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PRBC transfusion question

Posted

Specializes in Cath Lab, EP. Has 10 years experience.

Assumed care of my patient (ETOH, end stage liver disease, new hepatorenal syndrome, GIB with unstable hematacrit, glowing yellow, etc, etc) to find that the nurse before me had his PRBC's y'd into his maintenance fluid: D5 1/2 NS @ 175cc/h. He got 3 units like that before I picked him up.

I'm curious if that would render the cells useless, with the MIV being a hypertonic solution and all. The day nurse is one of the "older experienced nurses" so I want to make sure this isn't some trick of the trade that I'm not privvy to. I asked my charge nurse, we called blood bank, no one had any specific info for us other than "never mix with anything but NS." The blood was y'd into the port nearest the patient which is about a foot of distance for the two solutions to mix...not sure if crenation would occur under these circumstances or not.

TemperStripe

Specializes in ICU. Has 5 years experience.

Whoa.

Curious about any answers to this. I, too, was under the impression than anything other than NS would lyse the cells.

sassyrn333

Specializes in Cath Lab, EP. Has 10 years experience.

I think D5 1/2 NS is a hypertonic solution which would crenate RBC's. I'm just not sure if that would ruin the cells or not. I was sure that hypotonic solutions were really bad because lysis of 4 units of PRBC's would be definitely be a problem. Thank you for your post, though. That was the most specific info I have seen.

sunnycalifRN

Has 6 years experience.

I thought it should only run in by itself . . . no other fluid . . . the NS is only to flush in the blood in the tubing when the transfusion is done.

fiveofpeep

Specializes in critical care, PACU. Has 2 years experience.

the last thing that pt needs is a bunch of intracellular components from mass hemolysis :-/

sassyrn333

Specializes in Cath Lab, EP. Has 10 years experience.

Exactly.

"Let's throw some extra K at your new renal failure and watch your nurse crap her pants..."

Wow, yeah, no, you never run blood in with anything else, especially a dextrose solution!

armyicurn

Specializes in ICU-my whole life!!.

what? you better bring this to her attention! time for an in-service and do not forget to write that SPR

danamobile

Specializes in GSICU, med/surg.

oh man that is not good nursing practice... lazy if you ask me!! I honestly hope she didn't know better, better to not know and do than know and ignore, although both serious :( I hate hearing this kind of stuff! I'm glad you know your reasoning...

caroladybelle, BSN, RN

Specializes in Oncology/Haemetology/HIV.

Exactly.

"Let's throw some extra K at your new renal failure and watch your nurse crap her pants..."

Not to mention risk, hhe hemolytic reactions that occasionally occur, with this error and also basically waste the 3 units.

(one of the few massive hemolytic reactions that I have seen, occurred from someone running RBCs through inappropriate solution)