Re: blood transfusions

[vhrn]

Maybe I'm just old and behind times, but I was taught that NOTHING is to run into the same IV site as a blood transfusion. I work with a nurse whom I have followed on 2 separate occasions who ran Versed into the same site as blood (PRC's), and NS w/20 KCL and a Zofran gtt y'd into the same angiocath as PRBC's. Can someone out there tell me I need to lighten up, or do I need to call the Red Cross??

[queenjean]

Good question. I thought it was because in the unlikely event that you have a reaction, you really badly need to know if it's the blood that is causing it.

That was my thought, too; but then I wondered; what's the difference? If you stop it, flush with saline, IVP morphine over a minute, flush with saline, start the blood again, and then five or ten minutes later the pt has a reaction, how can you tell which caused it? If you have multiple lines, and the patient has a reaction, you can't tell whether it was the morphine you ran in the left dorsal hand or the blood you have running in the right ac.

So that led me to believe that there must be another reason; but I couldn't come up with one.

Anyone else have any thoughts about it?

[scattycarrot, BSN, RN]

NaCl is the only product which can be used to precede and to follow an infusion of blood products. Its all about compatability. Remember that blood is like any IV drug and whatever you administer intravenously, you need to make sure that those products are compatabable with one another. For example, dextrose, if given with blood, causes clumping and hemolysis of RBC. Likewise, other medications can do the same thing. Stopping the IV line to administer other medications and flushing of the line with NaCL prior and after the delivery of said medication, prevents unwanted reactions between products.

[queenjean]

Thanks, SC, that's what I was looking for. Some sort of phyiological/biological reason behind it.

[CaLLaCoDe, BSN, RN]

i'm an lpn, and in my facility we don't give blood; so i never take those patients.

*why* should nothing run with the blood? what is the biological/physiological basis behind not being able to give an iv push of morphine, for example, with the blood instead of stopping, flushing, giving med, and flushing again? help me understand how that is different than giving it straight with the blood.

i just don't quite understand the reasoning behind it; i'm sure it's there, though our facility seems to have enough other suspect, outdated protocols...

anyhow, thanks in advance.

j

what a great question. i think the rational might be that you can misconstrue a reaction to morphine, versed or anything else as a patient's reaction to the blood transfusion. and since blood transfusion reactions are so gut wrenchingly serious, keep it simple and don't mess with that line other than flushing with ns before and after a transfusion.

i know some one has a better answer. anyone? next....

[Spidey's mom, ADN, BSN, RN]

But . . . when you think about it . . . . we are infusing all those "incompatible with blood" products into blood . . in our veins. If dextrose causes "clumping" in blood in a IV tube . . .why doesn't it cause clumping in a vein? I love these kinds of questions . . .. .I think too hard about stuff.

steph

[queenjean]

Here's my thought process:

I'm assuming that when blood it transfused, it's pretty concentrated. Not a lot of excess fluids. So the clumping would affect it more. Also, it's going through an artificial tube that doesn't have give, like our vessels. Another thought is that the age, the processing, testing, and storage the blood goes through makes it more likely to be damaged or to clump when something like dextrose is added in the tubing prior to it actually reaching the body.

Maybe? Maybe not?

[bigsyis]

You don't need to call the Red Cross, but I certainly would make your manager aware of this. As the OPs have said, NS is the only thing that should run into the same port as blood products. After one is certain that there will be no further need to use that site for blood products, THEN it may be used for the type things that you describe.

[Spidey's mom, ADN, BSN, RN]

I would definitely look at the policy and procedure book at your hospital. I've seen this and it is against policy where I work.

steph

[scattycarrot, BSN, RN]

But . . . when you think about it . . . . we are infusing all those "incompatible with blood" products into blood . . in our veins. If dextrose causes "clumping" in blood in a IV tube . . .why doesn't it cause clumping in a vein? I love these kinds of questions . . .. .I think too hard about stuff.

steph

Good point. The problem here is the language used as we tend to say 'blood transfusion' when in actaul fact we are giving packed red blood cells and not whole blood. Whole blood transfusions are rarely given and contains RBC,plasma and plasma proteins. Packed RBC's are a blood product and are as queenjean said, more concentrated and is why clumbing is more likely. I am happy to be corrected if this is incorrect!!

[Spidey's mom, ADN, BSN, RN]

Good point. The problem here is the language used as we tend to say 'blood transfusion' when in actaul fact we are giving packed red blood cells and not whole blood. Whole blood transfusions are rarely given and contains RBC,plasma and plasma proteins. Packed RBC's are a blood product and are as queenjean said, more concentrated and is why clumbing is more likely. I am happy to be corrected if this is incorrect!!

I'm sure you are right . . . . . it just struck me this morning as I was reading this that there are some products that are incompatible with "blood" . ... and yet we infuse those into blood with an IV.

Like I said - I over-think things . ..

steph

[scattycarrot, BSN, RN]

I'm sure you are right . . . . . it just struck me this morning as I was reading this that there are some products that are incompatible with "blood" . ... and yet we infuse those into blood with an IV.

Like I said - I over-think things . ..

steph

Its better to 'over-think' things,as you put it, than to under-think and to never ask.....So, why are we doing that? Whats the rational and evidence behind this particular action and/or intervention? Asking questions and thinking about things is what makes you a good nurse and most importantly, a SAFE nurse. Never stop 'over-thinking' things!!!

[StacieRN, RN]

Due to the cells being concentrated using any fluid not isotonic will cause cell lysis (damage to the cells) thus rendering them useless. So, only NS. This is true of platelets as well.

see this site under osmotic injury (page 2)

http://www.americasblood.org/download/bulletin_v7_n4.pdf

Hope this was of help.

Stacie