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?
I don't understand your co-worker's rationale. As others have mentioned, it's not the volume of the bag that matters, it's the volume infused into the patient. I do not understand why your co-worker would prime both sides of the Y set with saline, either.
I use either a 250 or 100mL bag of saline for one side of the Y set, and the blood on the other. I prime the tubing with the saline, making sure to cover the filter with saline. Then I clamp the saline side, unclamp the blood side, and waste the saline that's in the tubing until blood is within inches of the connector. Then I connect it to the patient and begin the transfusion.
hmm you don't need 2 NS bags to prime. you just need one and with the help of gravity, the NS will flow into the second port. At my hospital, I have seen nurses use a 50 ml NS bag to prime and use it as a flush when giving blood transfusion. Never had a problem with 50cc of NS fluids
Makes me wonder how she usually primes a line and how she defines "priming". Our Y-tubing is 20cc's and while you want to avoid all unnecessary fluids in CHF'rs and ESRD, the 20cc is nothing compared to how much fluid they will pull into the vascular system due to the packed RBC's. With severe CHF'rs, lasix should coincide with the blood and dialysis for ESRD anyway, making the 20cc's relatively a non-issue.
Uh why in the crap would you need to prime both sides???? The blood side is what, like 2 mL at the most, until it hits the chamber and mixes with the primed saline? That side doesn't even NEED primed. Maybe we're talking different Y sets or something.
Ha, that is very silly. Why on Earth would she use two bags of NS? The part that cracks me up is that the two 100 ml bags almost add up to the 250 ml bag she was complaining about. She'd probably stroke out if she saw that I use a liter bag most of the time because it's what's handy.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Two normal saline bags of 100 cc adds up to 200 cc's. Hanging the 250 is only a 50cc difference. Why prime both the y tubing? I have never done that. I am sure it's based on cost for there is no documented evidence to prime both y tubing on the blood tubing. I find her behavior odd. It may well be a MD preference or policy issue but you were not wrong with your actions.
Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
While we're on the topic, have any of you used -tubing for anything other than blood administration?
Yes in the ER when we needed to get lots of fluids in quickly, we would use blood/Y tubing and we could hang 2 liters of fluid wide open if needed. In critical situations, we would start 2 lines /large bore IVs/ both with blood tubing and hang 4 liters. Works great for trauma/bleeds plus if you need to give blood you've already got the tubing set up, saves time. If they stabilize, you can stop some of the fluids.
ckh23, BSN, RN
1,446 Posts
Tell her to mind her business and go take care of her own patients and stay away from yours. I can't stand when nurses do this.