6 hour blood transfusion

[pedsnurse2002]

i was given an order to run blood transfusion over 6 hours secondary to hypotension after 15min with no other s/sx of reaction. our p/p says to run over 4 hours. just wanted to see what anyone else thought about a 6 hour infusion. what happens to blood after 4 hours?

[oramar]

Every place I ever worked had a policy that said blood hanging more than 4 hours had to be discarded. By that time I imagine it has been room temp for a while and it starts to deteriorate.

[PostOpPrincess, BSN, RN]

Secondary to hypotension? Why over 6 hours then? I am not clear on this.

[Murse901, MSN, RN]

Apparently, the blood is at more risk for bacterial proliferation/contamination:

https://allnurses.com/general-nursing-student/blood-transfusion-question-330440.html

[pedsnurse2002]

after first 15 min blood pressure dropped each time attempted to increase rate, with no other s/sx of reaction. doctor notified and increased infusion time from 4 hours to 6 hours. otherwise no other problems during transfusion. thank you for all your input.

[diane227, LPN, RN]

At every facility where I have worked in my 31 years, blood never hangs for more than 4 hours. Perhaps the physician who wrote this order does not know this.

[elkpark]

Every place I've ever worked, the policy was that blood had to be discarded four hours after it first left the blood bank. If I had an order like that, I would check with my NM or supervisor before I carried it out.

[PostOpPrincess, BSN, RN]

If the BP kept dropping with the transfusion, my first question would be, "why?" and should I investigate it first before continuing with the transfusion. I guess this scenario is not clear to me.

[PostOpPrincess, BSN, RN]

Oh and if your policy says do not give blood after 4 hours, typically that is something you ought to follow...however, medicine is not a linear--so I would write that as a verbal order for c.y.a.

But definitely investigate as to why the patient is so hypotensive in the first place, but yet you're giving blood so slowly.

If I were auditing the chart, this doesn't make sense...granted, all the details are not here....

[Sunrise2009]

my source here says do not transfuse a unit of blood for longer than four hours,

and RBCs deteriorate after two hours

[PICNICRN, BSN, RN]

No way should you follow that order. Too much risk for the pt. Perhaps the doc needs to do some more CEUs.

How far off from baseline was the pt b/p anyway? How old was the kid? Did you use a warmer?

[GrumpyRN63, ADN, RN]

I wouldn't keep it up past the 4 hours,( my NM and Blood Bank would have a s&*t fit, never mind the risk to the pt and my license ) regardless of how it was ordered, MD next time needs to order 1/2 units to run over 4 hrs each