PRBC rate for chf/renal patients

[SNB1014, RN]

Hi,

I have searched online but have failed to find a definitive answer, to say the least.

my unit gets a large share of CHF patients who need PRBCs. At what rate (mL/hr) do you administer PRBCs to these patients in order to prevent fluid overload?

whenever i look in lippincott or related sources, it keeps telling me "per doctor's order" or doesnt address chf other than "run slower". my doctors never write a specific rate, at least that i know of.

does you unit have a P&P for this? what do you do?

Thanks in advance. If you have a source for your answer, please link it!

[MunoRN, RN]

There's no rate that totally prevents fluid overload, the slower it's infused the more chance the kidneys get to excrete the fluid that the RBC's pull in from outside of the vascular system. We usually take the entire 4 hour hang time limit for RBC's so long as there is no acute bleed we're trying to keep up with. CHF patients have a habit of "chewing up" RBCs so usually this is just treating chronic anemia and there's no need to rush.

Unfortunately I've never seen hard numbers on this that I could refer you to, there's quite a few variables that the Nurse needs to account for.

[Sun0408, ASN, RN]

What is the time frame at your facilty blood must be infused in.. Mine is 4 hours max, some as little as 3 hours. So I run at the minimum amount ml/hr to get it all in by the max time frame. That is usually at 100ml/hr to 125ml/hr. If the doc is worried about fluid overload, many will order lasix after the first unit.

[BluegrassRN]

125 is the slowest I run it. Assess heart and lung sounds q1hr, more frequently if pt is a bad CHFer. Our protocol states to complete it within 4 hours of removing it from the lab. By the time you get everything hooked up and track down a witness, it's more like 3.5 hours, and with the varying amounts in the bag (I've had them have as little as 225mL and as much as 375mL), 125 insures it will be complete within the time frame.

Your P&P may have differing parameters, but I think 4 hours in adult med is fairly typical.

[turnforthenurse, MSN, NP]

I run it between 100 to 125mL/hr. That meets the 4 hr time frame to infuse PRBCs in. I assess their heart and lung sounds Q1H. Where I work the docs never prescribe the rate for blood administration, it just needs to be administered within 4 hours of hanging. A lot of times the docs will prescribe some Lasix in between units to prevent fluid overload.

[Esme12, ASN, BSN, RN]

You need to check with your facilities policy and procedure, but the time limit PBRC's may be hanging is 4 hours. So....because of the fluid sensitivity of some of these patients Lasix is usually administered just prior and in between/after units.

[imintrouble, BSN, RN]

Our MDs write time parameters when they order the PRBC.

"Over 3 hrs"

"Over 4 hrs"

Sometimes one will write over 1-2 hrs, but that's unusual.

If for some reason there aren't any time orders, I'll run it at 100/hr.

As others have posted, Lasix orders are not uncommon.