"Y" tubing and transfusion reaction

Specialties Med-Surg

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Maybe this was answered before, but I did a little search here and couldnt find anything.

With regards to using "Y" tubings with blood transfusions and having a bag of NS ready - Purpose of the Y tubing is so that if there's a transfusion reaction, you can quickly just clamp the blood line and open the NS wide. Isnt the pt going to be getting quite a bit more blood b/c the NS is going to first flush the whole existing line's worth of blood into the pt?

On the standard tubings we use, there's a very distal port approx 6 inches from the insertion site that can accomodate a secondary line. Wouldnt it make more sense to setup a secondary gravity set line with NS and attach it to this distal port, so that if there's a transfusion reaction you're only clearing a few cc of blood from the line, as opposed to 10x that amount with using the Y tubing? (I hope I'm making myself clear here...)

I asked some nurses on my unit and they kind of shrugged, saying I guess that would make sense... I guess my real question is whats the use of the special Y tubing if a secondary line primed with NS and attached to the distal port can work even better?

Thanks everyone.

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Specializes in ICUs, Tele, etc..

The purpose other than flushing would be to prime the tubing with ns before blood is started. Though you do make sense, about having extra blood being pumped in the circulation if you use the NS bag that's used to prime the tubing to flush it thru.

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As an extern, I actually witnessed a tranfusion reaction, after which the blood was stopped and the blood in the tubing was run into the pt along with the NS. Pt said "I feel a little tingly" from the very beginning, and so, whatever was in the tubing was a significant amount compared to what was already infused. It quickly developed into a entire body surface of rashes. Fortunately he was fine.

I'm NOT flushing that tubing again this way again.

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My pt had a transfusion reaction last week - her temperature spiked, no other signs/symptoms. According to the other nurses 3 out of the 4 times they tried transfusing previously she spiked so no one was majorly concerned.

However, as soon as I noticed the temperature spike, I clamped the blood and then disconnected the whole y tubing business and ran a bag of NS that was hanging there and already primed from before since she was on NS just before the transfusion started. In this way, once the reaction was noticed no more blood transfused into her, not even a few drops from the line. I'd think we'd want it to be this way especially if it was a very serious reaction.

Y tubings are universal, I guess, in all hospitals for tranfusions, so I'm just wondering why the need for it...

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My pt had a transfusion reaction last week - her temperature spiked, no other signs/symptoms. According to the other nurses 3 out of the 4 times they tried transfusing previously she spiked so no one was majorly concerned.

However, as soon as I noticed the temperature spike, I clamped the blood and then disconnected the whole y tubing business and ran a bag of NS that was hanging there and already primed from before since she was on NS just before the transfusion started. In this way, once the reaction was noticed no more blood transfused into her, not even a few drops from the line. I'd think we'd want it to be this way especially if it was a very serious reaction.

Y tubings are universal, I guess, in all hospitals for tranfusions, so I'm just wondering why the need for it...

Good question. Maybe it's to make sure you have a bag of NS ready?

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Specializes in Clinical Infusion Educator.

Dear NY Newgrad,

One of the purposes of the Y tubing is to allow you to set-up and prepare for

the blood transfusion ie.. starting the NS fluids and then hooking up the Blood once you have the unit on hand. It also allows you to have a solution which will clear a line once the infusion is done without alot of extra manipulation.

Your hospital policy should delineate the steps to take in case of a transfusion reaction. Those steps include: Dissconnecting the entire set at the catheters hub, or at the injection cap and hooking up to new tubing with a new bag of NS. You don't want whats remaining in that Y tubing to infuse into the patient and it's wonderful that you, as a new grad thought about that.

DD

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Dear NY Newgrad,

Your hospital policy should delineate the steps to take in case of a transfusion reaction. Those steps include: Dissconnecting the entire set at the catheters hub, or at the injection cap and hooking up to new tubing with a new bag of NS. You don't want whats remaining in that Y tubing to infuse into the patient and it's wonderful that you, as a new grad thought about that.

DD

I hear what you're saying, except that on hospital orientation we were told in case of reaction clamp the blood and open the NS. I automatically asked the instructor why that makes sense, since you're still infusing the whole line's worth of blood. She just shrugged and said I know I got that question before. ?!? Do I just shrug this off as a policy that I dont fully understand? When my NM comes back from vacation I will definitely ask her about it.

In terms of having the bag of NS ready to flush the line when you're done with the blood - we dont do that, we take down the bag of blood with the whole tubing set and put in a biohazard bag. Just flush the heplock and then reattach a seperate tubing if you have to run something else.

Thanks for the responses though.

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where i work, we keep extra tubing in the room still packaged. if there is a reaction, we clamp the tubing, immediately disconnect and start the NS with the new tubing.

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Specializes in cardiac unit.

I'm glad that someone else is wondering why you need the Y-tubing. I've been really curious as to why you can't just run the blood as a piggy-back to NS using regular primary and secondary tubing. What I've been told is that the Y-tubing is specifically made to withstand the heat generated by the IV pump...this ensures that the blood is not hemolyzed by this heat. Has anyone heard the same?

I'm also VERY curious as to why you wouldn't use a standard piggyback setup that would automatically start the NS as soon as the blood is done infusing. Anyone have a rationale for this?

Thanks.

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Specializes in SICU.

Blood tubing is especially desgined to filter blood and reduce the hemolization of blood as it is infused. Where I work you prim the tubing before running blood though it. We also set up a second bag of NS with primed tubing attached to the nearest port in case of reaction.

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Blood tubing is especially desgined to filter blood and reduce the hemolization of blood as it is infused. Where I work you prim the tubing before running blood though it. We also set up a second bag of NS with primed tubing attached to the nearest port in case of reaction.

Funny how this thread was revived...

Either way, my original question still stands. You write that you attach NS with primed tubing to the nearest port in case of reaction. Logically, thats how I agree it should be.

However,with the standard blood Y tubing that we use, the bag of NS and the blood come together at the top of the tubing, which means they share a several feet of common tubing. In case of reaction, when you open the bag of saline which is connected at the top, you'd still be infusing all that tubing with the blood inside.

I still think you'd be safer just piggybacking the NS to the port closest to the pt...

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Specializes in SICU.

We have 3 bags, 2 NS and 1 blood all hanging at the same time.

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