Priming blood tubing with...blood??

Nurses General Nursing

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My facility is doing away with priming blood tubing with saline. The policy basically says to prime the tubing with the blood, infuse the blood and then we have the option of following the blood with saline to flush remaining blood out of the tubing into the patient.

I tried this for the first time the other night. I let the PRBC's flow slowly into the tubing, through the filter and through the rest of the tubing. I had air bubbles, lots of air bubbles. I ended up wasting (and cringing) at least 20 ml of blood into the sink to get rid of the air.

What could possibly be the rationale for this change? I was told many facilities are doing away with using saline at all for priming or following the blood.

Also, any hints on how to prime with blood without getting all the air bubbles.

Thanks,

Robinbird

Specializes in Acute Care.

I've heard two rationales for priming with saline; (my hospital uses the y-set)

1. Gets rid of air bubbles

2. "Cushions" the blood cells from falling directly onto the filter at first to keep them from exploding.

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Specializes in NICU, Post-partum.
Quote from Virgo_RN's post: "We do premedicate patients with known iodine allergies prior to cardiac catheterization, typically with Prednisone. In this case, the benefit of PCI outweighs the risk of a contrast reaction, which is minimized by premedicating."

Oh, I refused that too a week ago, because I'd had a reaction while having an IVP, in 1968. Again I was afraid of "masking" another one. So I didn't get the CT scan to find the source of bleeding that could be causing my anemia. The upper and lower endoscopies didn't reveal it. Thanks for your post. I'll read up on the use of predisone with iodine dye........

The Benedryl isn't going to "mask" any symptoms if you are having a major, life-threatening reaction. Even though blood products goes through all kinds of processing before it finds it's way to the patient, sometimes patients feel a mild reaction, but unless it escalates at least some, the transfusion will continue. It's really for your comfort.

Are they sure that it's bleeding that is causing your anemia or is it anemia that is causing your bleeding? I am anemic and I have not yet had to have a transfusion, but I have to watch my diet and iron supplements like a hawk. You wouldn't believe how much I will bleed from a mere paper cut.

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Specializes in ICU and EMS.
Not sure what the reasoning would be for priming with saline, actually.

I just covered blood transfusions last semester. We were taught that without priming the tubing with saline, the red blood cells would "stick" to the walls of the tubing.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

We prime with blood, since the purpose is to give the blood right? Never though much about it.

We also do not pre-medicate, unless there's a history.

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We premedicate on an individual basis; for example, the pt who has, prior to the infusion, spiked a couple of mild to moderate temps. If it spikes during the transfusion, I have to run a transfusion reaction and throw away the rest of the blood.

I think we will soon be going to a standard premedication protocol. One of the lab techs was telling me that the newer research is indicating that mild itching and/or a mild to moderate temp elevation is not a true transfusion reaction, and so premedicating with benadryl and tylenol will prevent unnecessary delays, tests, and waste. She said that a true infusion reaction will NOT be masked by tylenol or benadryl.

I've only seen one true infusion reaction, and there is no way it would have been masked. 40 year old guy turned beet red, couldn't breathe, became confused and incontinent of b/b about 10 minutes into the transfusion. That's the only true reaction I've ever seen. Over the last couple of years, I have stopped about 10 transfusions for mild temp spikes, only to have subsequent labwork show no indication of transfusion reaction. 10 units of precious blood down the drain (per our protocol), all because of a little temp elevation.

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Specializes in Med Surg, Peds, OB, L/D, Ortho.

i work in ortho...i don't feel like i have been at work if i haven't hung blood on at least one pt. a week! never have primed with blood i always prime with saline...and flush with saline right down to the last drop! we also use the blood of virgins kept in separate closets....the pts. get a kick out of this! :yeah:

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Specializes in Med/Surg, Hospice.
You could also try pinching off the lower part of the tubing while the larger drip chamber on the bottom of the blood tubing is filling up and has plenty of blood in it before letting the blood flow into the rest of the tubing.

Good luck!

Great tip! Thanks!

We prime our tubing with blood and have an extra pump set primed with NS and ready to go in case of a reaction. I haven't had a lot of problems with it, other than that little bit of blood that drips off the end when I connect it to the patient, which is why I always have some gauze and ETOH swabs in my pocket when hanging blood.

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Specializes in Psych, ER, Resp/Med, LTC, Education.

I'm here in NY and we use the saline as well. Does everyone else use the special "Y" tubing? That's what we use in this area and I like to actually start the saline running at a slow rate--like a KVO rate--and get my pre-transfusion VS. Then go and get the blood and double check and I am ready to go right in and hang it and know the line I am using is good as teh KVO ran in well. I clamp off the saline side and pop on the blood to the second spike and I'm set. I then take my 5 minute VS 5 min from the time the blood actually gets to the patient. Thats the only thing is there is a delay waiting for the saline to run through and the blood to reach the patient. But I have used that window of time to get my pre-transfusion VS's as well, if in a rush. I would hate to have to prime with blood. Seems like I would be more apt to have contact with it. Yuck! LOL And we don't generally premedicate here either.

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Specializes in Emergency Nursing, Cardiology.

1) There is no waste of precious blood product while trying to rid (prime) the tubing of bubbles

2) You can pinpoint the moment that the bood actually started infusing into the pt

which leads to 3) then you will know exactly when the blood product began to transfuse and can monitor for reactions within the "important ten minutes". >>

We also use the Y tubing, connected to the blood and the saline. The only difference is that now we are no longer allowed to prime with saline. My question in starting this thread is why are they not letting us prime with saline anymore. Is there some evidence based practice study that has found that this practice is not advised? I will ask our nurse educator but I was hoping someone out there would have some insight...

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Specializes in M/S, Travel Nursing, Pulmonary.

Actually, now that people mention it, I have heard the theory on blood not going through tubing correctly if not primed with saline first. I had forgotten all about it since everywhere I've been uses saline. Not using it never came up.

Thank for the info guys.

It seems people have done it without priming with saline first though. So for them, I wonder if there is some variable that is different that is not being accounted for. Maybe different, special tubing or something. IDK.

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Specializes in Medical.

We prime with saline using a Y-connection, too.

In addition to the concerns already raised (cells sticking to the tubing, cell damage with the filter, air bubbles, checking for cannula patency etc), my hospital sees priming with blood as an infection control issue. Blood is certainly carefully screened, but we treat all blood (including donor units) with universal precautions.

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we only have wide bore giving sets which we attach a blood filter. we prime with blood

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