IV infiltration with PRBC

[Videos Depot, BSN]

Nurses, I know prevention is better than cure but what do we do in a scenario of infiltrated IV with Blood? Does it go down naturally? Do we apply cold or warm compress? And how long does it take to see the swelling go down? 

[chare]

Why don't you start by telling us what you think should be done.

[Videos Depot, BSN]

Then it means I'm just gonna answer my own question. Aside from cold/warm packs, I am looking for any other new or fresh ideas or hacks (if there’s any) based on experts experiences. 

[chare]

23 minutes ago, Videos Depot said:

Then it means I'm just gonna answer my own question. ...

There are many here that are more than willing to help you.  This is why I asked you to start by explaining what you thought should be done, and why.  This allows those of us willing to help you better understand what you already know, and to build on that knowledge.

Strikes colors and withdraws from field of battle.

[TriciaJ, RN]

Anything in the procedures manual?  What do your coworkers think?  Did you notify the doctor?

[amoLucia]

Did you elevate the limb?

[Covidnursedropout]

It's essentially a bruise, but not one associated with an injury.  Elevate and apply warmth.

[JBMmom, MSN, NP]

How much volume was infused? How much might have been infused after the infiltration? How symptomatic is the site? Elevation, ice, and monitoring for potential compartment syndrome if there is too much pressure added at the site. Blood isn't a vesicant so there isn't a need for any antidote administration. 

[Videos Depot, BSN]

The volume infused was 70-100cc. There were no signs of infiltration for the first hour. After an hour then I checked to see the pt and do VS as well, thats when I noticed it being infiltrated. The pt was not complaining of any pain but it is obviously swollen and the pt was a bruiser so the site was even more noticeable. Called pharmacy and they recommend warm compress and limb elevation. I went home with a heavy heart thinking about the injury of infiltration. 
 

Thanks for the info’s everyone. ??

[londonflo]

On 5/15/2021 at 8:00 PM, Videos Depot said:

The volume infused was 70-100cc. There were no signs of infiltration for the first hour

I am assuming it was on a pump.

On 5/15/2021 at 8:00 PM, Videos Depot said:

After an hour then I checked to see the pt and do VS as well, thats when I noticed it being infiltrated. 

Good...that's why you check.      The next point is where you lose me:

On 5/15/2021 at 8:00 PM, Videos Depot said:

. Called pharmacy and they recommend warm compress and limb elevation. I

Were you thinking PRBCs were a vesicant when they go outside the vein?  If so when we cut or bruise ourselves we would cause extensive tissue damage...which is not the case.  With regard to pharmacy making a recommendation to apply warm compresses and limb elevation..is this part of their practice act? I truly don't know if it is. 

Once I had a student somehow squirt Vistaril IM sol. in her eye. Yes I called pharmacy about that. 

You don't need to call the MD unless there is a transfusion  or odd reaction. 

Have you investigated a CEU article about administering blood products or talking to your nursing floor educator? 

I am not trying to be harsh or a know-it-all. Some schools/hospitals do excellent education on the administration of blood products, some not so well. 

I can palpably feel your anxiety and appreciate that you know the administration of blood products is a serious business. You care about your patients. 

My little story here is not what happened with you but it may illustrate how anxiety-producing giving blood can be...A student's patient was getting PRBC and it was about 30 minutes in to the infusion, I was in the next room really involved with a dressing change. The student told me the patient was diaphoretic, the HR had gone up and the patient "felt funny". I said first -- turn off the pump and then get the patient's nurse. Later she said to me ...as students we were told never to touch blood...and I explained that if something untoward is happening turn off the pump and then get the patient's nurse. The patient was not showing signs of a transfusion RX, rather he was older and the volume was too much, too fast. We did call the MD (which was required in this case) and slowly started the infusion again. The patient did fine. 

 

 

[amoLucia]

Back in the Dark Ages, I remember we had to sit with the pt for the first 30 mins of the infusion. Like a bedside babysitter.

A year ago, I rec'd 2 units for emergency hemorrhage. Let me tell you, NOBODY could monitor my infusion any more stringently than I did.

And my deepest gratitude to the donors who donated those life-saving units during the height of covid.

[londonflo]

2 minutes ago, amoLucia said:

Back in the Dark Ages, I remember we had to sit with the pt for the first 30 mins of the infusion. Like a bedside babysitter.

Me too! The RNs would announce "I'm  going to give BLOOD now".. That was the warning == you won't see me for at least half an hour.

In those days we also gave blood to some patients who were going home from surgeries that had an EBL that was more than the 200 cc's we see always documented now but not severe. I remember one MD telling me. "Let's give her a unit of PRBCs to perk her up for discharge."

Sometimes the hospital blood bank didn't have the exact type needed and the police had to pick it up from the BB and bring it to the hospital.  (the city I worked in had 7 hospitals!)

Medicare patients used to be eligible for PRBCs with Hgbs of 10 or less. Now it is 8 Hgb.