Transfusing blood in an emergency situation

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Specializes in ICU.

I'm still a nursing student and I haven't had any experience with critical situations where blood products are urgently needed (I've transfused blood but it wasn't where the patient was actively bleeding out, hemoglobin dropped low enough to warrant it).

Per textbook, you should infuse the blood slowly at say 50ml/hour for the first 15 mins and watch for a reaction and then increase the rate if there is no reaction. However, if the patient is critical/bleeding out, do you suspend that rule and just "pour" that blood in as fast as it will go and hope they don't react? I'm guessing that the pros (getting the hemoglobin and BP back up) outweigh the cons (possible chance of a reaction) in such a situation. Is that right?

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Specializes in Pediatric/Adolescent, Med-Surg.

Yep, if it is an emergency and pt is actively bleeding out or coding, I just give blood wide open to gravity. The risk of a transfusion reaction is not as important compared to the need to get blood in fast.

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Specializes in ICU.

Makes perfect sense. Thank you, ChristineN!

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Specializes in ER, Peds, Informatics.

Yes, you run the blood in as fast as possible. I've had more than 1 unit of blood running in with pressure bags at the same time in patients that are bleeding out (AAAs, GI bleeds, ruptured ectopics, traumas, etc.) If the pt is coding or just at the point, it's more important to get some circulating volume and get them more stable than to worry about a reaction.

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Specializes in Emergency/Trauma.

Some trauma bays stock a few units of O- blood in the bay in order to facilitate getting blood hung and transfusing rapidly in the case of a huge bleed. Blood can also be run through a rapid transfuser such as a Level I. Make sure the person in charge of it knows how to properly operate it unless you want to see what happens to a unit of O- at high pressure. XD

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Specializes in Cardiac, ER.

I work in a 68 bed Level I Trauma ED,..We keep uncrossed blood in the department and use the Level I infuser when needed. We can hang 2 units at a time per Level I and if I remember correctly we can infuse those 2 units in about 4 minutes! So yes,...if your patients is dying get that blood in fast!

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We use a Level 1 rapid infuser with O- blood for actively bleeding trauma patients.

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^ this. And I'm quite amazed that you've infused blood as a student! They didn't allow us to do that.

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Specializes in ER.

We also use a level 1 and keep blood products in trauma center. 6 units O- and six o+. We run em in as fast as we can. A couple of weeks ago I actually ran blood on a pump for the first time since nursing school on a patient that was holding in the department.

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

Yep. The risks of not rapidly replacing the blood far outweight the risk of transfusion reaction in critical situations. Our rapid infuser will deliver a unit of warmed blood every 40 seconds when running it all out. My peprsonal record is 53 units of blood products to one paient in one shift.

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Specializes in ICU.
Yep. The risks of not rapidly replacing the blood far outweight the risk of transfusion reaction in critical situations. Our rapid infuser will deliver a unit of warmed blood every 40 seconds when running it all out. My peprsonal record is 53 units of blood products to one paient in one shift.

Whoa, 53 units? What was the outcome?

And BTW, thank you everyone who responded! I didn't know about the rapid infuser.

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Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
Whoa, 53 units? What was the outcome?

And BTW, thank you everyone who responded! I didn't know about the rapid infuser.

*** Was a Harly vs steel bridge. I got her out of the OR. We were sucking the blood out through an abdominal Whitman's pach about as fast as I was putting in with the rapid infuser. After 14 or so hours she stabilized enough to be taken to IR where they were able to see and cauterize enough bleeders that she started to not leak it out as fast as we were putting it in. 4 months in SICU, then to med-surg for a while then to rehab for a year or so. Eventualy walked out of the hospital on her own feet.

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