Blood Transfusions Question??

[jk2185, BSN, RN]

How fast do you run in a unit of PRBCs? CHF patient? Elderly patient? What's the fastest you've run PRBCs in?Do you always pre-medicate? and if so, with what?Ever found it harder to infuse through certain types of access? Ex: Ever messed up a chest port or other central line from infusing products??Ever had a patient with a reaction? What happened?What about other products such as cryo, FFP, or platelets.I'm gathering data to better my own practice because most times I'm going based on feel (and evidence, of course).

[Spidey's mom, ADN, BSN, RN]

My first thought . . . what does the physician's order say?:)

[summerly]

Or look up the policy/procedure

[Spidey's mom, ADN, BSN, RN]

That was my second thought summerly!

[jk2185, BSN, RN]

Often it says briefly "transfuse 1 unit PRBC."

[roser13, ASN, RN]

We've always run PRBC wide open.

[Spidey's mom, ADN, BSN, RN]

Often it says briefly "transfuse 1 unit PRBC."

Then you need to look at your facility's P&P.

Some units, like roser13 stated, run them wide open. I don't because usually my patients are little old ladies with low iron and a hx of CHF.

I will say that this can get confusing without some help. Our P&P says we can't run them any faster than a certain amount but nurses regularly do.

[brownbook]

Your hospital has to have a policy on transfusing blood. You get a copy of the policy and keep it with you. Your hospital has to have a transfusion reaction form. You keep that with you.

Many doctors have no idea what the hospital policy is. I would not be shocked if a doctor said..."run it in over 6 hours" which is against all blood transfusion policies I've ever heard of. Generally speaking, for a generally debilitated elderly patient with CHF I would run it over 4 hours unless something else was going on.

A physician will order premedication. A nurse cannot just automatically premedicate unless it is written into the hospital policy, standard protocol for blood transfusions.

I've never had a blood transfusion reaction....maybe I have slowed blood down, given some benadryl per doctor orders, not a ABO incompatibility reaction, just a (I forget what medical term to use??) minor ?? allergic reaction.

I have never transfused blood through anything except a peripheral IV site. Not that other ports, sites, aren't very acceptable to use, just the places and types of patients I have had.

[Rose_Queen, BSN, MSN, RN]

Many doctors have no idea what the hospital policy is. I would not be shocked if a doctor said..."run it in over 6 hours" which is against all blood transfusion policies I've ever heard of.

My facility actually specifically addresses this within the policy. For some of our CHF patients, they do need blood given that slowly. Blood bank splits the unit into 2 bags and each bag is run over 3 hours. Meets the criteria of blood being in within 4 hours of leaving the blood bank without increasing the risk of fluid overloading the patient.

As for how fast I've run blood? Well, when I'm the one hanging blood, it means a massive transfusion. We're using the rapid infuser with huge IVs and running under pressure at 300mm Hg. We can get a unit of blood in within 90 seconds.

[CelticGoddess, BSN, RN]

My first thought . . . what does the physician's order say?:)

And the hospitals policy. Go by the two and you would be okay.

I work Onc/Palliative/Med-surg, so most times when I give blood it's either going into a port, PICC or IJ. Have yet to have issues after the transfusion. My onc patients are always pre-medicated but the MD writes those orders. (Usually Benadryl, Tylenol and occasionally decadron).

I have seen a handful of transfusion reactions, most were mild, but a couple were severe: One was an allergic reaction (and as the patient was receiving her own stem cells, they think it was actually the preservative)

The other the patient spiked a temp, and developed gross hematuria. I never did find out what the outcome of that was. He was very sick to begin with which had a lot to do with the reaction.

[NurseGirl525, ASN, RN]

I guess it depends on the situation. Sometimes, it's as fast as you can get it in, others, it's 150mL/hr. You need to see your hospital policy and what the physician wants. I would clarify the order if I wasn't sure.

[KatieMI, BSN, MSN, RN]

Well, if it so happens that policy says "up to four hours" (does it mean one? two? three and a half?) and the order says nothing in particular, then you probably should use your clinical skills.

Baseline, you got to take vitals right before and 15 min after transfusion (the 15 min from the moment the PRBC hit the recipient's vein). If there is no changes, the safe limit of speed for PRBC transfusion, counting that it stays 85% within the bloodstream:

- no CV problems, no acute bleed: 500 cc/h (1 unit/around 40 min)

- mild to moderate CV problem (NY class II, LVEF around 40%, no JVD/SOB at rest): 300 cc/h, 1 unit/1 hour 15 min

- severe CV pathology (NY class III-IV, LVEF 30% or below, JVD/SOB at rest, unstable vitals EXCEPT continuing acute bleed): 150- 200 cc/h, around 2 h/unit with as little normal saline flush as possible, b/o added sodium. Do not forget asking doc about Lasix after. Vitals check q15 min round the time.

The key is patient having no new symptoms and stable vitals. Mean BP should either stay the same or go slightly up, NOT decrease.

Continuing acute bleed: wide open unless ordered otherwise. I still have my transfusion slip somewhere, it said 38 units of only PRBC (plus FFP, platelets, pressors, you name it all) within 2.5 hours.