Jump to content

Blood transfusions-how fast do you go?

Updated | Posted

You are reading page 2 of Blood transfusions-how fast do you go?. If you want to start from the beginning Go to First Page.

grinnurse, RN

Specializes in Med/Surge.

One of the nurses on my floor will start out slow and then zip it up to 185 even if they are elderly as long as they don't have CHF problems. Myself, I start slow and don't go over 125 regardless and I always stay with my patients the 1st 15 minutes! I can't imagine not being right at the bedside while transfusing blood.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

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.

Tweety, BSN, RN

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. Has 28 years experience.

Chaya said:
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?

We used to never use pumps, it wasn't alllowed. They changed their policy and it's fun to hear new nurses look at me aghast "I WOULD NEVER RUN BLOOD WITHOUT A PUMP, HOW UNSAFE". This happened to me just the other day in fact. Well, I never have infilrations giving blood. wink. Actually, I like using pumps, gives you more control, but in our cheap unit we don't always have pumps available.

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. Our policy states that we must stay with the patient for the first 15 minutes of each unit to watch for a reaction. After the first 15 minutes, the rate depends on the patient. I usually do not go over 125cc/hr. We have to be very careful to prevent fluid overload on many of our patients. Also, we don't want to blow that IV site that it took several attempts to start. We have to have the blood infused within 4 hours, and for many of our patient's this is pushing their limit.

My gripe about giving blood - is when I see co-workers go and hang blood and they start the 15 minutes from when they hang it. My 15 minutes starts from the time the blood actually starts going into the person.

telehead

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.

I work in oncology, with many elderly patients. That said, we normally run our blood over 2 hours.

We run all PRBCs on a pump, same with plasma. Sometimes platelets are run straight in, but usually on a pump just for good measure.

We stay with the pt for the first 5 minutes, come back and check vitals at 15 minutes, then they're good to go.

We generally give 2 units at a time, so sometimes folks will run the first unit in over an hour and 45 minutes, then use the same tubing for the second unit, since tubing is good for 4 hours.

Depending on the patient and the IV, I'll sometimes run the saline in at 300 just to get the blood to the patient, then slow it back down to 175 or so.

4theBetterGetter, RN

Specializes in Med Surg, Peds, OB, L/D, Ortho.

at the hospital i work at it is policy to start the unit at 300 cc/hr for the first 15 min. then decrease to run in over 1-4 hrs. as the pt condition indicates. always using caution with the frail, elderly, cardiac and pediatric patient.

Binkey, BSN

Specializes in Clinical Infusion Educator.

Wow...

Running a transfusion in at 300cc for the first hour, or 75cc for the first 15 minutes is way to fast according to published standards. Your hemolytic reactions will usually be detected during the first 15 minutes, therefore no more than 30 cc is usually run in during that short 15 minute period.

Diane

4theBetterGetter, RN

Specializes in Med Surg, Peds, OB, L/D, Ortho.

Binkey said:
Wow...

Running a transfusion in at 300cc for the first hour, or 75cc for the first 15 minutes is way to fast according to published standards. Your hemolytic reactions will usually be detected during the first 15 minutes, therefore no more than 30 cc is usually run in during that short 15 minute period.

Diane

Nooooo not 300 cc for an hour just for the first 15 min. Sorry I was unclear on that.

caroladybelle, BSN, RN

Specializes in Oncology/Haemetology/HIV.

As a hemo/onco traveler, it varies a great deal from place to place.

First, hemo/onco gives a lot of blood products, TPN, antibiotics, chemo and cardiac drips. When you have limited lines, multiple drugs and some meds that cannot be run within an hour or two of blood products, you have to work fast and efficient. Second, I am usually on a BMT and/or biologic unit, so it tends to be staffed better (hopefully, but not always!) than standard med surg units, with more monitoring.

Most places will run PRBCs on a pump. Some prefer that FFP and Platelets be run free by gravity, though a few permit pumps. Most want cryopricipitate run by gravity. And for the few places that transfuse granulocytes....they must ALWAYS be gravity hung, especially since you have to invert/agitate the bag and chamber every 5-15 minutes.

That said, PRBCs are run over 2-3hours, Platelets over 30-60 minutes, FFP 30-60 minutes, and Granulocytes (if well tolerated) over 1-2 hours. With CHFers/high risk for fluid overload patients, they will probably be getting lasix with the infusion, as they will be getting a lot of fluid from all their IVs, not just the blood products. They will also get blood premeds if records indicate the need.

Danielle RN

Specializes in Forensics.

Hi all,

I'm one of those "lucky" ones to have experience on both sides of the fence, being a nurse and a patient.

I was born with Cooley's Anemia, so I've been getting blood transfusions every 2-3 weeks since I was 9 months old. I don't make my own hemoglobin, so I must get it from others.

I could never imagine getting a unit of blood over 4 hours. That would be agony for me, since I need to get two units each time I'm at the hospital. I understand as a nurse that blood shouldn't be pushed quickly but, trust me, two hours is more than enough for a unit of blood for a healthy person, unless the unit is abnormally large (400+ml).

This is a way of life for many people, like myself, and it's very hard to live a normal life when you spend so much time at the hospital. Therefore, I think it should be taken into consideration the amount of time you are giving the transfusions over. Not only is it time consuming when you give a unit of blood over 3 or 4 hours, but the blood is also in danger of going bad or developing clots.

This is only my opinion, and I'm giving it from both sides of the spectrum. A normal unit of blood is usually between 275 and 325 ml, and I wouldn't have a problem giving a patient a unit of that size over 2 hours. As a matter of fact, the hospital that I used to go to for blood always tried to push my units in an hour and a half, and I always made them put it over two hours instead. So, I'm actually giving it more time than many nurses do here in New York. I don't like getting blood over 1.5 hrs, unless it's a really small bag. Otherwise, I end up with tachycardia and tachypnea.

I don't mean to step on anyones toes. I just thought you might want to hear a patient's point of view on this. :)

I think it also depends on whether the patient is a first-time recipient or not. I do run first-timers blood a bit more slowly than our folks who come in and are getting their fifth unit in two days.

I know each unit of blood is different, but in my experience someone "experienced" with transfusions usually does not react as often as a first-timer. Even then the reaction frequency is very low.

Nobody on our unit does anything that isn't approved in our organization's policy and procedure manual (being a newish nurse I have -definitely- checked), so while our rates may go against published guidelines for other institutions, we're well within our bounds at our own hospital. :)

And I know the question wasn't whether the IV can handle the rate but whether the pt can handle the blood...but you might be amazed at what a puny little 20 gauge PIV can handle. Over the past few days I've been running in chemo pre-hydration at close to 500/hr and the IV held up beautifully. (Doesn't mean I was totally happy about running it in that fast, but chemo orders are chemo orders.)

Danielle RN

Specializes in Forensics.

Runningnurse said:
I know each unit of blood is different, but in my experience someone "experienced" with transfusions usually does not react as often as a first-timer. Even then the reaction frequency is very low.

Funny you should mention that.

When I was 23 years old, I was a victim of one of the worst blood transfusion reactions around. I had a Transfusion-Related Acute Lung Injury (TRALI) and it put me on life support. My friend had donated the blood to me for the very first time, and she had a protein that my body didn't like very much. I ended up with non-cardiogenic pulmonary edema and an oxygen sat of 50, before I was intubated. That was March 2000, and it's a miracle that I'm alive today.

Before that time, I never had a transfusion reaction before, aside from the minor hives and low-grade fevers that are common. I had thousands of units of blood before that time, and never thought I would ever have a reaction like that. Ever since then, I treat every one of my (or my patient's) transfusions as if it is my first.

I understand what you mean, though. 🙂

As for needle gauges, I have used different ones at different times, and they all held up pretty well. I ended up getting two mediports (at seperate times) down the road, which made things easier, but I have since had them removed due to clotting.