Saline flushes or Blood

[gwenith]

I am curious to know how widespread the practice of putting up 100 ml bags of saline between bags of blood during a transfusion.

Where I work most A&E units don't do this nor do some ICU's but the medical and surgical wards do. In some places it has even become an "unofficial" policy not only to run this extra saline but to get the doctor to order lasix to remove the excess fluid. What is often happening is that the nurses are convincing the resident docs to do this so they continue the practice to reinforce it to nurses in a viscious cycle.

I can find no research supporting not doing this but I can't find research supporting it either. Any suggestions/opinions factual information will be gratefully accepted.

[Rapheal]

New bag of 100 cc NS and new tubing between each unit of blood. NS to prime the tubing and to flush. New NS and tubing between units because after the first unit of blood has run the tubing may maybe contaminated by bacterial growth during the time it takes to start the second unit.

Lasix between units to prevent fluid volume overload - especially with our CHF patients. We may also give the patient Benadryl and or Tylenol before or between units if they have had a reaction to blood transfusions in the past, or if they have been known to spike a temp during transfusions.

PS. Rapheals tip for the day. I run the pump at about 200 cc an hour until the blood reaches the IV site and then turn it down to the ordered cc/hour. This way when I am in the room for the 15 minutes that policy dictates- I get more time with the patient when they are actually receiving the blood- versus the time it takes to actually go thru the tubing and reach the patient. Learned this tip from a seasoned nurse- and am passing it on.

[RNKPCE]

I have never given much thought to why we hang saline, but many of the above reason makes sense. Though if we have a transfusion reaction I would get a new tubing set up of saline because you wouldn't want to push anymore incompatible blood into the patient to get to the saline.

Also lasix between units or after a unit is not routine on my unit. It does happen fairly often as I work on a cardiac step down unit and a lot of our patients have CHF.