Rate to run blood?

jkr2020788 · Jun 7, 2012

In our hospital, the unit of blood is always different mls-wise. This is because most of the time, different donors give different amounts of blood and there are different cleaning methods of the blood.

As far as the time, I ALWAYS see MDs write something like "transfuse 1 unit PRBCs over so and so hours." Ive worked at a few hospitals, and the MDs always write the time in which they want the blood infused. Just everything after 4 hours must not be used.

NoviceRN10 · Jun 7, 2012

In our hospital, the unit of blood is always different mls-wise. This is because most of the time, different donors give different amounts of blood and there are different cleaning methods of the blood.
As far as the time, I ALWAYS see MDs write something like "transfuse 1 unit PRBCs over so and so hours." Ive worked at a few hospitals, and the MDs always write the time in which they want the blood infused. Just everything after 4 hours must not be used.

I have never seen the time to infuse mentioned in any doctor's orders for the transfusions where I work. I usually run it between 125-175 an hr (depending on how many units I am trying to get in the pt) and our units are usually 350 ml.

That Guy, BSN, RN, EMT-B · Jun 7, 2012

On med surg it was 100 for the first 15 and then up to 175ml/hr after that.

Now though I can run it as fast as I please. I love the ER

emtb2rn, BSN, RN, EMT-B · Jun 7, 2012

We also always have mls listed on the info sheet attached to the bag as well as "infuse over" however long in the order. I've also run blood wide open for the bleed out.

classicdame, MSN, EdD · Jun 7, 2012

look at the hospital policy. If that is not helpful, call the blood bank or lab director. My medical director for our BB and I created a policy with that info so nurses would have a reference. Will depend on pt, size of cathlon, pump or gravity, type of blood product and size of tubing.

jkr2020788 · Jun 7, 2012

some of the docs need to understand that the order of "run over 4 hours" is kinda hard to do considering the time it takes to scan (or however other hospitals verify blood products) and the first 15 mins at a slower rate. yet somehow we figure a way to squeeze it rightttttt in the time limit :)

nurse2033, MSN, RN · Jun 7, 2012

The straight answer is, as fast as is safe for the patient. A 20 year old GSW victim gets it fast, Nana who has CHF gets it slow. Don't forget, they are getting blood because they need it, sooner rather than later is better.

nurseprnRN, BSN, RN · Jun 7, 2012

to expand on what nurse2033 said above, the answer is both more and less than your policy indicates. the generally-accepted rule that banked blood should be infused in less than four hours from the time it left the blood bank's control is related to infection control and cell preservation once it's out of refrigeration.

other than that, though, the rate to run ends up being largely a nursing decision, considering the presence of any medical treatment plan and your own nursing judgment of the patient before you. i realize that as a new grad you don't have a lot of nursing judgment yet, so let me give you some explanation.

in nurse2033's example, the gsw who bled out a lot on the field is young, with, presumably, a young heart and snappy physiological reflexes. if he lost his blood fast, he should get blood back fast; even if you were to fluid-overload him, he would probably be able to compensate rapidly.

nana, at 63, may have lost her red cells in different ways. if she's an alcoholic and bleeding out of her esophageal varices steadily but not hugely, she needs replacement to maintain bp and oxygenation. how fast she gets it will depend on a few things. one, is her heart and physiological backup system up to a fast refill, or will this push her into congestive failure? how do you know?, well, in at the same time you're checking her for hives and other s/s of mismatch, you will listen carefully to her heart and lungs. you'll do this before you start the blood, because you know she could get fluid-overloaded and you want to check her baseline. then as you run it in as fast as she might need it related to her bp/bleed rate, you'll check for an s3 (and maybe s4 if she's worse) which will tell you about how her heart is handling that extra venous return, and her chest, for incipient rales. if she develops rales or s3, then you slow the blood and call the physician, who will likely order some diuretic for the fluid overload, and continue the red cells going in. this is intermediate icu territory, with the potential to go critical if she pops a varix, so keep a close eye on her.

if nana is 75 and anemic and has no acute bleeding now or recently, but has just sorta lost red cells in her gut from her daily asa habit, or because she has old bone marrow, or is malnourished, or has a chronic illness like cancer, she needs the red cells but she doesn't need them fast. she lost them slowly and you can give them slowly, to give her heart a chance to get used to the idea. monitor her closely for rales, too, and be sure you don't let anybody put a big slug of ns into her along with the packed cells.

DebblesRN, ASN, BSN, RN · Jun 7, 2012

On average, there is about 300ml of blood in a unit.

I think in most places, you run the blood quickly in EMERGENT situations, otherwise, run over 2-4 hrs, depending on the situation.

I also came from a place where docs like to order "run over 4 hrs" (but that was cardiac, and EVERYONE had low EF and CHF) so they NEEDED it slow. We also used to push lasix between units of blood.

I agree with the advice everyone has passed on, check policy and procedure for your facility, check doctor's orders (because some will tell you how quickly they want it infused) and evaluate the condition and medical history of the patient and WHY they are getting blood--you will learn, with experience when to get it in quick, and when to let it run the four hours.

GrnTea has a great post! Very helpful advice there.

Good luck to you. :)

Penelope_Pitstop, BSN, RN · Jun 18, 2012

We are to run the blood at 60 mL/hr for the first fifteen minutes, then I usually bump it up to 125 or so. We can run it at a max of 180 on the M/S floor. Our units are usually 290 mL.