Gave Blood transfusion too fast maybe?

Nurses General Nursing

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Wanted to ask if anyone knew any effects of issuing a blood transfusion too fast besides the obvious ones that are easily found or included in text. What happened is my patients was admitted for a Hemoglobin level of 3.2. This was his first time to receive a blood transfusion. Only 1 unit was transfused at a time over four hours. I ran it at 50 over the first 15 minutes and patient had no issues. Turned it up to 90 ml/hr and after it was done his hemoglobin ( after two hours h&h was done) it only went from 3.2 to 4.7 after a unit of blood or (250 mls) were given.

Couod there be a reason why it only went up so little.

You're not giving us enough clinical information. Is the person still actively bleeding while you're transfusing the blood? Hemolysis? Cold aggultinin antibodies? There are any number of reasons it "only" went to 4.7, however just reading this casually 4.7 sounds like a decent response to 1U. Needs more, and an intervention to whatever is causing the bleeding.

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Specializes in Critical Care.

I've given 10 units of blood in 15-20 minutes.

You're fine.

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Specializes in 15 years in ICU, 22 years in PACU.
I've given 10 units of blood in 15-20 minutes.

You're fine.

NO, you are NOT. (In the vast majority of cases)

I would need a clinical condition that would support the decision to give 10 units of blood in 15 minutes.

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Specializes in Critical Care.
NO, you are NOT. (In the vast majority of cases)

I would need a clinical condition that would support the decision to give 10 units of blood in 15 minutes.

How about a cracked chest at the bedside that's bleeding out?

Or how about a massive trauma with a HGB of 2.5?

Good enough for you?

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Specializes in Emergency, Telemetry, Transplant.
How about a cracked chest at the bedside that's bleeding out?

Or how about a massive trauma with a HGB of 2.5?

Good enough for you?

Those are most definitely not in the "vast majority of cases." I think Maverick's point was (and I apologize for putting words in people's mouths) that even though it can be done, i.e, 10 units in 15 mintues, and you were OK doing it before, it does not always mean it is good idea; especially in this case, because we know very little about the clinical situation of the pt from the OP.

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Specializes in Critical Care.
Those are most definitely not in the "vast majority of cases." I think Maverick's point was (and I apologize for putting words in people's mouths) that even though it can be done, i.e, 10 units in 15 mintues, and you were OK doing it before, it does not always mean it is good idea; especially in this case, because we know very little about the clinical situation of the pt from the OP.

My point is that when proper safety protocols are followed, there presents little to no risk for the patient. Most transfusion guidelines are extremely conservative, and the OP is worried that one unit over 4 hours is too fast which is laughably absurd.

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My point is that when proper safety protocols are followed, there presents little to no risk for the patient. Most transfusion guidelines are extremely conservative, and the OP is worried that one unit over 4 hours is too fast which is laughably absurd.

One nurse giving 10 units of blood in 15 minutes.... I envision the I Love Lucy episode where a conveyor belt has candy and she has to wrap each piece. It goes faster and faster, she ends up stuffing unwrapped candy in her mouth, down the front of her dress, etc.

I don't think it's physically possible! That's more absurd to me than a new nurse concerned about fluid overload and her patient's hgb not going up enough.

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Specializes in Critical Care.
One nurse giving 10 units of blood in 15 minutes.... I envision the I Love Lucy episode where a conveyor belt has candy and she has to wrap each piece. It goes faster and faster, she ends up stuffing unwrapped candy in her mouth, down the front of her dress, etc.

I don't think it's physically possible! That's more absurd to me than a new nurse concerned about fluid overload and her patient's hgb not going up enough.

definitely possible.. level 1 and a cordis.

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definitely possible.. level 1 and a cordis.

Okay, thanks for the info.

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Specializes in OR, Nursing Professional Development.
One nurse giving 10 units of blood in 15 minutes.... I envision the I Love Lucy episode where a conveyor belt has candy and she has to wrap each piece. It goes faster and faster, she ends up stuffing unwrapped candy in her mouth, down the front of her dress, etc.

I don't think it's physically possible! That's more absurd to me than a new nurse concerned about fluid overload and her patient's hgb not going up enough.

Aren't you in periop? You've truly never seen a massive transfusion for a trauma patient or major GI bleed? Not only is it possible, it can even be extremely organized. We use type and crossed if possible, type specific is the next step, and O neg if necessary (and for many of these it is). We have a response team that goes to the patient: an aide for transport between blood bank and patient location, one coordinator who assists with checking blood, tracking how much has been given, when to draw labs, and a few other duties. We then also have a transfusionist who runs the rapid infuser and checks blood with the coordinator.

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Aren't you in periop? You've truly never seen a massive transfusion for a trauma patient or major GI bleed? Not only is it possible, it can even be extremely organized. We use type and crossed if possible, type specific is the next step, and O neg if necessary (and for many of these it is). We have a response team that goes to the patient: an aide for transport between blood bank and patient location, one coordinator who assists with checking blood, tracking how much has been given, when to draw labs, and a few other duties. We then also have a transfusionist who runs the rapid infuser and checks blood with the coordinator.

Yeah, I know, I know, just the way username posted it..."I've given 10 units of blood in 15 - 20 minutes". Makes more sense to describe how you posted it. Not "one" nurse doing it, but a very large group of health care providers.

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Specializes in 15 years in ICU, 22 years in PACU.
My point is that when proper safety protocols are followed, there presents little to no risk for the patient. Most transfusion guidelines are extremely conservative, and the OP is worried that one unit over 4 hours is too fast which is laughably absurd.

In these RARE cases, the greater risk to the patient is their current condition. WITHOUT blood they are essentially dead.

Do NOT confuse this with your much more common bedside blood transfusion. Proper protocols should always be followed to minimize the totally preventable risk of administering the wrong blood or the mostly preventable risk of administering it too fast for THAT patient.

There may also be some confusion about the 4 hours to administer blood. The 4 hours refers to the suggested maximum time for blood to be out of the controlled temperature of the blood bank refrigerator. That includes transport, bedside checks, setting up the administration set or pump and then the actual administration of the blood. The idea is to minimize bacterial growth in the perfect media for bacterial growth. Don't want too many germs hitch-hiking a ride along with your blood transfusion.

Forcing blood to hang over 4 hours (90ml/hr) is unnecessarily slow and worth a chuckle.

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