Can you give preblood transfusion IV meds less than 30 mins before the transfusion?

Editorial Team / Admin · Apr 28, 2018

What does your facility's protocol state?

Sour Lemon · Apr 28, 2018

What does your facility's protocol state?

Or your actual MD orders?

brownbook · Apr 28, 2018

Gosh, so nit picky.....both responses are of course correct, but I can't imagine any doctor or nurse getting so concerned over this issue. I can't imagine it would make that big a difference?

I wonder of the poster was chastised for when he gave the pre blood transfusion meds, or just curious. What about 15 minutes? Or 10 minutes? Or 25 minutes? Sounds a little OCD to me.

Sorry, I'm in a nit picky mood today: :rolleyes:

Sour Lemon · Apr 28, 2018

Gosh, so nit picky.....both responses are of course correct, but I can't imagine any doctor or nurse getting so concerned over this issue. I can't imagine it would make that big a difference?
I wonder of the poster was chastised for when he gave the pre blood transfusion meds, or just curious. What about 15 minutes? Or 10 minutes? Or 25 minutes? Sounds a little OCD to me.
Sorry, I'm in a nit picky mood today:

I agree, but in cases where the patient might be intermittently febrile, I like to give Tylenol in time for it to start working well. I hate getting vitals 15 minutes after the transfusion has started and being right on the fence about stopping or continuing it.

LovingLife123 · Apr 28, 2018

I've never once been told to hold meds prior to transfusing. I'm kind of grasping the concept of why somebody might think to, but when I thoroughly think it through, it doesn't make sense.

Double-Helix, BSN, RN · Apr 28, 2018

You want the premeds to be effective, which means you need to allow time for onset prior to starting the transfusion. If your patient is allergic to platelets, for example, and you give the premeds immediately before starting the transfusion, they may still react because their allergic response is triggered before the antihistamine or steroids have time to control it. Exactly how long you should wait depends on onset and peak effect of the medication. This will vary depending on the drug and route of administration, so you can consulting a drug guide or hospital formulary for that specific information.

Some of these responses make me roll my eyes. Of course following the policy or orders is the right answer, but it doesn't help the nurse understand WHY this is important. Taking the time to explain the rationale will help the OP much more than taking the easy way out and telling him/her to be a good boy/girl and follow the orders.

cleback · Apr 28, 2018

Our protocol says 30 min before. Would be kinda pointless to give immediately before.

MunoRN, RN · Apr 28, 2018

I would guess you're referring to premedication for a febrile non-hemolytic reaction, in which case the medication is primarily for patient, and nurse, comfort. It keeps the transfusion being unnecessarily discontinued as much as for comfort.

guest940422 · Apr 28, 2018

Yes, you can. Ideally, they would have some time to kick in. But if the blood is already on the unit and you haven't given them yet, you are going to miss your window to hang your blood. It's better for the patient to get the meds right before than not at all.

If the patient has decent labs and a ton of antibodies, is at higher risk of reaction and not symptomatic, then send the blood back to the bank and premedicate first.

If the patient has ****** labs, is symptomatic, and the pre-meds are just being thrown in for good measure, flush the IV with the pre-meds and hang the blood... don't delay the blood for Tylenol.

For the love of God don't "just do what the policy says" or " just follow your orders" you're a nurse not a monkey. Orders and policies do not replace critical thinking. Each patient is different.

End Soapbox

The short answer is Yes. PO drugs don't have an onset for 30-60 min. But IV drugs will be systemically absorbed within 5-10 min or less. The meds aren't useless just because you didn't wait 30 min.

Have Nurse, ADN, RN · Apr 30, 2018

I've never once been told to hold meds prior to transfusing. I'm kind of grasping the concept of why somebody might think to, but when I thoroughly think it through, it doesn't make sense.

Yes, but we don't know how new this nurse is, or if they've ever done this before. The fact that they are asking is wise and should be encouraged.

guest940422 · May 2, 2018

Yes, but we don't know how new this nurse is, or if they've ever done this before. The fact that they are asking is wise and should be encouraged.

Thank you, if there are a few vultures around all nurses (I've been guilty myself). Hopefully your co-workers are more forgiving. At the end of the day everyone runs into situations where they need a secound brain to think things through. Don't ever do something you aren't sure about without asking. Much better to get a funny look before the fact than after.