neonatal transfusion policy, PLEASE HELP

EricJRN, MSN, RN · Jan 13, 2008

Welcome to the site. I moved your post to the NICU Forum to see if someone can help you out.

BittyBabyGrower, MSN, RN · Jan 13, 2008

It will follow the hospital protocol for blood transfusions. The main differences are that neonatal txs are run by themselves without NS piggyback usually, the blood should be CMV negative, the usual dosage is 10-20 ml/kg.

elizabells, BSN, RN · Jan 13, 2008

And (at least on my unit) it's run through a PIV only, as 1-2Fr central lines are not big enough to run blood. They give blood through central lines in adults sometimes, right?

Oh, and we ONLY use O- blood in girls and O + or - for boys. We still send type and cross and do the usual 2 RN 3 way checks, but for PRBCs, it's always O.

Sweeper933 · Jan 13, 2008

We check our VS the same as for adults - but some of it is a little easier as our babies are on temp/hr monitors continuously... We usually give 10 or 15ml/kg and usually run it over 3-3.5hrs. Like Elizabells stated above - we also only give blood through PIVs. Unless of course PIV access is an issue and we have the "ok" from the MD to run it through something else. As far as I can remember, we will give any blood type, as long as it is compatible with the baby. While we are always monitoring for transfusion reactions, I've always been told that it is extremely rare (if not impossible) to happen in a premature baby. The only other thing that I can think of, is that when the baby is also under phototherapy lights while receiving the transfusion, we cover the tubing that the blood is running through with a blanket - this way the "fresh" blood isn't exposed to the bili lights.

elizabells, BSN, RN · Jan 13, 2008

I just remembered, though - sometimes we give blood through an umbilical venous line if we're doing a double-volume exchange or something like that. Those are usually more like 5Fr, and a PIV just can't handle that much blood over 4 hours, which is how long it lasts once it leaves our blood bank.

Jolie, BSN · Jan 13, 2008

And (at least on my unit) it's run through a PIV only, as 1-2Fr central lines are not big enough to run blood. They give blood through central lines in adults sometimes, right?
Oh, and we ONLY use O- blood in girls and O + or - for boys. We still send type and cross and do the usual 2 RN 3 way checks, but for PRBCs, it's always O.

I've never worked in a unit with this policy. What is the rationale for not using type-specific blood?

oletirednurz · Jan 13, 2008

I've never worked in a unit with this policy. What is the rationale for not using type-specific blood?

Joint Comm as for it and I have to produce one. I am totally lost.

BittyBabyGrower, MSN, RN · Jan 13, 2008

I sit on the policy and procedure committee at our hospital and most other places use their hospital based blood transfusion policy with exceptions added to it that are pertinent to NICU, so you will get many different ways here, but you really need to go to the directors and the CNS of your unit to set this up so that it jives with your already set hospital based policy. If you added some of the things here then you would have to implement them and if the docs didn't want it done that way (ie the specific blood type) then you would be heading into hot waters since you would have to have orders to override that part of the policy. Things such as not giving blood thru the smaller piccs is usually included in the picc policy which things come from the manufacturer in that policy, the bili light affecting the blood and having to be covered may be another units preference.

Do you have a standards committee at your hospital? That is where I would start with the help of your CNS and unit director. Review your hospital policy also to see if there is any thing in there about peds, if not then you will have to also get together with peds to help put it together. We have very little things that are neonatal specific, but are branches off other hospital policies, including our IV, central line, policies.

Jolie, BSN · Jan 13, 2008

Joint Comm as for it and I have to produce one. I am totally lost.

I understand the need for a transfusion policy, just wonder why Elizabells' unit won't transfuse type-specific blood.

BittyBabyGrower, MSN, RN · Jan 13, 2008

I'm curious too.....there are times when our blood bank is putting out SOS calls for blood as we have a huge level 1 trauma center at our hospital and if we had to wait for only 0 blood we would be waiting a long time. It's bad enough we have to wait sometimes almost a day for platelets!

elizabells, BSN, RN · Jan 14, 2008

We just... don't. I've just read our entire policy through, and there actually isn't anything in it about only using Type O blood in neonates. However, in nearly two years, I've never seen anything other than O used for PRBCs.

I imagine supply is not as much of an issue, as we're a major hospital in NYC that conducts regular blood drives on the premises? I do recall one time we ran out of platelets and they had to be couriered in from New Jersey, but I've never had a problem getting PRBCs, unless the blood bank itself was overworked and couldn't get it prepared quickly.