Paediatric blood transfusion

[RN4798]

Hi, I'm just seeking advice from PICU/NICU nurses regarding your policy/procedures for administering blood transfusions to neonates/infants. 
 

I'm an ED nurse and on shift the other night we had to administer a blood transfusion to an anaemic 1.5 month old. We struggled to find a specific hospital policy for the best way to administer it and each policy was slightly different and unclear (preferred method is through a syringe driver with a filtered line for <50mls blood). The amount we were to infuse was >50mls. Some policies state to just 'spike' the blood bag with a blood giving set (but our hospital policy requires the use of burettes for paeds). Another suggestion was to half the total amount between two syringes and infuse them both through the driver at half the ordered rate at the same time but we were concerned about attaching a 'chooks foot/3 way line' to the tiny cannula and overloading it causing infiltration as it was a very difficult insertion.

we sought the opinion of a NICU nurse and determined the best method was to transfer the 70mls blood into a burette chamber and then infuse it through a filtered blood line through the Alaris pump (we transferred a few extra mls into the burette to facilitate line priming and then programmed to infuse required amount).

another nurse raised concerns that we should of 'spiked' the blood bag with the burette set and filled the burette with the required amount of blood that way instead of inserting it through the needle free valve with a luer lock syringe - she stated that syringing it through the burette valve and filling it that way could cause Haemolysis of the RBC and that not having the blood bag attached to the top of the burette is an 'infection risk'. (We used a needless valve to withdraw the blood from the bag and maintained aseptic technique, the burette 'spike' was left capped & untouched and we only accessed the luer lock 'port' of the burette to transfer the blood into the chamber).
The NICU nurse said it's not standard procedure to spike the blood bag and leave it attached to the burette/giving set for neonates/tiny infants due to the risk of giving too much blood to the baby so they usually just withdraw the required amount of blood from the bag and syringe drive it in (there mls are usually <50mls though) so we did not have anything 'spiked' above the burette until the end when we spiked the small saline bag to flush the blood line.

I have been STRESSED all weekend that not 'spiking' the blood bag with the burette and instead transferring the blood via a measured syringe manually into the burette needle less valve was the incorrect practice and may cause harm.

we were uncomfortable in the first instance doing a transfusion on a tiny baby in ED and this has made me so anxious. 

chasing the opinions of paeds nurses 

*we are located in Australia 

thank you 

[offlabel]

Lots of ways to do this and as long as the basic principles are observed, it doesn't matter how you do it. Obviously, the blood needs to go through a filter whether that is before it goes into a syringe or burette or downstream during the infusion. A metered device (syringe/burette) is mandatory. Not sure the risk of hemolysis is grounded in reality. So what I would have done is spike the bag with a stand alone blood filter,

                spike with Luer adapter                                                                                        and draw out blood with a 60 cc syringe and transfuse through microbore tubing on a syringe pump.