients to the floor for the sole purpose of getting blood transfusions, that sounds mighty inefficient to me.

I work in ICU, so we do things a little out of the ordinary during critical situations sometimes. A couple weeks ago I had a patient with GI bleed transferred to me from the floor with a HGB of 4. Yep... it was rechecked and the HGB was indeed 4. She was barely responsive and pale as a ghost. B/P was 60-70's systolic. NG placed with immediate return of 1000cc blood and coffee grounds.

I asked the GI physician if I could 'slam in' two units at once. He said SURE. So that's what I did. I hooked up TWO bags of PRBC's and ran them both in at 500cc/hr. They were both infused (per #20 peripheral IV's) within 45 minutes... After those two bags had been rapidly infused, patient's b/p stabilized with SBP 120's-130's, color pink, awake + alert and calling family members on the phone. It was a dramatic difference from an hour before.

Anyhoo, I ran in the patient's next two units separately and at approx 250cc/hr. The GI docs were wanting to do an EGD when she was stabilized and after FOUR units of blood had infused... so, for this patients sake, the faster, the better.

Most of the time, I'll run blood in at 125-150cc/hr. :)

Specializes in Med-Surg, Geriatric, Behavioral Health.

I usually start off the first 15 mins at 50ml/hr. If pt tolerates and is fairly young, I bump it up to 125ml/hr. If elderly or has heart condition, I bump it up to 100. I listen to their lung sounds afterward at intervals. Lasix between units is common.

Specializes in Med-Surg.

Depends on the patient. 150 cc/hr is not a lot of fluid to be transfused over an hour when you think about it. That's only 2.5 cc/minute. Not a whole lot faster than the 125 cc/hr you use.

If the patient is elderly, has a history of CHF then obviously you're going to go slower.

If the next time you get grief, simply point out your policy to the person saying "look up the policy, it says four hours". End of discussion. But seriously 2 hours for a blood transfusion is not going to harm your average healthy patient or throw them into fluid overload.

I usually take the full four hours. I start off slow for about five minutes and then crank it up. But if I have an order for multiple transfusion and the patient is young (as are often my patients) I'll go faster depending on their history.

Specializes in Adult tele, peds psych, peds crit care.
onarie said:
I work on a med/surg telemetry floor. The majority of our patients are elderly and have CHF, CRF, COPD, or some other chronic condition. When we give blood, we use a pump and start it at 75cc/hr.

I work tele also and I generally run blood at 75 for 15 minutes then increase per the patient's status. For the CHFers, I calculate the rate based on a 4 hour infusion. No sense playing with fire.

Lowest H&H I ever saw was actually the night before last- I had a 36 y/o female with an H&H of 3.4/16.5

She drove herself into the hospital with a simple c/o "being tired all the time". Well NO KIDDING! On monitor, a simple sinus rhythm, 60's with pvc's that quieted as the 4 units of prbc's infused.

I had seen blood transfusion given 200ml/hr. No reactions and given on a 22 gauge needle. in our hospital, 20g is the number. I usually run the blood over 4hr. stay with the patient and start counting the 15min when the blood enters the patient body.

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