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?
It does not matter!!!! The tubing volume would be more critical if it did! You might want to point out to her the difference may be more in the "cost" of the 250 ml bag over the 100 ml bag since you are Not infusing all the bag anyway. It is to "prime" the tubing and a small post flush of the tubing at most. If you are concerned that the NS may not be clamped off while running the blood, or that you are hooking up the NS and Blood tubing before even going to get the blood and it is not on an infusion pump, it might be a concern, but on a well regulated flow for a bag used just to prime tubing for the blood, it is totally irrelevant! The volume of fluid required to "prime" the tubing is the same whether it is a 250 ml bag or a 100 ml bag!!!
I guess the only way it would matter is if you were running it off the pump (gravity), where if for some reason you looked away and all of a sudden all the NS ran in after the blood was done. If its on a pump shouldn't matter. Then it would be an issue for the ESRD and CHF ers.
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.
Yes! I've thought of this for my trauma patients, I will do this in the future, I knew the Y-tubing could be used for something else! Nice tip.
Thanks for the clarifications ladies, she one of those nurses who don't feel they should back off because she has almost 20 years of experience and I have about 2 years so she repeatedly tells me that I need to listen to her. HA!
I didn't even have a confrontation with her off the priming thing, I just let her do what she wanted because she is a know-it-all. Before this little priming snafu we go to verify the blood, and she asks why isn't your Y-set tubing ready. I said well we need to get this blood verified and hung and then I will quickly prime and hang the blood. (I usually prime my Y-tubing first, but this was an emergency and the PRBC's got there before I got to prime the tubing) then she says 90% of nurses will prime their tubing first before verifying the blood.
NOt wanting to argue with her, because she loves to tell me that I don't listen to her, as if I'm her student, I say ok (you know you just have to go along with her to make her feel good) then she says where's the print out of the patient's blood type. I say oh we can look it up in the computer now since we changed computer systems, but let's verify the blood to get it started then we can print out the patients blood type form. She then storms away from me saying what if the system goes down, how will you know the patient's blood type etc.... etc... she refuses to verify blood with me and tells another nurse to do it.
At this point I'm still ignoring her, because she made a scene.
The charge nurse comes by and asks if I started relieving her for her break, I say yes, we have a bit of an emergency but I will relieve her.
I ask her (the nurse) if she wanted to go on break or if she wants me to go first (this is all after her little storm session, I still remain calm) Then she throws down a paper she had in her hand and was like ok, so do you want to do my work for me, breaks are not important right now, this is the trauma room.
I say (calmly) ok, this is why I'm asking you if you want me to go on break first because the charge nurse asked me to start breaks, (the truama room was now calm, the patients were stablilized, we can start going for out 30 min breaks).
She then picks up the phone to call the charge to complain that all I'm thinking about is breaks and other things are more important, not realizing the charge put me in there to help and relieve her for her break.
So I go and find the charge nurse myself, I tell her that I'm trying to be professional, not blowing up in anger but this nurse is really pushing my buttons,so she pulls both of us into the office.
She (the nurse) starts complaining that I never listen to her (which is a lie, she loves to talk and most people, including me just stand up and listen to her when she is on her speeches) (also I'm not your student, so I don't need to be precepted by you)
The charge then tells her that she understands she has a student, but I'm not her student, I'm a fellow RN and she doesn't need to instruct me. Later on the charge even told me that she's done the same thing to her.
I don't mind learning from experienced nurses, but if your rationales don't make sense I (as a prudent nurse myself) have a right to question it. Also I told her if you want to teach me anything pull me aside and show me, don't blow up in front of everyone and watch your attitude with me. I'm not that brand new of a nurse and I'm not your kid (as that she's old enough to be my mother, and she tells me I remind her of her daughter)
That's even more odd. I would have assumed that she an inexperienced RN but yet full of herself. To have 20 years of experience and prime blood tubing in such an unusual manner... you'd think that in all that time of nursing she would have at SOME point had a chance to learn it the right way whether it be through an inservice, observation of others, or just some general frig'awareness. What is she, walking around with blinders on? Maybe she's describing technique FROM 20 years ago. No.. even that can't be because if you REALLY want saline in that second line, you can backprime with the original bag. Sorry, something just irks me about this person.
I prime blood with a 1,000 cc bag since the pharmacist told me that 1,000 cc bags are actually cheaper than 100s and 250s (which makes sense given economies of scale involved). We reserve the 100s and 250s for mixing meds.
I prime blood with a 1000 cc bag since the pharmacist told me that 1,000 cc bags are actually cheaper than 100s and 250s (which makes sense given economies of scale involved). We reserve the 100s and 250s for mixing meds.[/quote']
Kind of like how the 2 liter bottles of soda cost just as much as the 20 ounce sodas. It's not really the cost of the fluid, but the cost of the packaging and manufacturing. You have to make, package, label and ship ten 100cc bags to equal the volume in a one liter bag, but there's a lot more plastic that go into the ten 100cc bags then the one liter bag.
Kinda like when I've got a pt on KVO fluids for a med line, and hang a 1000cc bag. It's not that plan on giving the 1000 units, but if that patient goes down the tubes, I may need to bolus, etc. The cost to the patient is the same, 100 cc or 1000 cc bag.
But with blood tubing? We do the 250 cc bag. Here's what I do:
Hook up the saline, and for at least a minute or so, run the saline in at the maximum rate I'm going to infuse the blood. If I've got someone with paper thin veins, I want that vein to blow before I hook up blood. I then KVO the fluid, go get the blood, and start the transfusion per our protocol. At our site, we can do two bags back to back if we have the tubing up less than 4 hours total.
If that patient had a reaction, the LAST thing I would do is use the saline toe clear the line. That line would get taken down in the blink of an eye, and I'd probably even try to aspirate the blood back that was in the J-loop, while calling for someone to call the doc and get me orders for solumedrol, benedryl, whatever.
With dialysis, things are different than with a peripheral, but I still can't see what the big deal is. I mean, jeez, you've got them hooked up to a dialysis machine, pluck off an extra 50 ccs....seems like that nurse was strange...
I don't know what you mean by that. There is one way to administer blood: per protocol. I don't care if you can do it standing on your head, the only thing I want is per protocol.
And if you DO do it standing on your head, then keep it to yourself.
LilyBelleD
2 Posts
It does not matter!!!! The tubing volume would be more critical if it did! You might want to point out to her the difference may be more in the "cost" of the 250 ml bag over the 100 ml bag since you are Not infusing all the bag anyway. It is to "prime" the tubing and a small post flush of the tubing at most. If you are concerned that the NS may not be clamped off while running the blood, or that you are hooking up the NS and Blood tubing before even going to get the blood and it is not on an infusion pump, it might be a concern, but on a well regulated flow for a bag used just to prime tubing for the blood, it is totally irrelevant! The volume of fluid required to "prime" the tubing is the same whether it is a 250 ml bag or a 100 ml bag!!!