Blood Transfusions Question??

loriangel14, RN · Jul 3, 2016

It depends on the patient. Usually I start it around 125 and if they are ok then I will up it to 150 or so. It depends on the patient . Our policy just states no more than 4 hours. You only pre educate if it's ordered. Once I had a lady with a history of reactions and she was ordered IV be Benedryl before hand. About 15 minutes in she developed a temp and rigors.

Lev, MSN, RN, NP · Jul 3, 2016

It really depends on the need and also if they have heart failure or kidney failure etc. The fastest I've run blood in was wide open on a level one pressure infuser (trauma arrest patient). Blood must be given over 4 hours from the time you get it from the blood bank. In the ER, I generally give blood over anywhere from 1-3 hours. The order either says to give each unit "as quickly as tolerated" or over 1, 2, or 3 hours. When I worked med-surg at my old hospital the orders didn't indicate how fast to run the blood over so I would usually match the rate of their IV fluids (and I would turn their IVF off) as long as I could give the whole unit within 4 hours. I rarely premedicate unless it is a patient who has many antibodies and had a reaction to the first unit of blood or if a CHF patient is getting a couple units of blood in which case I will premedicate with lasix before the second unit. Some patients are sensitive to the cold temperature of the blood. I have never messed up a port or central line and only once had to change an IV line mid tranfusion - it started leaking. It is very important to make sure you have a working IV line. If the line aspirates it mean it is not even partially occluded. You can give blood through at 24 or 22 g catheter - just be sure they are working properly. I would not give blood through a 24g catheter unless I could aspirate blood when pulling back (I have never had to do this). I have given blood through a 22g catheter many times. I have had patients have allergic reactions (hives), febrile reactions, and had a patient develop shortness of breath. In most cases, we medicated the patient and continued the transfusion. I have never given cyro. I understand it is given a lot in the ICU setting. I have given FFP/Platelets. You can use regular IV tubing vs the blood tubing. I usually run FFP over 1/2 hour - 1 hour. Can run off the pump. At my old hospital, the bloodbank sent up special tubing with the platelets. Make sure you stay with the patient for the first 15 minutes of the transfusion to monitor for reactions. I run my blood very slow during the first 15 minutes. They will have a reaction even if only 15 CCs reach them. I start my blood at 999ml/hr on the pump until all the saline is primed into the patient and then pause and lower the rate once I see red reaching the patient's IV. That is from when I time the start of the transfusion.

Kitiger, RN · Jul 3, 2016

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.

Oh MY!

Kitiger, RN · Jul 3, 2016

It depends on the patient. Usually I start it around 125 and if they are ok then I will up it to 150 or so. It depends on the patient . Our policy just states no more than 4 hours. You only pre educate if it's ordered. Once I had a lady with a history of reactions and she was ordered IV be Benedryl before hand. About 15 minutes in she developed a temp and rigors.

Pre educate? Auto correct, right?

DeenieRN · Jul 3, 2016

Agreeing with all other posters: check order, check policy, confirm with Doc if necessary.

Take note of pts CV status prior to transfusion.

Always assess before transfusion - listen to your lung sounds!

I had a young 20 something pt with no CV hx or hx of reactions, not present with SOB after starting transfusion, but at 15 min I recheck VS and listen to lung sounds again, and the bases were wet, even though the pt didn't complain of SOB?! It was good to catch it early.

Elvish, BSN, DNP, RN, NP · Jul 3, 2016

Man, one of the longest nights of my life was when I had to give 3 units of blood when the physician's order specifically stated to give each over 4 hours. So, I was in this poor postpartum woman's room at least every hour waking her up. Fortunately, she was also kind enough to break my streak. Because up until then, every single patient I transfused for somewhere around 5 years had a reaction, some more minor than others.

It would totally depend on the situation, OP. I've had some postpartum situations where we're running in a unit of blood wide open, done in

AZQuik · Jul 3, 2016

Agreeing with all other posters: check order, check policy, confirm with Doc if necessary.
Take note of pts CV status prior to transfusion.
Always assess before transfusion - listen to your lung sounds!
I had a young 20 something pt with no CV hx or hx of reactions, not present with SOB after starting transfusion, but at 15 min I recheck VS and listen to lung sounds again, and the bases were wet, even though the pt didn't complain of SOB?! It was good to catch it early.

Sounds like TRALI. Often transfusion reactions require a cxr because this is a risk.

loriangel14, RN · Jul 4, 2016

Pre educate? Auto correct, right?

lol yes. Not what I meant to say.

lrobinson5 · Jul 4, 2016

The orders will pretty much address most of your questions. I've had one patient that had a reaction to blood. I actually started to hear him wheeze while standing at the edge of the bed. I immediately stopped the transfusion, he maybe got 5 mL. It really wasn't a huge deal, the patient was fine, I actually can't remember a lot of the details other than what he looked and sounded like.

kaylee. · Jul 4, 2016

Definitly depends on the many patient scenarios listed. Often our docs will order to give over 3 hrs. I usually start the 1st 15 min slow, our policy is 100 cchr then we can up it to 150-200 cchr. But depending on the iv access, if its a peripheral, and there is no huge rush, slower is better. Depending on the frailty of the veins. Like 150/hr. Picc line or bigger is best and makes me feel more comfortable.

blackribbon · Jul 4, 2016

I run it at about 75-100 for the first 30 minutes when I am at the bedside monitoring the patient. I turn it up to 150 then if they are tolerating it well.

However, our policy says never over 100ml/hr with a 20 gauge catheter because it can cause the blood to hemolysis and most of our patients arrive with 20 gauge IV catheters. I know I have nurses try to turn up my infusion rates when they are set at 100, but I try to follow policy, both for the patient's safety and to protect my licence.

Max time has to be watched (bag can't be on the floor for more than 4 hours). I have never had a problem with infusing the whole bag in that time though.

KatieMI, BSN, MSN, RN · Jul 4, 2016

I run it at about 75-100 for the first 30 minutes when I am at the bedside monitoring the patient. I turn it up to 150 then if they are tolerating it well.
However, our policy says never over 100ml/hr with a 20 gauge catheter because it can cause the blood to hemolysis and most of our patients arrive with 20 gauge IV catheters. I know I have nurses try to turn up my infusion rates when they are set at 100, but I try to follow policy, both for the patient's safety and to protect my licence.
Max time has to be watched (bag can't be on the floor for more than 4 hours). I have never had a problem with infusing the whole bag in that time
22g does not cause hemolysis even with pressure applied.
Blood Transfusions and IV Catheter Gauge | Infusion Nurse Blog
multiple mentions within cited articles
There is no solid evidence even reg. 24g, although it is going to be slow.
Sorry, but schmolicies based on someone's opinion instead of facts is my pet peeve:devil: