Priming blood tubing with...blood??

[robinbird]

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

[cardiacRN2006, ADN, RN]

Another Y tubing, saline hanging type of girl here.

In addition to the previously mentioned benefits of priming with saline, what about when you hang the second unit?

The first PRBC has been cross matched to the pt, and the second unit has been cross matched. But have unit 1 and 2 been cross matched against each other? Nope.

I like the saline to flush out the blood remaining in the tubing before I hand that second unit.

[truern]

We use the Y tubing, prime with saline, run the blood, have the saline set at KVO for so many mls to flush the tubing after the blood infuses. We also use the same tubing for a second unit if ordered.

Just seems "cleaner" to me somehow to have the saline prime and flush.

[mina123]

the rationale behind not priming with saline is because the RN always has to sit with the patient the first 15 minutes of transfusion and if u are priming with saline the real blood transfusion can occur as late as 30 minutes and u might be already out of pt's room doing something else, so if u prime with blood sit and watch your pt for that first 15 minutes any reaction u will be able to act very quickly. Any time if there is a reaction change the entire tubing hang 0.9% Ns at kvo rate, and the entire blood with it;s tubing should be sent out for culture to the lab. Also any reaction which is happening should be treated accordingly to what's going on with the patient. As we know there's many different kinds of blood transfusion reactions.

[madwife2002, BSN, RN]

Read your hospital protocol and you will find the answers to your questions. i never ever primed with saline as I could not and still do not understand the rationale behind it. So during a discussion at work about how we prime our lines we discovered everybody bar me primed with saline ran the saline in at 999 until the blood reached the pt then changed it to the required time for blood. Nobody and I mean nobody knew why they primed with saline so we checked our hospital protocol.

The protocol clearly stated prime your line with saline but no rationale-so now I prime with saline because it states so in the protocol and that is the only thing that would protect me in a law suit.

[Magsulfate, BSN, RN]

Also, what do you hang to run in case of a transfusion reaction?

While we're on the topic of blood transfusions, I have a question about the now prevalent practise of giving Benadryl before transfusing patients - me! I've had transfusions for severe anemia in the past few years, and refused the Benadryl due to my stringent education regarding the "masking" of symptoms. My refusal caused all sorts of negative personnel reactions, which tried my stubbornness.

When and due to what, has this become standard of practice?

Benadryl is not going go mask a major transfusion reaction, EVER. It will help with any discomfort that you might have. A very mild reaction to the blood. However, it will NEVER mask a transfusion reaction, I promise.

[Magsulfate, BSN, RN]

the rationale behind not priming with saline is because the RN always has to sit with the patient the first 15 minutes of transfusion and if u are priming with saline the real blood transfusion can occur as late as 30 minutes and u might be already out of pt's room doing something else, so if u prime with blood sit and watch your pt for that first 15 minutes any reaction u will be able to act very quickly. Any time if there is a reaction change the entire tubing hang 0.9% Ns at kvo rate, and the entire blood with it;s tubing should be sent out for culture to the lab. Also any reaction which is happening should be treated accordingly to what's going on with the patient. As we know there's many different kinds of blood transfusion reactions.

This is exactly what I was thinking. Yes, your reaction is going to happen in the first 15 minutes of your transfusion. That is why I always prime the tubing with blood, I'm not going to stand there forever to wait for the blood to drip down.

[NeoNurseTX, RN]

i've actually never seen it primed w/ saline but we have VERY short blood tubing and the prbcs come filtered already.

[cardiacRN2006, ADN, RN]

the rationale behind not priming with saline is because the RN always has to sit with the patient the first 15 minutes of transfusion and if u are priming with saline the real blood transfusion can occur as late as 30 minutes and u might be already out of pt's room doing something else, so if u prime with blood sit and watch your pt for that first 15 minutes any reaction u will be able to act very quickly. Any time if there is a reaction change the entire tubing hang 0.9% Ns at kvo rate, and the entire blood with it;s tubing should be sent out for culture to the lab. Also any reaction which is happening should be treated accordingly to what's going on with the patient. As we know there's many different kinds of blood transfusion reactions.

Huh? It takes about 20 seconds for the blood to travel down the primed saline line towards the pt. And I don't start that 15 minute window until the blood touches the pt.

[ScrappyED, BSN, RN]

Me too with the "huh?". We don't put blood on a pump in the ED and even if we did, priming the line with saline doesn't take but a few extra seconds. you run the saline through, mainly to make sure the IV is going to hold up and to minimize loss of the RBC's.

For those of you who run blood on a pump--do you have the twin sets that allow saline flushes or do you have to do a piggyback setup? Either way you could turn the pump to "999" and run the blood into the tubing very quickly.:)

[cardiacRN2006, ADN, RN]

I don't run blood on a pump either....

[litbitblack, ASN, RN]

What i would do since our policy said prime with saline is prime with saline to below the drip chamber them mix the blood via gravity so there is only a short bit of line for the saline. Also if i had a peripheral line i had questions about i would then start the saline about 15 minutes before i went to get the blood at full rate to make sure the line could handle it. Course if its a chf pt i would not do that but it does save you time if your line infilterates.

[Virgo_RN, BSN, RN]

We use the blood administration sets with the Y tubing. You can choose to hang a minibag of saline or not. I like to use saline because I feel it's more efficient. Once I know a pt. needs blood, I can set up the transfusion before I have the blood, simply by priming the tubing with some NS, setting up the pump, and getting that first set of vitals, all while I wait for the blood to come from the blood bank. Then all I have to do is get the blood double checked by another RN and spike the bag. I'll run the saline in at a faster rate, until the blood reaches the patient, then I'll slow it down to the 75mL/hr for the first ten minutes, get my second set of vitals, then increase the rate. It's really not a huge deal. If you simply cannot wait that extra thirty seconds for the blood to make it down the tubing to the patient, then all you have to do is take the tubing out of the pump and let the NS flow out of the line until the blood is at the end of the tubing. Put it back on the pump, and off you go.