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!

[suzy253, 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.

That's the way I was taught as well...by a wonderful preceptor.

[nici1978]

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!

i have been doing it the same way, that is how i learned it

some times after the blood is running for a while you will have some airbubbles in it ( not all the time) than in my facility we runn again some saline in to get all the air out

nici

[barefootlady, ADN, RN]

Prime with NSS. We are required to use Y-tubing, and to stay close to patient for first 15 minutes of transfusion to assess for reaction. We are required to use a IV machine too. Once NSS is infusing at KVO, vein is assessed to be patent, then NSS is clamped and blood is allowed to flow. Still at KVO. After first 50 cc of blood is infused most nurses reset rate to 150 cc hr if no problems. It takes a special order to allow blood to hang over 4 hours, to split units,or to use warmer. Blood is strill a big deal here, we never take it for granted and must do many checks to even give it.