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

[RNsRWe, ASN, RN]

What about the blood that is left in the tubing when you are finished?

Its so interesting to hear about these different methods of practice. In nursing school (I graduated in 2006), we learned to use saline. Obviously there is some reason why we are moving away from saline, I just don't know what it is. I have not asked the people who wrote the policy why they changed the policy but I will ask my nurse educator on Monday.

Thanks for responding, it's good to know that with the proper technique there is a way to do it and not to waste valuable blood.

When the blood can no longer go through the pump (meaning it's gotten to the empty cartridge part, but there's still blood in the lower tubing) we just run it in by gravity. You only get smears left in the tubing at that point, and if you're very particular you can run saline through, but honestly at that point, there's not a significant amount of blood left--just the smears.

Frankly, I'm more concerned about the "waste" we have when we get orders to give 2 units PRBC to patients with an H/H of 9.7 and 29.3! See that enough to make me think I wasted my OWN blood donating

[RNsRWe, ASN, 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.:)

We have twin sets, use pumps every time, and piggyback the blood INTO the saline at a port close to the patient: the idea is that if someone had a reaction to the blood we could stop the blood nearly instantly and run the saline (which is on a roller clamp) wide open and flush it immediately.

The pumps are set according to policy: very very slowly at first, then moved up in increments as the patients' assessments indicate tolerance.

[RNsRWe, ASN, 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.

Bingo. Except that our policy is we MUST hang that minibag; how would you quickly flush a line if there were a blood reaction? If there's a bag there, line primed, and the blood piggybacked INTO the saline line, you have an immediate shut-off and flush setup ready to go.

The distance between the insertion of the blood tubing and the length of saline-only line to the patient is only like 6", so it can be cleared out fast.

[RNsRWe, ASN, 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.

Second unit gets a second set of tubing, no question. We can use the saline bag from the first unit, but all the tubing is replaced, as there would be blood from the first unit in the last six inches or so of that tubing. And since no blood product is to be hanging on the patient more than four hours, there's no way to use that tubing again, no matter how well you flush it--at least not in our policy.

New unit, new tubes, no question about cross-contaminations.

[cardiacRN2006, ADN, RN]

Second unit gets a second set of tubing, no question. We can use the saline bag from the first unit, but all the tubing is replaced, as there would be blood from the first unit in the last six inches or so of that tubing. And since no blood product is to be hanging on the patient more than four hours, there's no way to use that tubing again, no matter how well you flush it--at least not in our policy.

New unit, new tubes, no question about cross-contaminations.

I can easily (and safely) get 2 PRBCs in within 4 hours. Our policy allows 4 units per blood tubing.

I guess we're all comfortable with what we know..

[truern]

I can easily (and safely) get 2 PRBCs in within 4 hours. Our policy allows 4 units per blood tubing.

I guess we're all comfortable with what we know..

I think the most we infuse with one tubing set is 2 units...but yeah, you can run those in easily over 4 hours if the patient warrants.

[RNsRWe, ASN, RN]

I can easily (and safely) get 2 PRBCs in within 4 hours. Our policy allows 4 units per blood tubing.

I guess we're all comfortable with what we know..

Oh, most of the time we can do that, too. But because it's med-surg, and frequently our blood is going to the elderly who also are CHF, we have to watch that. MOST of the time, the blood is in within 3 hours no problem. But sometimes, we do get orders specifically to spread it over the four hours, or we have to so the patient can tolerate it.

Personally, I think too many of our docs love to drop blood on patients when their H&H really isn't a problem. People think when they donate they're giving to the car accident victims who require it to survive (and that's true) but SO MUCH of the time I see it given to people with H&H's at least as good as mine on any given day I have to wonder...

PS:We can only give the one unit per tubing so that in case of a reaction, there's no question as to WHAT they are reacting to. The entire blood tubing set, with bag, goes back to the lab in case of a reaction.