Safest + convenient method for blood transfusion

[Maddy_Rose]

Hello all, I am a student in their last preceptorship and have a question about transfusions that I've been confusing myself with!

A couple weeks ago my preceptor and I were giving blood to an elderly man. Before we started the transfusion she told me that we needed to switch his regular saline lock over to one with 2 extensions, like a double saline lock that comes together at the insertion site (I hope the terminology makes sense, I'm in Canada). At first I assumed this was so if their was a reaction, we could switch our patient back over to a normal infusion pronto. But afterwards I wasn't so sure because another nurse on our team said she wouldn't have done it that way, she would have just switched out the lines and capped the regular infusion so that it would be ready to go if needed.

Both of those options made sense I suppose, my only problem with the first scenario is if we did have to stop the blood, we would have blood hanging out in one of the extensions while running the normal infusion, which seems kind of weird. Unless we flushed the blood-containing extension through, which doesn't seems like a good idea if their was a reaction going on.

Can anybody clarify what the easiest and safest IV line set up is for blood transfusions? It seems to me the easiest to manage (as long as you were careful) would be to D/C the regular infusion saline lock and all, cap it to keep it sterile, and switch the lines at the catheter hub.

[dah doh, BSN, RN]

Blood products need a dedicated IV line. Your preceptor should have disconnected the primary IVF and capped it off. Then flush the saline lock with saline prior to starting the blood. Usually there is a NS flush solution on the other side of the "y" blood tubing; so what your preceptor did doesn't make sense especially since another nurse on that unit contradicted her. Did you ask your preceptor why she did it that way? You don't happen to mean a stopcock do you? I've seen it set up like that but only in ICU.

[classicdame, MSN, EdD]

dedicated lines serve another purpose. The American Asso of Blood Banks recommend that tubing be changed every four hours. So if you hang a unit and it infuses in less than four hours the temptation would be to resume the primary with the same tubing as you used for hanging blood. There could still be some blood product in the tubing that could cause complications later.

[Pikake]

Who does it benefit more? If it is for the patient, then your not wrong. However, there is more than one way to do things as long as it falls within guidelines.

[Maddy_Rose]

Ignore this, double post!

[Maddy_Rose]

Blood products need a dedicated IV line. Your preceptor should have disconnected the primary IVF and capped it off. Then flush the saline lock with saline prior to starting the blood. Usually there is a NS flush solution on the other side of the "y" blood tubing; so what your preceptor did doesn't make sense especially since another nurse on that unit contradicted her. Did you ask your preceptor why she did it that way? You don't happen to mean a stopcock do you? I've seen it set up like that but only in ICU.

Honestly I don't recall why she did it that way, it was a couple weeks ago. I would ask her about it but she's on vacation right now :) And nope don't mean a stopcock at all. So the way you do it, if the patient started to have a reaction, you would switch it back to IVF at the saline lock? It would be alright to let that bit of blood left in the saline lock run into the patient?

[Maddy_Rose]

Who does it benefit more? If it is for the patient, then your not wrong. However, there is more than one way to do things as long as it falls within guidelines.

Yes I'm sure that true for a lot of these types of things...haven't had a spare moment to see what the hospital policy is.

[iluvivt, BSN, RN]

Yes....blood must be administered by itself. This is done with a typical Y-type blood tubing with an in-line 170 or 180 micron filter.

Normal saline is hung on one side of the Y and your desired blood product the other side. The reason that blood needs to be administered by itself is to reduce the risk of bacterial contamination.

The product you are describing is an extension set or double T-ext that can be added directly to the cannula. It is acceptable to do this. I would do this if I only had one line and needed to give some Lasix or Benadryl in-between infusions as it can be convenient that way.

A better way is just to start another PIV for the blood unless the patient is unable to handle the IVFs and blood from all fluids . perspective. It is big hassle when a PIV infiltrates during the tranfusion. You only have so much time to infuse it,a blood infiltratiiion is always a 4 + on the infiltration scale, and its usually just messier resart and discontinuation. it is much easier for me to just give the patient another site.

[Maddy_Rose]

The product you are describing is an extension set or double T-ext that can be added directly to the cannula. It is acceptable to do this. I would do this if I only had one line and needed to give some Lasix or Benadryl in-between infusions as it can be convenient that way.

Hmmm now that you mention it she may have done that in case we had to to give those medications. So as long as you flush with NS before and after giving meds like that there should be no compatibility issues where the double extension sets come together?

Thank you everyone for clarifying, I feel picky asking so many questions but it's been very clarifying!

[iluvivt, BSN, RN]

In your situation it is not a compatibility issue. The reason blood is given by itself is because the risk for bacterial contamination is high. You are after all giving the medication into someones blood! So indeed if the nurse did add the double extension or T extension in case she did need to give any medications during the infusion of the blood you could flush that tail with NS ..give the med.....then flush again with NS. There is a lot of confusion about adding double extension sets and/or T extensions at the site of an IV cannula. They were designed so that patients could receive multiple IVFs and medications and avoid another venipuncture and thus preserve veins. So many medications that are incompatible if they are mixed can be given by setting up the sytem correctly because it is not considered mixing.