Regarding FFP transfusion

Altra, BSN, RN · Mar 13, 2012

I want to better understand your question. Think about why we give FFP. If FFP is being infused quickly, I would conclude that the patient needs it quickly, emergently. As in ... an INR of 5 with active LGIB.

I only slow down FFP when the patient is already fluid overloaded or is at great risk of such.

psu_213, BSN, RN · Mar 13, 2012

Unless contraindicated (ex. fluid overload) I bolus it it...999 on an Alaris pump. I have seen nurses 'free flow' it wide open.

BacktoBasics · Mar 24, 2012

Don't know why. I run it wide open. They need FFP for a reason right? Check your hospital policy though.

SWAT RN · Mar 25, 2012

The rate of infusion really just depends on why your giving it. As far as why its ok to run it fast...my guess is that its safe because it does not require type and crossmatch. I always run it wide open off pump unless theres some kind of cardiac history.

caroladybelle, BSN, RN · Mar 25, 2012

First, because there are much fewer reactions and less dangerous reactions to it.

Second, because frequently the issues that you are treating with it (volume deficit, acute bleeds with elevated bleeding times) generally need more rapid intervention.

Third, being thinner than PRBCs, the higher rate is more easily tolerated.

In actuality, pretty much all blood products, other than granulacytes, can be rapidly infused if need be. It isp preferable not to do so with PRBCs, because there are more severe reactions with those that could cause long term issues. Platelets (more with PTs that have received a lot of platelets, especially if random donor) may cause a reaction, but is generally a more benign one (hives or itching). I gave never seen a reaction to FFP.

And while I have never seen this with FFP, I have seen platelet transfusions that were mistakenly done over 3-4 hrs, where they literally clot off the tubing filter. Do not know if they can occur with FFP, though as I have never seen it happen.

BelgianRN · Mar 26, 2012

And while I have never seen this with FFP, I have seen platelet transfusions that were mistakenly done over 3-4 hrs, where they literally clot off the tubing filter. Do not know if they can occur with FFP, though as I have never seen it happen.

Doubt it since you need platelets mostly to make a clot ^^.

In dutch there is a nice saying: "niet lullen, maar vullen" it translates to "no memberes, but fill" but then it doesn't rhyme anymore and it doesn't make sense anymore either since the slang for member in dutch is also to stand around and chat.

Point I'm trying to make is generally blood products are transfused based on the acuity of the situation. Of course if the situation allows you give it over more time so you can monitor for reactions and stop the transfusion in time. If time permits you also transfuse just one unit at a time so you can identify which unit triggered the reaction. But if need be, 5 lines and a level one can work wonders ^^.

According to a Belgian registry, that scores nursing interventions on patients and that in turn decides how many nurses your department gets funding for. We used to have to document all units of blood as run independently of one another. If run together it would count as just one transfusion (and score the same level of intensity as running in one unit of PRBC's/FFP/TC). Thankfully that changed, but for years if we had a ruptured AAA or something we'd have to change documentation (read falsify) to make it appear as if every unit of bloodproduct was run over one minute one after the other.

Sorry for digressing it's just the frustration that rises when bureaucrats start messing with the nursing system.

hodgieRN · May 4, 2012

In my opinion, I think you should run into plasma slowly for the first increment, than increase it. I've had three who had hypersensitivity reactions with FFP. Thankfully, they were awake and could tell me they were itching or had hives. It's true that the reaction isn't as bad as others. Type and cross helped knock out hemolytic reactions, but, respectively, I think it's a good thing to be safe just for the first part of it at least. If someone is bleeding out or needs emergency surgery, of course, do what you gotta do. But on an intubated pt, they could have hives and you wouldn't know it until the 2nd or 3rd unit. Do nurses honestly pull back the gown and check the skin for every unit of FFP on a comatose pt? And honestly, I bet if any nurse was a pt in the hospital, stable, needing FFP, and awake, I bet they would feel a little uneasy if the bedside nurse said "I'm just gonna dump this in...it's fine. Let me know if you get hives."

psu_213, BSN, RN · May 4, 2012

In my opinion, I think you should run into plasma slowly for the first increment, than increase it. I've had three who had hypersensitivity reactions with FFP. Thankfully, they were awake and could tell me they were itching or had hives. It's true that the reaction isn't as bad as others. Type and cross helped knock out hemolytic reactions, but, respectively, I think it's a good thing to be safe just for the first part of it at least. If someone is bleeding out or needs emergency surgery, of course, do what you gotta do. But on an intubated pt, they could have hives and you wouldn't know it until the 2nd or 3rd unit. Do nurses honestly pull back the gown and check the skin for every unit of FFP on a comatose pt? And honestly, I bet if any nurse was a pt in the hospital, stable, needing FFP, and awake, I bet they would feel a little uneasy if the bedside nurse said "I'm just gonna dump this in...it's fine. Let me know if you get hives."

I respectfully disagree. I understand that, if it is necessary for me to have FFP, it should be run in quickly. If I develop hives or itching, I will alert the nurse...I consented to getting the FFP and it means that I understood the risks.