How fast is too fast to transfuse blood?

darkangel83 · Sep 9, 2011

I have always been taught that blood must be given in at least a 20 gauge...nothing smaller..

I have seen blood transfused via a pressure infuser in emergency situations. In that case, the blood is in in a matter of minutes.

Mulan · Sep 9, 2011

Check your policy regarding gauge, some places 22 is okay if that's all you can get.

NeoPediRN · Sep 9, 2011

It depends on who your patient is. If you have a little old lady with CHF you're going to infuse that bad boy over as close to 4 hours as possible, and probably giving Lasix in between the first and second unit.

If you have a trauma you may be rapidly infusing your blood in a matter of minutes.

Blood goes in over 2-4 hours depending on the order and situation.

A size #22 is harder to infuse blood with because it's viscous compared to a fluid like NS, but it can be done, slowly. If you infuse blood rapidly with a #22 you end up with hemolysis.

nurseprnRN, BSN, RN · Sep 9, 2011

it's less an issue of iv catheter size (they give blood transfusions to newborns and premies and small kids and you're sure not gonna get a 20ga into some of them) and more an issue of need and baseline physiology.

someone young and otherwise healthy who has recently had an unpleasant encounter with a sharp object and lost a lot of his own blood as a result (remember: surgery is just expensive trauma) needs replacement fast.

the little old lady with chest pain from anemia who acquired her anemia slowly may not do well if you pump her poor old vascular system full of extra volume rapidly (think chf), so more slowly is better for her.

see, it's not just a one-size-fits-all task, it's a nursing intervention that needs a thoughtful assessment before proceeding.

sethmctenn · Sep 9, 2011

I think the needle manufacturer should have a maximum flow rate for that brand of needle listed on their website. The inner diameter of the needle and viscosity of the infusion affect the flow rate. I'm sure the rate listed in the link below is for water not blood.

http://www.bd.com/infusion/pdfs/D16131.pdf

Here's an article that may be of interest http://www.gdmedical.ch/media/DIR_234330/2cfb7ee2a75cff6bffff9b73ffffffe7.pdf

glamgalRN · Sep 9, 2011

Our hospital policy is it must go through a 20 gauge or larger IV. I did run blood through a 22g once (got an order from the MD for that) when I was a new nurse and it took forever to go through and I think someone said there's a chance of hemolysis of the RBCs.

My goal is usually to run the blood in over 3 hours. If it's a patient's first time getting blood i'll run it in a little slower, but never faster than 2 hours. However this was on a med/surg floor. I'm guessing the ER is different.

My one tip for you as a new nurse is to make sure you get the vitals right before you go down to blood bank to pick up the blood. There have been a few times I got the blood first and then got the patient's initial vitals and they had a fever so I had to return the blood..ugh!! That can be time consuming!

Jenni811, RN · Sep 9, 2011

um, i usually run it at 100ml/hr for the first 15-20 minutes. Do my 15 minute check, as per policy requirment. then if everything looks fine i run it at 125ml/hr. There is approx. 300mL per unit of blood, so total it takes like 2 hours maybe?

Bags are only good to hang for 4 hours, so really you shouldn't go too much slower than that.

Jenni811, RN · Sep 9, 2011

um, i usually run it at 100ml/hr for the first 15-20 minutes. Do my 15 minute check, as per policy requirment. then if everything looks fine i run it at 125ml/hr. There is approx. 300mL per unit of blood, so total it takes like 2 hours maybe?
Bags are only good to hang for 4 hours, so really you shouldn't go too much slower than that.

I take that back. You can go quite a bit slower, cause the way i do it only takes about 2 hours. So really, you COULD do half what i do. :) my math was just a little off.

So really, you could keep them running at 100/hr and it will be done in 3 hours. (Approx.)

CerebralCRNA · Sep 9, 2011

A unit of blood at times in the OR and the ER can be infused as fast as five minutes, that is why they make the Belmont and also Level I infusers. Also, the smaller the radius of the catheter will result in slower flow as flow is proportional to 1/radius (to the 4th power), which is derived from puiosselles law (8nl/Pi*r^4).

In an emergent scenario, 16g if possible and get the blood in as fast as possible.

Hope that helps.

Jenni811, RN · Sep 9, 2011

Also, the smaller the radius of the catheter will result in slower flow as flow is proportional to 1/radius (to the 4th power), which is derived from puiosselles law (8nl/Pi*r^4).

:sstrs::sstrs:

misswoosie · Sep 9, 2011

Give it according to the Drs written (or verbal in an emergency)

22g is too small to give blood through

The rate will depend on the indication for transfusion- eg blood loss (will be given according to amount lost, lab values and rate of blood loss or anemia when it can be given over 2-4 hrs.If blood is to be given over less than a couple of hours (except in extreme emergencies when there may not be time initially) a blood warmer should be used to avoid shock.

Blood can be given STAT using a pressure bag

(they give blood transfusions to newborns and premies and small kids and you're sure not gonna get a 20ga into some of them

This is a whole different ball game to adults and I would imagine that most neonates that receive blood transfusions will be in ICU

and will probably have central venous catheters in situ.The blood has to be matched more carefully than for adults.

If you give a neonate or infant a unit of blood you will kill it! The average circulating blood volume in a neonate is 85 TO 90 ML/KG INFANT 75 TO 80 ML/KG

So for a neonate that weighs 8lbs or 3.6kg that's around 300mls.

In neonates in cardio-thoracic OR we used to set up a blood warmer with transfusion set leading to a 3 way tap attached to one of the lumens of the central line and then then the anesthesiologist, could draw bllod from the blood warmer using a syringe and the 3 way tap and give it according to surgical blood loss.