How fast to you run a unit of blood?

[DutchgirlRN, ASN, RN]

I work on a Med-Surg floor and we run alot of blood. Most doctor's just order T&C and infuse and we generally run it at 225 cc/hr. The units are generally 360 cc each not 240 cc. I like to run it alittle slower 175cc/hr. The problem is that some docs order it over 4 hours per unit and our protocol is that it has to be infused in 3 hours Or they write 1 hour per unit. I recently had a young girl who had a Hgb of 4.6 and the doc insisted I run 6 units in at an hour for each unit. I trust this particular doc very much and considering her age and physical condition I did run it in that fast and she did very well and pinked up quickly. Just wondering what everyone else thinks is the proper rate to hang blood?

[Town & Country]

There are established norms like you described, but obviously as with the case with this young girl, every case is different.

She was able to handle to faster infusion without danger of fluid overload.

[Tweety, BSN, RN]

Our protocol is a unit may be run up to four hours.

One has to take into consideration the patient. A patient with CHF for instance I run very slowly over the four hours. A younger person I run faster about an hour. So I agree with the doc, each unit over one hour on someone that young and with that low of a hgb is appropriate.

Blood can be infused in emergencies very rapidly over minutes.

There's a lot of leeway with rate of administration.

[purplemania, BSN, RN]

I think the critical factor here, as always, is the nurse. We need to know our patient and monitor our patient.

[RNKPCE]

If the doctor doesn't prescribe a rate I run it over 3 hours, our units are aprox 240cc. We wouldn't have a shocky patient needing blood on my floor n quickly. Like 3rdshiftguy we have a lot of CHF patients and need to give the blood slowly often with Lasix after or between units.

It is just in the last few years that we are stocking blood tubing for iv pumps. Boy does that make life easier. No more constantly having to see if the blood has gotten sluggish and slowed down.

[LydiaGreen]

Our protocol is that the unit must have completed infusing by four hours with the four hours starting at the time the blood is removed from the fridge in the lab. Generally, it's run over three hours but it really does depend on each individual patient. A little old lady with a poor Hx would get it slowly, a guy in his 20's with a good Hx could receive it a little quicker. It all depends.

[DutchgirlRN, ASN, RN]

Thanks that's how I run blood. You do have to take in consideration the age and condition of the patient and I think that's most important. Our hospital does only allow 3 hours for the blood to infuse once it's been spiked. With 360cc of blood in a unit it makes it kinda rough sometimes when you have a little frail patient especially with CHF. Of course then lasix is in order. Alittle off subject here, I once saw a nurse push the lasix in the line with the blood towards the end of the infusion. I told her no! I learned nothing but NS mixes with blood. Correct?

[oramar]

I am with you on the varation of true cc per unit. I have seen units that did not have 200cc and others that have about 350cc. Our protocol says no less than 2 hrs and no more than 4hrs. After you have infused about a million units, all you have to do it look at it and you know. Someone once told me that they add saline to the bag in the lab or the blood bank. I wonder if that is true? We have many elderly people with weak hearts and we go as slow as we can get away with. I would rather throw a way a little than send someone into CHF.

[MandyInMS]

No more than 4 hours from frig to finish...rate depends on the pt/orders.

[rjflyn, ASN, RN]

I'm going to chime in about the amount of blood in a unit. The amount varies depending on where it came from ie the Red Cross (RC) or United Blood Centers (UBC) to name the biggest. It also depends on what exactly the unit is and what the anticoagulant was when the unit was collected.

Units of packed red cells (PRBC'S) that come from the RC generally are around the 325-360 cc amount- the variation comes from a number of factors ie the donors hemoglobin, how full the orginal donation bag got when it was collected- they collect it by weight not volume.

If all else fails read the label.

How fast well that all depends i've worked ER, ICU and PICU- so I have given a unit as fast as a couple minutes to the limit of 4hrs- per the blood banks limit in every hospital I have worked.

Rj:rolleyes:

[Burnt Out, ASN, RN]

Our policy is that the blood must be infused in 4 hours after it is released from the blood bank.

We hardly ever have young folks getting PRBCs, but if we do, we generally run it faster than in our elderly patients. I also tend to give blood a little slower to those that have had a reaction in the past (we screen on our admission forms) or have antibodies.

Just use your judgement with your patient's condition and history.

[rollingstone]

I run a unit at 200-250cc/hr, unless otherwise ordered. If multiple units are ordered and the patient has a hx of CHF the physicians usually order an IV dose of lasix between units to head off fluid overload.