Need some reassurence that senior RN's advice was right--
If you're running a mass transfusion, and your lines on your level one are both primed with blood and you need to get FFP up, (and assuming your filter is still good), is it okay to spike the FFP even though your drip chamber(s) has blood in it? I wasn't sure today if I needed to change the whole Level 1 tubing set when switching from prbcs to ffp. Or if I needed to hang saline on one side and prime up into the empty blood bag (YUCK) on the other side to try to clear all the prbcs out of the drip chamber and tubing.
Another nurse told me to just spike the FFP right on the tubing filled with blood, so I did. And then later, I spiked more blood on the tubing/drip chamber that now had FFP in it. Is that consistent with what you would do? I felt rather uneasy doing this since I've never heard of mixing blood products or sharing tubing for different blood products. But it WAS a mass transfusion.
Also, on the Level 1, if the products keep flowing ok, then does the filter still need to be changed? Another nurse changed the filter for me because I knew 4-5 units had gone through, but it seemed to work fine--so was it unnecessary to change the filter?
Also, I was actually not on my home turf....I was pulled into the OR....and the anesthesiologist had me run Normasol, which I'm not familiar with. He indicated it was okay with blood. Any thing I should know about Normasol-does it have Ca in it like LR?-anything I should be aware of in the future regarding normasol and blood?
After the procedure, pt's K was 7.1-we were thinking from hemolysis. I wasn't sure if it was from my spiking different blood products on top of each other????, or---the Level 1 tubing was never moved to the central line---so most of the products were going through a 20G AC IV--doesn't seem like the best size for high pressure and mass transfusion. I'm kicking myself for not catching that. Maybe the high potassium was unrelated to the blood/blood product transfusion?
Lastly, anything special about platelets for mass transfusion? The anesthesiologist hung them separate. But out of curiosity, do people put platelets on the Level 1? I had heard not to put them on the IV plum pumps. And can you spike platelets onto tubing that you've run FFP and/or PRBCs through?
Pt is intubated in ICU, had splenectomy, among other things (hx pancreatitis). They got the K down. Coags, fibrinogen, platelets, h and h all seem to be okay. But I just want to get another opinion on mixing my blood products.
This was a big deal for me to go to OR to do this today-but it would have been nice if my first mass transfusion had been in the ER-on my own turf with my colleagues.