I work in a very busy ED. I had a horrible, crazy busy night. My patient had blood ordered to be infused over two hours and I accidentally set the pump to infuse over 30 mins. I've never made this big of a mistake before. What do I do? Do I go tell my manager everything? Do I hope the ICU caught and corrected it? This was last week so the patient already received the transfusion. I can't believe I did this.
Well believe it because you did, just like every one of us out there who'd like to call "overs." Take a little time and beat yourself up over it and then let it go because it's history. And don't poke the bear.
Make sure that you don't do it again, but otherwise there isn't a whole lot to do. You would be monitoring for the same transfusion reactions and give the same treatments whether give over 3 minutes or 3 hours. More than likely there is little detriment to the patient from giving one unit over 30 minutes rather than 2 hours.
As an aside, I'm somewhat surprised that you have a time that your blood was ordered to be infused over. In our ED, ICUs, and PICU time of infusion is more of a nursing decision based on why we are giving blood and the patient's individual risk factors. I've pressure infused or hand pumped in platelets and PRBCs for acute hemorrhage, even when not part of a trauma or MTP. If our providers are concerned about our infusion times, it is generally that we are not giving the blood fast enough to sick patients.
Don't be so hard on yourself. The Er is a busy place to work and can get chaotic. The best thing to do is remain calm when it get busy
Honestly? If I can bang in a unit of blood in 30 minutes, I'm a happy ED RN.
I've never heard of parameters for infusing blood in the ED, I know that is different on the floors though. If you're feeling bad enough about it, go "tell on" yourself. I've done it plenty of times and the response is usually to stop obsessing over it. Was there harm to the patient? Probably not, or you would have heard about it already. Cut yourself some slack, and if that's the biggest mistake you ever make, consider yourself lucky.
Most nurses in my ER dont use a pump, but I always do but there's some times that I've administered blood wide open before on a 16/18ga and they finish within 30min to 1hour no problem. I stayed with the patient in the first 15 minutes as I should.
It's a standard of care in transfusion medicine that PRBCs be infused over ~2 hours in hemodynamically stable pts who aren't exsanguinating. So maybe anticipate a similar order in the future when your patient is stable but just needs a whif of blood. Buuuuut like others have said, I've given units over mere minutes, so the risk to the pt was probably minimal unless they were a volume-sensitive type.
We always have time parameters! 50ml/hr for first 15 minutes(as per hospital protocol) and then at a rate decided by the provider, but no more than 4 hours
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