Need Help with Blood Administration

[peds4now]

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!

[pink2blue1]

On our unit we give a lot of blood all the time. How we do it is once we get an order for blood and make sure that the pt is type and cross matched and the units are ready, we hang the blood tubing with NS and run it at TKO until the unit of blood comes up. Most of the time our patients are not on NS but on something else, so we just change over to NS nad do it that way. I have never seen anyone on my unit do it any other way.

[Reno1978, BSN, RN]

I was taught to prime with NS first above the level of the filter, then start the blood, which drips into the filter chamber, hitting NS instead of the filter directly.

[pupinstuff]

I work on a renal unit where transfusions are common (d/t anemia). I always prime with NS.

[Ivanna_Nurse, BSN, RN]

Hey All! We also use the Y tubing. I prime with NS, clamp and run the blood in... Good to know the rationale behind the saline in the filter first, thanks for teaching me something new! ~Ivanna

[NicoleERRN, RN]

I always try and do what I am taught... I prime with NS first ...that said my main reason for priming with NS is b/c I put all my blood on a pump and the tubing is really difficult to prime with blood! when i was on orientation my nurse primed with blood and air ended up in her line and it was a big pain and wasted some blood... i would rather drip out some NS and save all the blood when priming.. then i can also infuse NS to make sure i have a good line! Just check your policy and procedures to make sure you are compliant. Awesome question!

[TStewartfan]

I prime with saline up to the secondary blood tubing and prime the filter with the blood itself then set it on 150 ml/hr and let it infuse. I have had nurses that I was with fill the filter up halfway with saline and then blood but I learning in nursing school to infuse up the the secondary filter with NS and then blood to prime the filter itself and then after the blood has infused I bump up the NS to 200 cc/hr to clear out the line of all the blood so the patient gets every last drop. And if it is rapid infusion I put it under pressure, prime the line with saline to make sure there is no air and then clamp off the NS and let the blood flow under pressure.

[not now, RN]

My hospital doesn't really want us using Y-tubing anymore, the only reason we can use it is to get rid of the rest of the stock. I think because if you give multiple units you have to toss the entire thing. If we do use it we prime the entire tubing with saline then run the blood.

What they wanted us to do is use regular tubing primed with saline, clamp at the last port and low-port the blood. The saline is clamped not on the pump and the blood tubing is in the pump

[Tait, MSN, RN]

Classic Y-Tubing infusion I was trained by a wonderful ICU nurse to prime with saline to just above the filter for the same reason as mentioned before, to save cells.

My rationale as far as the tubing goes would be this: Prime it how you like, however if you prime with saline be aware when the blood hits the patient so you can keep track of that precious first 15 minutes and any reactions. Technically I suppose if the line is primed with saline it could diffuse the blood, lessen the severity of the reaction making it "possible" to be missed in the first 15 mintues. Then your patient is suddenly getting full on blood and no one is there for the reaction.

Just a thought.

Tait

PS. Oh and as a sside note I was trained to NEVER run blood in a line with anything other than NS. If there isn't a site available, start a new IV.

[Dorito, ASN, RN]

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.

That's the way I was taught to run blood as well. I agree, sometimes if it's running a little sluggish you can run a little saline to speed it up.

[GrumpyRN63, ADN, RN]

I use Y tubing, prime the tubing up past the filter w/NS, clamp off NS, spike blood, run the blood, when the blood/ blood products are complete, open the NS and chase the blood to ensure they get it all,also be sure you use a whole new set up with each transfusion . BTW, we only infuse by gravity.

[sleeplessonthelake]

I have allways primed my tubing awith NS then ran my pack cells. Then changed my tubing p the PRBC's have ran in and KVO my NS or as your protocal calls for. Allways watch your pt closely when administering PRBC's or any blood products.

[peds4now, RN]

Thank you all for your help. Now I remember being taught prime the NS to the filter to stop hemolysis. I think that's what I'm gonna do in the future. Makes sense. It's good to see there are people doing it the various ways too.

Thanks!