On hanging blood...

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Specializes in Cardiac.

I am a new grad who worked for about 2 months in California and now relocated to Arkansas. I am working on a cardiac step-down unit. I had a little issue the other day and just wanted some advice. I had a patient brought to my unit from ER at around 2PM the other day with a diagnosis of DVT. She had been having abdominal pain for a few weeks, spoke only Spanish, and had been taking a slew of NSAID's (hence the DVT). So, there were orders for a CT of the abdomen & pelvis, an order to Type & Cross 4 units, and transfuse 2 units of PRBC's.... anyways.... They had brought up the Bari-Cat drink (2 bottles-marked with times to complete, with the last time being around 4:00 PM0. The bottles were brought around 2:30 or so. they called and notified me that the blood was ready around 3, but she was already drinking the drink and I thought that I should wait to start the blood until after the CT was done. So, I let her finish that Bari-Cat stuff and she finished it and went for the test and came back around 6PM. Well, my rationale was that I remembered working at a Cancer Hospital in Californai and they gave lots of blood and the nurses always said that blood is so important and you don't give it unless you are monitoring the patient. So, how could I run the blood through in 4 hours if she would go off for a test? I did not think that I would send the patient for the test with the blood because how could I monitor her when she was off the ward? What if the blood stopped running and clotted off? What if somebody changed the rate and it went in too fast and she had a hemolytic reaction? I don't know... I just know that it was too hard to work for this license and I do not want to lose it. So, the night nurse came in and asked why the blood wasn't done and I told her the whole story and she was upset.

The following day when she came (last night) to report for work she made a big stink again and brought it up to my preceptor. After, I came in the morning yesterday and the blood was still hanging after she gave it. She also did not give Lasix after the blood was done..... I was so upset. She is a person who always has to find things wrong... The preceptor told me that but I just had some ???'s about blood and all of that. Another RN that night before I gave report said that she would have done the same thing (and she has been a nurse for 18 years) and that the night RN could hang the blood. ???? Any comments or things people can tell me about hanging blood?

Stacey

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Specializes in ICU, ER, HH, NICU, now FNP.

No matter what you do, some people on the opposite shift will always assume that you left work for them because you were lazy and wanted to leave work for them instead of doing it yourself.

Don't be so hard on yourself. She sounds like an a person with a chip on her shoulder.

This is why there is more than one shift! Because we can't possibly do all that needs to be done for our patients on one shift obviously!

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Specializes in cardiac/critical care/ informatics.

In our hospital they won't accept someone getting blood in CT so you made the right decision, unless of course their hgb was critical. Some nurses are just lazy and don't want more work for themselves.

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Specializes in Nephrology, Cardiology, ER, ICU.

Why was the blood being given? Was the patient chronically anemic or having an acute GI bleed? If the blood loss was acute, I would have hung the blood when it arrived. However, if there was to be a delay, I would still have notified the MD or provider ordering the blood to ensure it was okay to wait. My take on it.

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Specializes in Day Surgery/Infusion/ED.

I would have definitely called to get an order to OK holding the blood til after the CT.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

What a B! Next time I would specifically lie and tell this nurse that the blood didn't go up earlier because the blood bank didn't have a unit ready. Pass the buck. Let her try to rag on them. I don't hang any blood on any patient leaving the unit unless I am going with them. You did the right thing.

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Specializes in Day Surgery/Infusion/ED.
What a B! Next time I would specifically lie and tell this nurse that the blood didn't go up earlier because the blood bank didn't have a unit ready. Pass the buck. Let her try to rag on them. I don't hang any blood on any patient leaving the unit unless I am going with them. You did the right thing.

I hope you were being sarcastic and not truly encouraging that nurses lie to each other, let alone blame colleagues in other departments. Just the sort of thing we really want to encourage. :rolleyes:

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Let me share my transfusion horror story:

Our policy was to stay with the patient for the first 15 minutes of the transfusion. VS were to be done q 15 min x2. I stayed with the pt. After about 2-3 minutes of the transfusion, the patient began acting differently. She became sluggish, just turned over and said she did not feel well and wanted to sleep (of course it is the middle of the night when these things happen). Any way, I turned off the blood, called the MD. Discontinued the blood and did transfusion reaction work up per policy. Mind you, the patients VS never changed. Temp, Pulse, BP all within normal range for pt.

Pt. perked up. Stable rest of night.

I came back to work next morning. Pt had gone to surgery for the problem she had come to hospital for. Transfusion was to get hgb up for surgery.

I asked about her, because they put her on the GYN floor post op. Was told: She is doing fine considering she got the wrong blood type. :eek:

I started to replay what I did. Making sure I did everything right. If I did everything right how did that happen.

Seems the lab person had labeled the blood wrong. Pt got an incompatible blood type. Fortunately only a few cc's of it. To say the least, the lab tech was immediately fired. No one ever said a word to me except the Doc who knew the situation, who said I did good stopping it as soon as I did.

So, with a little experience behind me, I think you did right. The timing for the CT was in progress. No way you could change that. And starting the blood after the CT was the right decision. Too many bad things could have happened if that pt had left your unit with that blood infusing. You were right on with your thinking. :wink2:

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