Help with understanding allergic transfusion reaction

Esme12, ASN, BSN, RN · Oct 25, 2013

Never take a chance with the life line....IVF at a TKVO rate ....maintain the IV at all costs.

The patients life depends on it. Any RX for allergic reaction to blood would be IV. Did your question specifically state the benadry was po? If not then it is IV meds as the standard

holinurse · Oct 25, 2013

It did not specify PO or IV; The choice read "administer antihistamine as prescribed" as I copy and pasted above. I chose it second in the order because I reasoned that an antihistamine med (figuring it would be given IV) would be given immediately after the Blood infusion was stopped.

What are your thoughts?

Esme12, ASN, BSN, RN · Oct 25, 2013

I see your question now....If you stop the transfusion....what are you going to do with the open IV site when you go retrieve the benadry? Something has to go there to replace the blood.

It makes more sense when you are actively doing it.

Your patient is having a reaction....you know to stop the blood, tubing and all needs to be removed to the site...now you have an open line...so...you have your new IV and tubing ready to replace it...you hang the TKVO IV and retrieve your med to be given as prescribed....usually IVP.

Does this Make sense now?

holinurse · Oct 25, 2013

Ahhhh! Meaning..that when the transfusion is stopped, the tubing that is running the blood is immediately replaced as well?!?! And therefore, new tubing (or more accurately other tubing already hanging there?) with NS running is set up before administering the Benadryl?

If what you are telling me is that the tubing infusing the blood is discarded, I can understand the rationale and you've taught me something I didn't get in school lol.

Esme12, ASN, BSN, RN · Oct 25, 2013

Ahhhh! Meaning..that when the transfusion is stopped, the tubing that is running the blood is immediately replaced as well?!?! And therefore, new tubing (or more accurately other tubing already hanging there?) with NS running is set up before administering the Benadryl?
If what you are telling me is that the tubing infusing the blood is discarded, I can understand the rationale and you've taught me something I didn't get in school lol.

The tubing isn't necessarily discarded...depending on the facility policy....all blood bank bags are returned for testing when there is a reaction....some require the tubing as well.

If your patient has a reaction.....that tubing is full of blood and cannot be infused into the patient possibly causing a worsening of their reaction. To minimize this risk the entire tubing is removed and new tubing and saline if replaced to the site in preparation of the IV meds of if the patient worsens, goes into shock and codes.

You have your blood and saline on the blood tubing...your patient has a reaction....you immediately stop the blood to prevent any further infusion of the blood. You take vitals quickly...leave the room tell the secretary to call the MD or hospitalist or a rapid response depending on the patient condition.... you go to the med room get another IV tubing and saline...return to the room flush the new line. Wearing gloves you remove the tubing from the IV site...cap the end of the blood tubing to prevent a mess and immediately hang the saline IV with new bag and tubing at the TKO rate, take a quick set of vitals, then take the MD call with med orders...return to the room take another set of vitals and give meds. Bag the blood and tubing if required to return to lab for testing.

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Esme12, ASN, BSN, RN · Oct 25, 2013

Your school didn't teach this? What program, diploma, ADN/ASN, BSN was this?

holinurse · Oct 25, 2013

They were very clear on immediately stopping the infusion, but not on the specifics that would take place with the tubing, whether it would still be used, sent to the lab etc. Either way, I probably should've realized these details myself because anyone would know not to use the same tubing if it still had the blood in it/or was used for the blood.

BTW, What is your name? Thanks for your help!!! :)

Esme12, ASN, BSN, RN · Oct 25, 2013

My name is Esme.....:) Look for my crazy weim dog pictures!!

Any time.......:)

KelRN215, BSN, RN · Oct 26, 2013

It did not specify PO or IV; The choice read "administer antihistamine as prescribed" as I copy and pasted above. I chose it second in the order because I reasoned that an antihistamine med (figuring it would be given IV) would be given immediately after the Blood infusion was stopped.
What are your thoughts?

You stop the blood and immediately begin saline. It was policy in my hospital to have normal saline set-up/primed/ready to hang in the event of a transfusion reaction.

holinurse · Oct 27, 2013

Thanks for the response!

nurseprnRN, BSN, RN · Oct 29, 2013

At the risk of being repetitious, the reason keeping the IV open (as opposed to discontinuing it with the blood) is the priority after stopping the blood is because if you are about to have an anaphylaxis episode to deal with, you'd be better off having a functional IV in place beforehand because you sure as hell will have a hard time establishing one after the fact.