Need Help with Blood Administration

[peds4now, RN]

Hi. I'm a newish nurse and there seems to be some disagreement on my unit about blood administration. Yes, I'm gonna look it up in books, but there are so many very experienced and knowledgeable people here-maybe you can help?

We've got the transfusion tubing, right? NS one side, blood the other. NOW, people on my unit are doing it 2 ways:

1) prime completely with NS, then with blood

2) prime only with blood, leaving NS in the bag, not even primed to the filter

Something in my gut says the NS is there for a reason. and it ain't for reactions, cause we are gonna change the tubing ASAP if that happens. So, I've been doing it way #1. But that leads to some weird mixing and even sometimes hard to see air in tubing, which is not good with precious blood! I'm thinking maybe I should go with way #2 but prime the saline to the filter.

What do you do? What are the rationales for different techniques? Is any of the above outright WRONG, or is it just different styles? Our policy and procedure doesn't say-it's probably intentionally vague to protect us-or the hospital!

[Tweety, BSN, RN]

Very good question. I'll be interested to hear what others do.

I prime wth just enough saline to drip through the y-tubing to the filter, and then I prime the other end of the y tubing with blood. So I guess I do #2 for the most part. This way the blood is transfused immediately and I'm not waiting for the blood to first remove the saline and then enter the patient. Saves a minute or two. Naturally prior to it all I'm assure myself the IV is good.

[chocokitten]

I always run NS first and fill the tubing up to above the level of the fliter. I was told that this provides a "cushion" so to speak so that fewer blood cells are destroyed during administration. We will then run the pump at about 200ml/hr til the blood moves down the tubing and gets close to the patient. Then we will slow it down and begin administering the blood per protocol. I would like to see research on this but I don't see any reason why someone would prime a tube with precious blood I'd use NS just to be safe.

[LiverpoolJane]

As a student nurse it was standard practice to prime with saline, however when I qualified I went to work in renal medicine and because renal patients tend to be on a strict fluid restriction we never primed with anything but packed red cells. I never prime with anything except the blood even when giving blood during dialysis treatment. Historically I was told the reason for the slow saline was to keep the cannula patent. I think this may be a case of "we've always done it this way?"

[JennaRN1006]

I am curious to see the answer to that, as well. In my hospital is to do #1. Prime the Y tubing, filter, and remaining tubing with NS. Clamp down the NS Y port and then prime the line with blood. I let the NS run out til the blood is at the end of the line before connecting to the patient.

This is our hospital policy, but I will definitely ask when I go back to work!

[BloomGirl]

On our unit we use the Y tubing also. I was taught to prime the entire length of the tubing first with NS, clamp off the NS then run in the blood.

[getoverit, BSN, RN, EMT-P]

I am curious to see the answer to that, as well. In my hospital is to do #1. Prime the Y tubing, filter, and remaining tubing with NS. Clamp down the NS Y port and then prime the line with blood. I let the NS run out til the blood is at the end of the line before connecting to the patient.

This is our hospital policy, but I will definitely ask when I go back to work!

This is the same thing I've always done. I agree with the theory of the "cushion" but never had any problem doing it this way. This is how my original preceptor showed me. Like someone said, making sure you don't do anything to cause hemolysis is the most important thing while prepping the bag.

[AliRae]

With my big kids I do way #1 ... prime all the tubing with saline then clamp saline and run blood through until it reaches the end. Then I put it on the pump and administer per protocol.

For the little ones, we have spiked filters that fit of the end of a syringe, so we just spike the bag with those, pull out however much we need plus a few mls for the tubing and run the blood through straight large-bore extension tubing.

[Tangerine Lipgloss]

I administered blood the same way as AliRae just described.

[siggie13]

I prime with the saline to the end of the tubing and then prime the filter with the blood into the saline. The blood hitting the filter can disrupt the RBSs and waste some much needed blood for the patient. I also will run the blood and saline at the same time if the IV line is small and the blood runs too slowly on its own. Keep in mind that once you get the blood from the blood bank, it has to be infused within 4 hours; not much time for people with poor vein status.

[Pepper The Cat, BSN, RN]

I prime with N/S and get the infusion started. Once I know the vein is good and there is no infiltration,etc, then I hang the blood, clamp off the N/S and then start the blood.

[Tweety, BSN, RN]

The blood hitting the filter can disrupt the RBSs and waste some much needed blood for the patient.

I didn't know that. Nice to hear a rationale for filling the filter with saline first. I love this site. I learn something all the time.