hanging blood with the wrong fluids

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last night was a crazy night on a busy med-surg floor. i work 2nd shift and hung a unit of blood half an hour before my shift ended. they called me today to inform me that i hung the blood with the pt's ordered fluids of d51/2nss. i realize that this is an error as blood is only to be hung with nss. i am curious how serious of an error it is though. i hung the blood at 10:30pm, and the next shift came on at 11pm. the blood completed infusion at 1:30am the next morning. i am hoping they noticed and switched it to nss before the blood completed infusion. any input would be greatly appreciated.

OP... :hug:

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Well I will say that for the first year I was a nurse I was oblivious to the fact that you were only supposed to hang blood with NS. See, the facility I worked at would routinely hang our PCA's and their carrying fluid with the blood product. I was shocked when I switched jobs and found out how dangerous such a practice could be. So that being said, I never had anything bad reactions while hanging D5 or even D5 1/2NS along with the blood, so my guess is it's probably a very, very, small risk.

thankfully there were no reactions whatsoever in this case either. i did, however, learning to triple check myself before turning the IV to "run".

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Specializes in Oncology; medical specialty website.
i suppose all facilities and their supplies differ. we do have special blood tubing, which was used... it is not y-shaped but it does enable the blood to be piggy-backed into an existing line of nss. unfortunately, nss was not the existing line in this particular case though. thankfully the patient's h&h came up after the transfusion and the patient is doing fine. i have learned from my mistake though, after pounding my head into a wall for a few hours. thanks for the input!

I'll bet you'll never, ever make that mistake again. ;)

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Specializes in ED, CTSurg, IVTeam, Oncology.
dextrose is sugar. sugar is what we put in water to make syrup. dextrose can cause fatal reactions when hung with blood.

really? first time that i've heard this one. can you please elaborate and explain just how...

...dextrose can cause fatal reactions when hung with blood?

i'll have to be really careful then, next time i push that amp of d50... :uhoh3:

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This is a little off topic but something I have been wondering for a while...I work in a NICU and we don't hang blood with anything, we just run it alone as is. I have floated to the PICU/PCICU but did not at those times ask the question...at what point do you start hanging blood with NS? Is there a certain age, weight? Just curious, thanks!

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Specializes in Oncology; medical specialty website.
This is a little off topic but something I have been wondering for a while...I work in a NICU and we don't hang blood with anything, we just run it alone as is. I have floated to the PICU/PCICU but did not at those times ask the question...at what point do you start hanging blood with NS? Is there a certain age, weight? Just curious, thanks!

That's a good question. I've given blood to infants with a syringe pump and there was no NSS (obviously), but I also gave it to an older child ( ~5y old) and he had NSS.

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The simplest way to avoid that mistake is to set up a totally new line, even if the running IV is NS. If becomes a habit (I use a 500cc bag of NS) to do this and to switch over the entire line, you won't frun the existing IVF even when you are able to hang the blood as a secondary. One of my pet peeves is coming in to a line that was used for blood and still has blood is the cassette, etc.,-I want the line to be totally separate from the blood line, and want it switched back (or new tubing used) when returning to the ordered IVF. Haven't been able to convince other nurses of that, though.

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Specializes in pediatrics, public health.
The simplest way to avoid that mistake is to set up a totally new line, even if the running IV is NS. If becomes a habit (I use a 500cc bag of NS) to do this and to switch over the entire line, you won't frun the existing IVF even when you are able to hang the blood as a secondary. One of my pet peeves is coming in to a line that was used for blood and still has blood is the cassette, etc.,-I want the line to be totally separate from the blood line, and want it switched back (or new tubing used) when returning to the ordered IVF. Haven't been able to convince other nurses of that, though.

At the peds hospital where I used to work, it was standard practice to change all of the tubing for the blood transfusion, and then change it again to go back to the regular IVF. We weren't allowed to use tubing that had touched blood for more than 4 hours. So, if the pt needed so much blood that it would take more than 4 hours, the tubing would get changed AGAIN after the first 4 hours. In fact, it was 4 hours from the time the blood left the blood bank, not from when it got hung, because blood wasn't supposed to be left unrefrigerated for longer than 4 hours. I was under the impression that this was an infection control measure, though I'm not sure of that. In any case, the practice of changing over all the tubing made it almost impossible to make the type of error made by the OP.

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Specializes in floor to ICU.
Not as bad as hanging blood with heparin:) Seen that one. Patient had no adverse reaction. It happens but do be extra vigilant when hanging blood.

Yup, seen a 25,000 units of heparin hung as a IVPB. Infused in an hour. I always hated following that nurse. But we are all HUMAN and I have made med errors in my 20yr span as a nurse. I don;t think I have ever made the same mistake twice. So, learn from your mistakes, hold your head up high and carry on.... :)

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I did the same thing a couple of weeks ago! I didn't know that you were supposed to hang only w/ NS. I have been a nurse for a year and a half, yet I was never told. Of course it is in the thousands of "hospital policies" that everyone reads, right? It was NOT checked by the second nurse and NOT caught by the nurse I gave report to either. My head is the only one to roll. :crying2: I asked a couple of other newer nurses and they didn't know either!

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Specializes in Oncology; medical specialty website.

You don't normally check the fluid that's hanging when you're getting a second check on the blood.

You really are supposed to read the policies. Hanging blood with NS only should have been something that was reviewed with you when you were being checked off for unit-based competencies as well. Ultimately, the mistake was yours alone. Learn from it and move on.

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Specializes in Critical Care.

As a general rule, you should always remember to hang blood with NS, and at least know what fluid the line was primed with. But we don't really hang blood "with" any fluids, we only prime and flush the line with fluids.

That being said, if you want to know what the adverse effects many have been, D51/2NS is usually classified as hypertonic, although it is sometimes described as slightly hypertonic isotonic solution. Hypertonic solutions such as D51/2NS do not cause RBS lysis, hypotonic solutions do. In fact, hypertonic solutions are sometimes used to protect against cell lysis by other factors such as staph toxin.

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