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Blood transfusions-how fast do you go?

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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). 😉

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.

GooeyRN, ADN, BSN, CNA, LPN, RN

Specializes in Psych, Med/Surg, LTC. Has 21 years experience.

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.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

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!).

unknown99, BSN, RN

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.

Thanks for the replies. Most of these folks are oncology patients age 70 and up. Very rare do we see young folks or those with few medical problems. I'm glad I'm not the only cautious RN on the planet! LOL. It's just that I have been hearing so many complaints from the actual patients lately, that I was beginning to question my own judgement.

meownsmile, BSN, RN

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.

rjflyn, ASN, RN

Specializes in Emergency. Has 23 years experience.

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.

Rj

SharonH, RN

Specializes in Med/Surg, Geriatrics. Has 20 years experience.

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.

Chaya, ASN, RN

Specializes in Rehab, Med Surg, Home Care. Has 15 years experience.

One of the places I work at runs blood by pump only and over 4 hours.

The other never uses a pump for blood and runs it in 3 hours.

I'm not sure if you can run it faster with a PICC/central line or if a faster rate makes hemolysis more likely?

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. :)

Thunderwolf, MSN, RN

Specializes in Med-Surg, Geriatric, Behavioral Health. Has 32 years experience.

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.

Chaya, ASN, RN

Specializes in Rehab, Med Surg, Home Care. Has 15 years experience.

I'd like to know if blood is commonly run on an infusion pump at most places? Or do you just hang it to gravity and regulate the drip?

Thunderwolf, MSN, RN

Specializes in Med-Surg, Geriatric, Behavioral Health. Has 32 years experience.

We use pumps.

Good question, I find the different answers/policies & procedures interesting. I guess I expected more uniform answers since evidenced based practice is in our faces at every opportunity :)

At our hospital (I'm in the SICU) we do everything from 3 minutes per unit on a rapid infuser in emergencies to 20 minutes or so off pump with a pressure bag with unstable fresh hearts. For someone who is not critical but needs blood to correct labs, we run them in at less than four hours, as policy is that the blood must be disposed of at the four hour mark.

rjflyn, ASN, RN

Specializes in Emergency. Has 23 years experience.

As far as pump use goes it depends on the pumps the hospital uses. i have worked in a couple facilities that their pumps were not to be used for blood.

Rj

Hi All,

I'm new here. Just to let you know that when my mother was given blood the nurse on shift had squeezed the bag just to finish it up. My father and I

felt that this was wrong but we never said anything to anyone about it. Now I wish I would have.

porterwoman

Specializes in ABMT. Has 8 years experience.

VizslaMom said:
HGB of 4

:sofahider