Really dumb blood admin question

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Specializes in cardiac/education.

Ok I feel really dumb asking this but....

Per my facility policy, blood should be administered "the first 50cc of blood slowly over 15 minutes to observe for transfusion reactions". To this end, I hung blood the other day when I set the pump at my initial 75ml/hr the other nurse argued that according to EBP (and policy!) the first 50 cc must go in within 15 min to be able to tell if a reaction was likely to happen, etc. But then that means I'd be setting the pump at 200 ml/hr for the first 15!! That would not be "slowly". ??? This doesn't make sense to me! I mean usually I start at 75 for 15 and then pop up to 125-150 if all goes well. What am I missing here? Am I misreading my P&P? This is where the confusion lies.

HELP!

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Specializes in Nurse Leader specializing in Labor & Delivery.

Is it possible you misread/misunderstood the way the policy was written? It would make more sense that it be "50ml/hour for the first 15 minutes" rather than "50ml for the first 15 minutes" (which would be 200ml/hour, as you said)

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Specializes in cardiac/education.

OMG Klone, I didn't think of that but no I don't think I misread but I was doing modules. I will have to check the written P&P this weekend. BUT 200ml/hr would be WAY too fast, right? That is what we were arguing as well....

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Specializes in Inpatient Oncology/Public Health.

I always do 75 ml/hr for the first 15 minutes but I don't think our policy gets that specific.

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Specializes in Nurse Leader specializing in Labor & Delivery.

Yes, definitely think 200ml/hour is too fast. We wouldn't run that at the normal admin speed, let alone the initial admin, which needs to be slower.

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Specializes in CMSRN.

I would definitely reread that. I usually start mine at 60 mL/hour for the first 15 minutes and then bump up to 120 mL/ hour if all is well.

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Our policy says to give the first 50 ml over 15 minutes which is 200 ml/hr. I then bump the rate down to 125 or 150 so that one unit transfuses in about 2 hours. I'll give the blood over 4 hours if patient had fluid over load issues.

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My two cents: that policy is ridiculous.

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Specializes in Nurse Leader specializing in Labor & Delivery.
Our policy says to give the first 50 ml over 15 minutes which is 200 ml/hr.

What would be the rationale behind giving it FASTER in the first 15 minutes?

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Specializes in Vascular Access.

Ideally, you should NOT be infusing any more than 30 cc in that first 15 minute period. The first 15 minutes is the time frame when the most deadly consequences to the administration of a blood transfusion reaction occur. So, start slow, monitor well, and then stop immediately as needed. Intravascular hemolytic reactions can occur with as little as 30mls of blood, and the quicker they manifest "themselves" the more deadly the reaction will be. So, do NOT set your pump for anything more than 120cc/hr for the first 15 minutes.

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Specializes in cardiac/education.
Our policy says to give the first 50 ml over 15 minutes which is 200 ml/hr. I then bump the rate down to 125 or 150 so that one unit transfuses in about 2 hours. I'll give the blood over 4 hours if patient had fluid over load issues.

See!!!! I don't get it. Why would you run the first 15 mins FASTER? My colleague argued that this helps trigger reactions faster therefore you can stop the infusion if one occurs. I'm definitely rereading and getting with my educator on this one! Thank you

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Specializes in Vascular Access.

Curious1,

Your "other nurse" is just plain wrong.. and you were right, and you were even MORE conservative than needed, but still right on. Yes, education is in order.

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