Running PRBC concurrently with NS?!

Nurses General Nursing

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Hi,

I'm a new RN working on a medical oncology unit and went off of orientation last week. Today a Dr came in and told me she'd like me to administer 2 units of PRBC's. She added that she'd like the patient's fluids, normal saline, to be reduced to 70 ml/hr during the infusion and returned to 125 ml/hr (the current running rate) after the transfusion was complete. I know you're typically not supposed to mix anything with blood, but being that it was normal saline and that's what we prime the transfusion line with I went to ask my trusted past preceptor what he thought. Together we agreed that I would get a second pump to run the blood through using the Y-port tubing, which is standard on our unit, and then connect it to the line running the NS. I connected the blood line to the lowest port, closest to the insertion site, on the fluids line. When the night shift came on I got reamed for making such a mistake. I don't know if what I did was truly wrong or if I was just being bullied. The RN II on nights is very mean to new nurses, but my colleagues have stated she's especially rough on me. Spending my ride home in tears is pretty commonplace. Anyway, I've spent the last 3 hours googling and haven't found a concrete answer. Though some sites indicate it's ok to run PRBC's concurrently with NS. My old preceptor pulled me aside before he left and told me it was fine and that they're compatible. The RN II said I read the order wrong. The Dr had not written the words "run concurrently". The order just read reduce rate to 70 and then return to 125. But when she verbalized it to me I took it to mean run together. I'm exhausted with anxiety. Besides answering regarding this issue, can you also tell me if things get better... Right now I feel like a failure, because no matter how many times I'm told I'm doing well, this woman (RN II) makes sure I go home feeling incompetent nightly. :/

Thanks in advance fellow nurses!

Oh man, we used to do this all the time! Hem/Onc, y'know? Sometimes, there were days where we'd have orders for Mg, K, Blood, NS, TPN and chemo. That was always a challenge! Thank God for triple lumen PICCs, but even then, we'd occasionally have to run things concurrently.

I remember the time we called the docs, pharmacy and the CNS and eventually got permission to run blood and chemo together, of all things. Yeah, that was a fun day!

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Specializes in Emergency.

Agree with above posters, NS is compatible with blood and will not harm your transfusion, that being said, best practice is probably to start another IV if you have blood running. If I need to run blood And only have one IV I will take the time during the initial transfusion monitoring when I need to be in the room anyway to initiate another line. That way if the patient requires any other medications (which are definitely not compatible) or in case of emergency I have an option. If pt needs concurrent fluids then perfect, also helps that 15 minutes pass a little quicker ;)

Don't beat yourself up about this. No harm came from it and the fact that you are bothered by it shows that you are reflecting and willing to learn.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thank you all very much for your replies. I'm going in early to check the hospitals policy, which I should have done rather than ask someone else.
Good for you!!!!

That is what you should do every time you do something new.....I ask then I look up....that's then 2 references.

You didn't hurt the patient and in many facilities what you did was not wrong. If you would have been unable to get a second site started that is what you would have done in the end anyhow.

Let us know.

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I have worked in places where blood can NEVER be infused via pump. Where it always required a dedicated line with NO NS running, just a bag and tubing in the room in case of transfusion reaction.

I have worked in places where blood is ALWAYS hung on a pump, always with a NS primer, etc.

My point is this nursing game is maddening. You would think something this standard and important would be universal. You will find differences of policies throughout your career.

You are doing fine. Don't let the mean nurses get you down.

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Hi,

I'm a new RN working on a medical oncology unit and went off of orientation last week. Today a Dr came in and told me she'd like me to administer 2 units of PRBC's. She added that she'd like the patient's fluids, normal saline, to be reduced to 70 ml/hr during the infusion and returned to 125 ml/hr (the current running rate) after the transfusion was complete. I know you're typically not supposed to mix anything with blood, but being that it was normal saline and that's what we prime the transfusion line with I went to ask my trusted past preceptor what he thought. Together we agreed that I would get a second pump to run the blood through using the Y-port tubing, which is standard on our unit, and then connect it to the line running the NS. I connected the blood line to the lowest port, closest to the insertion site, on the fluids line. When the night shift came on I got reamed for making such a mistake. I don't know if what I did was truly wrong or if I was just being bullied. The RN II on nights is very mean to new nurses, but my colleagues have stated she's especially rough on me. Spending my ride home in tears is pretty commonplace. Anyway, I've spent the last 3 hours googling and haven't found a concrete answer. Though some sites indicate it's ok to run PRBC's concurrently with NS. My old preceptor pulled me aside before he left and told me it was fine and that they're compatible. The RN II said I read the order wrong. The Dr had not written the words "run concurrently". The order just read reduce rate to 70 and then return to 125. But when she verbalized it to me I took it to mean run together. I'm exhausted with anxiety. Besides answering regarding this issue, can you also tell me if things get better... Right now I feel like a failure, because no matter how many times I'm told I'm doing well, this woman (RN II) makes sure I go home feeling incompetent nightly. :/

Thanks in advance fellow nurses!

You did nothing wrong. The only thing compatible with blood is NS. There is no reason you can't run NS and blood concurrently if that is what is ordered. They are compatible with each other. Unless of course there is some policy at your hospital that prohibits it.

Also, the mean nurse on the night shirt - the bully - should be fired. She probably costs the facility more money because of poor retention. Doubt if she is worth it.

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I have worked in places where blood can NEVER be infused via pump. Where it always required a dedicated line with NO NS running, just a bag and tubing in the room in case of transfusion reaction.

I have worked in places where blood is ALWAYS hung on a pump, always with a NS primer, etc.

My point is this nursing game is maddening. You would think something this standard and important would be universal. You will find differences of policies throughout your career.

You are doing fine. Don't let the mean nurses get you down.

Blood should not be run on a pump (unless someone can tell me there are new pumps that don't make for hemolysis and are specifically made for blood-- I'm willing to learn if this is true) and you should always be monitoring a pt getting blood and be ready to turn it off in an instant prn anyway. That has nothing to do with the need for a dedicated line (if you have one) or the fact that NS is perfectly safe and AABB-approved to run c blood products.

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Blood should not be run on a pump (unless someone can tell me there are new pumps that don't make for hemolysis and are specifically made for blood-- I'm willing to learn if this is true) and you should always be monitoring a pt getting blood and be ready to turn it off in an instant prn anyway. That has nothing to do with the need for a dedicated line (if you have one) or the fact that NS is perfectly safe and AABB-approved to run c blood products.

We have smart pumps at my hospital. You choose the drug your running, and blood is an option

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Thanks. Good to know.

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Specializes in being a Credible Source.
The people who are getting in a fluff about it don't know the physiology involved (including the ones with the idea that you just stop the IV fluids and give the blood at 125) and are ritualistically relying on inappropriate transfer of incomplete information that no IV fluids may run c blood products.
Kind of like the myth that you can only run blood through a 20 or bigger.

Had a nurse at work belittling me for saying it can be done through a 22. Finally, I copied a page out of the BB book which explicitly states that a 22 is acceptable. Next time she went off, I said "that's your opinion..." and handed her the copy. Pretty much ended that one.

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At both places I worked at as a floor RN - we had pumps with settings for blood administration. Both systems had specific "blood" tubing that if we didn't have it, we had to run it by gravity/calculating drip rates. With both pumps I used it wasn't the pumps but the tubing that cause hemolysis. (Not all pumps are created equal though, friends working elsewhere have told me stories about their pumps' limitations).

That being said, I always ran blood in alone without anything else. I liked having another IV access point peripherally just in case and would prefer to run maintenance fluid through there. Not always possible, so there is that consideration too.

I would definitely check policies/procedures. Another thing is, if policy doesn't prohibit it, you could ask whoever (physician, PA, NP) who insisted you run them together (blood products and NaCl) to write an order as such. I would definitely follow my policies but if the policy doesn't say or is vague, this would be something I might consider.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Hi,

I'm a new RN working on a medical oncology unit and went off of orientation last week. Today a Dr came in and told me she'd like me to administer 2 units of PRBC's. She added that she'd like the patient's fluids, normal saline, to be reduced to 70 ml/hr during the infusion and returned to 125 ml/hr (the current running rate) after the transfusion was complete. I know you're typically not supposed to mix anything with blood, but being that it was normal saline and that's what we prime the transfusion line with I went to ask my trusted past preceptor what he thought. Together we agreed that I would get a second pump to run the blood through using the Y-port tubing, which is standard on our unit, and then connect it to the line running the NS. I connected the blood line to the lowest port, closest to the insertion site, on the fluids line. When the night shift came on I got reamed for making such a mistake. I don't know if what I did was truly wrong or if I was just being bullied. The RN II on nights is very mean to new nurses, but my colleagues have stated she's especially rough on me. Spending my ride home in tears is pretty commonplace. Anyway, I've spent the last 3 hours googling and haven't found a concrete answer. Though some sites indicate it's ok to run PRBC's concurrently with NS. My old preceptor pulled me aside before he left and told me it was fine and that they're compatible. The RN II said I read the order wrong. The Dr had not written the words "run concurrently". The order just read reduce rate to 70 and then return to 125. But when she verbalized it to me I took it to mean run together. I'm exhausted with anxiety. Besides answering regarding this issue, can you also tell me if things get better... Right now I feel like a failure, because no matter how many times I'm told I'm doing well, this woman (RN II) makes sure I go home feeling incompetent nightly. :/

Thanks in advance fellow nurses!

*** The night nurse doesn't know what she is talking about. It is perfectly OK to run PRBCs with NS. It's done in every ICU I have ever worked in. She is wrong, and she is a bully. Don't let anyone "ream" you like that for any reason. If she feels you made a mistake (and now you know she doesn't know much herself) she can take it up with the charge nurse or nurse manager.

Don't take her crap, don't let her rent space in your head. YOU need to bring her inappropiate treatment of you to the attention of her nurse manager in writing. Use words like "hostile work enviroment" and "bully" and "abuse".

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Specializes in Case Mgmt, Anesthesia, ICU, ER, Dialysis.

If you can't run blood with NS, then I have been doing it wrong in every open heart I have ever provided anesthesia in. Just sayin. Does your hospital have Up To Date or another clinical resource database. I paid the $$ to have UpToDate on my phone and iPad with me in the OR, cause I always have a current evidence-based database with me to answer what I don't know.

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