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??

[Spidey's mom, ADN, BSN, 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

:w00t:Seems like I do remember this now . . .nursing school was a loooong time ago.

steph

[bigsyis]

asking questions and thinking about things is what makes you a good nurse and most importantly, a safe nurse. never stop 'over-thinking' things!!!

hear, hear! this is what makes a good nurse, and keeps them that way.

the day you think you've seen it all, heard it all, or god forbid-know it all, you become a dangerous nurse.

[vhrn]

Thanks for reinforcing what I already knew. I agree, if pt needs meds during the tx, stop blood, flush, med, flush, resume blood. I appreciate your reply.

[vhrn]

Thank you so much for your reply. I appreciate your reinforcing what I already knew, and thanks for the link to americasblood. My coworker and I searched the Red Cross site and launched numerous other searches last night but were unable to find much, unfortunately. Thanks again.

[vhrn]

As many other nurses replied, to run other meds/IVF (especially dextrose, and many gtts/ivpb's are mixed in dextrose) with blood, can cause clumping of the PRC's. To me, that means, if the PRC's clump, there are little "clots" running around in your vasculature, looking for a place to cause a problem, i.e. stroke or MI. Right, out there?

[EmmaG, RN]

As many other nurses replied, to run other meds/IVF (especially dextrose, and many gtts/ivpb's are mixed in dextrose) with blood, can cause clumping of the PRC's. To me, that means, if the PRC's clump, there are little "clots" running around in your vasculature, looking for a place to cause a problem, i.e. stroke or MI. Right, out there?

Many years ago, our floor had a patient who died suddenly after receiving blood hung with D5W.

[JazzyRN]

Unless its very emergent and theres no alternative, PRBCs should run alone. If the pt is on a versed gtt, the nurse should stop the transfusion and bolus the pt with an hours worth of versed and continue the blood, a couple times thru the infusion. I personally know of times where in the ICU we've given blood in the same line as some gtts, it was all emergent situations in pts with poor access, where we couldnt stop the gtts(pressors). but this should be a rarity. why dont you address your colleagues and ask them why they are doing it that way?

[vhrn]

The only reason I even mentioned calling the Red Cross is that we have only one nurse in our ICU who runs other IVF to the same site with blood. I personally have followed her twice when this was done. I've gone to our manager (2 different ones, one for each occurrence), and the incident wasn't addressed.

[chloeysmom]

What about blood running into a port of a central line? Can other fluids run into another port that is not NS and it not be harmful?

[NRSKarenRN, BSN, RN]

daytonite provided links:

http://www.muw.edu/nursing/iv.htm - the last half of this document has information about the procedure of blood transfusion and transfusion reactions

transfusion reactions

reactions may take up to 180 days to occur.

from australian red cross:

a triple lumen cvc is composed of three separate tubes bound together and designed so the exit site for each lumen comes out at a different spot. the nature of cvc’s is that they are placed in a large vein with a high blood flow so that substances are dispersed quickly through the blood. therefore, you can give a different fluid down each of the separate lumens: for example hydration fluid, blood and morphine can each be administered down separate lumens. however, it is important to consider that if you are administering different fluids at the same time via a triple lumen cvc, it may be difficult to determine which fluid may be implicated if an adverse reaction occurs

http://www.transfusion.com.au/qa/qa_answer.asp?qid=804

check out sunnybrook and women's college health sciences centre free bloody easy online course

[evil]

bloody-easy is an electronic learning tool providing practical information on transfusion medicine. it is designed to enhance the ability of physicians, nurses and technologists to use blood transfusion and its alternatives knowledgeably. this course will help physicians, nurses and technologists to recognize and manage adverse consequences of transfusion. it will also provide an evaluation and recognition of successful completion of the course.

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