PRBC transfusion and diuresis?

[hotshot12345]

So I had orders to transfused one 1 unit of PRBC, then give 20 mg IV Lasix, then give 1 more unit of PRBC. I was told that the Lasix is to prevent CHF, but I want more details if possible because another time, I transfused 2 units of PRBC at a faster rate but there was no diuretic ordered.

thanks

[blondy2061h, MSN, RN]

It's all just a matter of how well the patient can tolerate the fluid burden.

[Creamsoda, ASN, RN]

Someone young can usually handel the transfusion well with no issues, but the elderly often cant especially if they already have CHF, or any cardiac dysfunction so you usually need to give lasix inbetween.

[GrumpyRN63, ADN, RN]

It all depends on the pt. Many times you can transfuse without Lasix. If the pt has a hx (or is at risk)of CHF/poor renal/cardiac fnxn, many times you will chase the transfusion w/lasix to optimize the RBC's while getting rid of the extraneous fluid/NS that will just put the pt in or at risk of pulmonary edema.

[core0]

So I had orders to transfused one 1 unit of PRBC, then give 20 mg IV Lasix, then give 1 more unit of PRBC. I was told that the Lasix is to prevent CHF, but I want more details if possible because another time, I transfused 2 units of PRBC at a faster rate but there was no diuretic ordered.

thanks

I would point you here:

https://allnurses.com/forums/f8/blood-transfusion-258131.html

As the other posters pointed out its all about volume (and to some extent renal function). If they already have volume on board you can throw them into pulmonary edema with blood. If they have poor renal function or a bad heart this can be worse. If there are a lot of fluid shifts going on (post op for example) it can also be worse. I usually give some lasix either between units if there is any question on their heart or fluid status.

David Carpenter, PA-C