How Do You Prime Blood Tubing?

[All4NursingRN]

on an dialysis/ESRD or CHF patient?

one of my co-workers says that it was not appropriate to prime blood tubing with a 250 NS bag, instead she took two 100 ml bags of NS, spiked and primed each side of the Y-tubing.

Now I understand that you would not want to overload an ESRD/CHF patient with fluids, but if the patient (any patient) was to have a reaction to the blood you would NOT take the same blood tubing and flush the line anyway becuase you do not want to flush the additional blood in the line into the patient as to NOT further the reaction, wouldn't you spike a seperate bag of NS to flow into the patient?

Does it matter what size NS bag you choose to initially prime the tubing with?

[klone, MSN, RN]

Per your hospital's policy.

The size of the bag is irrelevant, because you're not putting the whole amount of the bag through the tubing when you prime it.

Some units do not have 100 ml bags readily accessible.

[MN-Nurse, ASN, RN]

I have no idea why your coworker wanted to prime with 2 bags of NS.

You are correct, if the pt has a reaction, you disconnect the blood set and use a new regular set.

[Do-over, ASN, RN]

Not really sure what difference the size of the bag makes... It matters more how much is infused.

Plus, with any luck, the blood can be infused with dialysis...

[All4NursingRN]

Thanks for the responses, because this fellow nurse made me feel dumb for priming it with a 250 ml NS bag because the patient was CHF (when indeed the patient was ESRD) but she was just running off at the mouth and didn't even know the patients entire history.

[iluvhrts]

I'm having a hard time with your co-workers rationale.. what matters is how much NS they get. I work in dialysis and we sometimes prime the tubing with saline but do not hook up the venous line of the patient until there is 2-3 inches of saline left in the line to reduce volume intake. When I worked in the CVICU, I did the same thing, primed the tubing with NS, spiked the blood, then ran the blood until it was almost at the end of the tubing (wasting the NS wherever you waste), then hooking to pt. If they have a blood reaction, it would be treated the same way no matter what size bag?? You wouldn't give them another unit of blood through that tubing...

[MN-Nurse, ASN, RN]

Thanks for the responses, because this fellow nurse made me feel dumb for priming it with a 250 ml NS bag because the patient was CHF (when indeed the patient was ESRD) but she was just running off at the mouth and didn't even know the patients entire history.

What the hades does CHF have to do with it?

[Pepper The Cat, BSN, RN]

I don't work with Dialysis pts, but I do work with pts with CHF.

I always prime with N/S - its hard to prime with blood. The amount of N/S they get is minial - less than 50cc.

Plus, we always give lasix between units to help with the posible fluid overload.

Finally - it does not matter what size bag you hang - you don't give the full bag! I usually hand a larger sized bag because most pts get 2 units so I can run the saline between units - and while I give the lasix.

[All4NursingRN]

she just walked up to me as I had the primed tubing in my hand and was like no, no, no if you're patient has CHF 250 ml is too much to prime with, she then took it from me got two 100 ml bags of NS and primed each side of the Y-tubing with it.

I just sat there looking at her like ok missy do what makes you feel happy.

Mind you she was precepting a student so I think she was in the mood to show off (more than she normally does anyway)

But yes we do worry about fluids overload with our CHFers and ESRD/Dialysis patients.

[All4NursingRN]

While we're on the topic, have any of you used Y-tubing for anything other than blood administration?

[Vespertinas]

I also don't understand why she primed BOTH sides of the Y tubing with it. That's not the way to do it anywhere.

To answer your second question, we use the Y tubing for all blood products including FFP and platelets. I can't think of another use for it.

And now that I think about it, since she implying that she empties the whole bag on her patient, I'd clarify with her that that's what she really meant. If it is, then I'd go ahead and tell your manager because who knows what other incorrect technique she is practicing and teaching. Maybe I wouldn't have been so ruffled about this if she was on her own, but as a headstrong preceptor she makes me concerned.

[wooh, BSN, RN]

I always prime with N/S - its hard to prime with blood. The amount of N/S they get is minial - less than 50cc.

I used to do the same, but our P&P changed and we aren't allowed to prime with saline. Fighting the pump and bubbles is super fun!