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.
I suspect whoever wrote or edited the policy screwed up the rate/volume terms. This will surely cause conflict between nurses who recognize the underlying issues and intent of the policy and nurses who have no idea.
That's crazy! I would never run blood that fast initially! 60ml/hr for the first 15 minutes then rate after that depends on clinical scenario/fluid overload/etc.
If someone is going to have a reaction, you would want as LITTLE as possible in their system IMHO!!
50ml over the first 15 minutes is actually a pretty common practice recommendation and policy.
The purpose of the first 15 minutes isn't to avoid a reaction, it's to elicit a reaction if one is going to occur so that it can be detected while the patient is still being closely observed. Reactions can occur after only a few mls of blood products but many do not occur until about 50mls of blood has transfused. So if you do close observation for the first 15 minutes, but the patient has only received 20mls during that time, then there is an increased risk the patient will have a reaction that occurs when the patient is no longer being closely monitored.
LOL, I guess we can't agree, I wonder if my educator will even be able to explain rationale. I'm looking for any EBP on it now but so far nothing good!
I get Muno's explanation but yes, with more blood infused you are more likely to spot a reaction but with more blood infused haven't you made the situation worse if a deadly reaction DOES occur? Seems like a double edged sword...??
Specializes in Nurse Leader specializing in Labor & Delivery.
LOL, I guess we can't agree, I wonder if my educator will even be able to explain rationale. I'm looking for any EBP on it now but so far nothing good!
Let us know if you find anything! I looked at our facility's policy the other day, and it just said that the nurse must be present during the first 15 minutes, and needs to take a set of vitals at the 15-minute point, but after that, just make sure it's infused within 4 hours. No mention of infusion rates.
Well, just finished orientation to one of my jobs and I took one of their learning modules which presented the question,
"During the first 15 min of transfusion, blood is to be administered slowly so that only 15-30 ml of product is transfused. Why?"
Answer was:
"for early recognition and treatment of an acute hemolytic transfusion reaction".
This is so bizarre that there are these two trains of thought floating around out there! The above flies in the face of what Muno suggests. I'm now going back to my other workplace to see their policy. So weird.
Well, just finished orientation to one of my jobs and I took one of their learning modules which presented the question,
"During the first 15 min of transfusion, blood is to be administered slowly so that only 15-30 ml of product is transfused. Why?"
Answer was:
"for early recognition and treatment of an acute hemolytic transfusion reaction".
This is so bizarre that there are these two trains of thought floating around out there! The above flies in the face of what Muno suggests. I'm now going back to my other workplace to see their policy. So weird.
I can't speak for the the rationale of those who put the recommendations, but if the purpose of the close observation period for the first 15 minutes to ensure the patient is closely observed during the time a reaction would become apparent then you couldn't stop the close observation period after only 15-30 mls. You would need to continue it until both the time requirement and the volume requirement are met. Since some reactions can take at least 50mls to occur, why would it make sense to only closely observe through the first 15mls?
I have actually a nurse start the pump at 50ml/hr, do the close obs vitals for 15 minutes at the end of which the blood was only now just reaching the end of the tubing, which sounds pretty silly since she wasn't yet through the time period when a reaction most likely would have occurred. It's the same problem with stopping the close obs period before sufficient blood has infused to trigger any of the reactions you are trying to detect.
I can't speak for the the rationale of those who put the recommendations, but if the purpose of the close observation period for the first 15 minutes to ensure the patient is closely observed during the time a reaction would become apparent then you couldn't stop the close observation period after only 15-30 mls. You would need to continue it until both the time requirement and the volume requirement are met. Since some reactions can take at least 50mls to occur, why would it make sense to only closely observe through the first 15mls?
I have actually a nurse start the pump at 50ml/hr, do the close obs vitals for 15 minutes at the end of which the blood was only now just reaching the end of the tubing, which sounds pretty silly since she wasn't yet through the time period when a reaction most likely would have occurred. It's the same problem with stopping the close obs period before sufficient blood has infused to trigger any of the reactions you are trying to detect.
I'm assuming the line was primed with saline in this scenario? At my previous hospital, we spiked saline and blood on a two pronged line, primed with saline. At my current hospital, no saline at all, you leave the second spike flapping in the wind and prime with blood only. So blood would actually be going in the whole time.
We use dual spike.. NS to prime then clamp off, spike blood and prime blood to tip of line.
Verify with 2 nurses, flush IV/get baseline VS then start 15min close monitoring with blood going in.
We also will open the saline at the end and clamp off blood to get the remaining amount in line to transfuse. Blood is a precious donation, should not be wasted!
ArtClassRN, ADN, RN
630 Posts
I suspect whoever wrote or edited the policy screwed up the rate/volume terms. This will surely cause conflict between nurses who recognize the underlying issues and intent of the policy and nurses who have no idea.