Can anyone help me with blood transfusion question

[andreead]

I just started my new med surg class and I have to do a blood transfusion in class.

I am trying to remember the skill and please correct me if I am wrong:

1. I spike the normal saline bag with a y tubing.( the clamp is closed at this time)

2. I open the roller clamp and I prime the line with normal saline. After I have enough blood to cover the filter, I close the roller clamp. I will also attach the tubing end to the patients port.

3. I will spike the blood bag and open the clamp for the blood bag and open the clamp for the saline bag. Some blood will go into the saline bag? I saw that and that was weird. Is that true?

4. I open the main clamp and I let it run initially at 2ml per minute for first 15 min take vitals and increase to what the order says if vitals are ok. Redo vitals in the end.

[GuEsT78]

Caring for kids with leukemia, I did the nurse tech end of a lot of transfusions (vital signs). The exact procedures (tubing and all) are likely to vary from school to school and hospital to hospital. What matters most is to understand why each item in the procedure is done. That'll keep you from neglecting what matters.

For instance, I wonder about checking the vital signs after 15 minutes and not checking vital signs until the end. Where I worked, we checked every 15 minutes for the first hour and, if necessary, every thirty minutes for the next hour. The one time I caught a reaction wasn't in that first 15 minutes. In that case, the temperature spike wasn't enough to stop the transfusion. Those kids absolutely had to have blood products.

My experience was long ago, so others will know more up-to-date procedures. But the principle to know why you're doing something in addition to what always applies. Google 'reaction to transfusion' and you'll find links to numerous, credible sources. Here is what Mayo Clinic tells their patients:

Blood transfusion Risks - Mayo Clinic

--Mike

[la_chica_suerte85, BSN, RN]

Caring for kids with leukemia, I did the nurse tech end of a lot of transfusions (vital signs). The exact procedures (tubing and all) are likely to vary from school to school and hospital to hospital. What matters most is to understand why each item in the procedure is done. That'll keep you from neglecting what matters.

For instance, I wonder about checking the vital signs after 15 minutes and not checking vital signs until the end. Where I worked, we checked every 15 minutes for the first hour and, if necessary, every thirty minutes for the next hour. The one time I caught a reaction wasn't in that first 15 minutes. In that case, the temperature spike wasn't enough to stop the transfusion. Those kids absolutely had to have blood products.

My experience was long ago, so others will know more up-to-date procedures. But the principle to know why you're doing something in addition to what always applies. Google 'reaction to transfusion' and you'll find links to numerous, credible sources. Here is what Mayo Clinic tells their patients:

Blood transfusion Risks - Mayo Clinic

--Mike

I'm pretty sure that it's until the end -- at least that's what we were taught (5 minutes, 15 minutes, then 30 minutes until the transfusion is done or according to agency policy). I'm curious about that too because with kids receiving a lot of transfusions, their risk for a reaction goes up.

There also are reviews as to whether priming with saline prior is necessary. http://www.perfusion.com/cgi-bin/absolutenm/articlefiles/5549-87973884.pdf

Anyway, I think part of why blood might go into the saline tubing is that the bag was lower than the saline (??) -- that's the only reason I've ever seen fluids flow back is when the heights of the bags are changed.

[futurecnm18]

On #3, you should not reopen the NS clamp. It should be closed when the blood is running which prevents blood from entering the bag of NS. Also, you should check vitals before you start blood, 15 minutes after blood has started and every hour while blood is running and an hour after blood is finished. I would also mention that you will monitor the patient while up to 24 hours after the transfusion for adverse effects. Once the blood is completed, then reopen the NS clamp to flush the line.

[NicuGal, MSN, RN]

You should refer to hospital policy for their VS protocol. Ours is at start, 15 minutes later, end. A reaction typically will happen within the first 15 minutes.

[Here.I.Stand, BSN, RN]

Don't open the clamp to the NS until the blood is finished -- then you just open it to flush the blood still in the tubing into the pt. If you leave it clamped, the blood won't back up.

As others have said, VS is dependent on the hospital and school policy. At my work we check VS before, 15 min in, and one hour post start time. But I work in an ICU, and we don't run a unit over hours either. We typically run it to gravity, or if it's a new GSW we might zip a unit in over 3-5 minutes on the pressure infuser (we're giving multiple blood products if this happens). On a med-surg unit, they might say it needs to run over 2-4 hrs, with more frequent VS. Check w/ your instructor.

[enuf_already]

And make sure that before you hang that bag of blood that you and another approved person check patient identification/blood information to make sure everything is correct!