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Transfusion Reaction

Specializes in Psych, Stepdown, Research.

So, I know what to look for as far as reactions during transfusion of PRBCs, FFP, etc. I'm also aware that you always want to stop the infusion and start a "new" line of NS at KVO. I think I understand that you can't use your existing line due to the microscopic infiltrates/anaphylactic "offenders", right? I'm just thinking of timeliness in an emergency, but it seems like you shouldn't use the existing line... right?

I've not yet seen a reaction, but I'm sure it's only a matter of time. Thanks in advance for the input. Love this site!

We never started a new site, just fresh lines.

Do-over, ASN, RN

Specializes in CICU.

I think the main reason you don't use the existing line is that it is full of blood. You either need to prime a new line, or you'd have to bleed the current line out until it runs clear, which I suspect would not be considered best practice.

It doesn't take long to set up a new infusion, and meanwhile you would have stopped the blood.

The minute amount of antigen/antibodies in the cannula itself.. does not warrant the time it take to insert a new line.

Do-over, ASN, RN

Specializes in CICU.

The minute amount of antigen/antibodies in the cannula itself.. does not warrant the time it take to insert a new line.

I am thinking of the IV line, not the angiocath - I agree that a new IV site is not required (at least according to the policy where I am).

vwde

Specializes in Psych, Stepdown, Research.

I am thinking of the IV line, not the angiocath - I agree that a new IV site is not required (at least according to the policy where I am).

That's what I meant. I understand that the IV can stay in, but do you have to replace the entire drip set with a new one, or can you clear it of blood and use it?

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

The American Asso of Blood Banks Manual recommends that the IV tubing be changed every four hours. The site does not require changing unless it is not patent.

turnforthenurse, MSN, NP

Specializes in ER, progressive care.

I was taught that in the event of a transfusion reaction, the tubing is changed all the way down to the insertion site and maintained with NS to keep the line open while you call the doctor and do other things. Blood tubing should be changed Q4H d/t the risk of infection, but if I'm hanging more than one bag of blood I always grab new tubing with each new bag of blood I am hanging.

LouisVRN, RN

Specializes in Med/Surg.

Our policy states that in the event of a transfusion reaction upon identification of a reaction blood is stopped and blood, normal saline primer and asll lines are returned to lab for testing. We also have specific lab and urine tests to collect. In 3 years I've had two transfusion reactions identified by fver.

Our policy is to have a separate, primed NS line hanging at the bedside, just in case. Usually a 500mL bag, with a dead-ender on the line. This way it's easy to switch the blood tubing for the NS tubing

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

That's what I meant. I understand that the IV can stay in, but do you have to replace the entire drip set with a new one, or can you clear it of blood and use it? NO!

The tubing may NOT be used even if flushed. It must be changed.....immediately.

nerdtonurse?, BSN, RN

Specializes in ICU, Telemetry.

The only time I've had a patient have a reaction I sent everything to the lab except the 20g catheter in the patient's arm. Started blood (something like 3rd unit out of 4, patient was GI bleed), and the patient starts saying they itch. Starts getting hives (I mean, within seconds). I was so worried there was an error with the blood that I unscrewed the line, then I stopped the pump. Sent bags, lines, everything to the lab, called and told MD what was up. Gave the patient a bucket of Solumedrol and Benedryl. All I could think was either the type and screen didn't catch something, or the blood was mislabeled (A instead of O, Pos instead of Neg, something like that).

Turned out the patient had a really bad allergy to Keflex, and guess what was in the blood? Whoever donated it was on abx. and didn't admit to it or forgot.

That whole "have you taken any medicines within the last so many days?" thing is not joke.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

Policies at the hospitals where I have worked required sending the unit of blood product and all related tubing to the blood bank in the event of a suspected transfusion reaction.

turnforthenurse, MSN, NP

Specializes in ER, progressive care.

Policies at the hospitals where I have worked required sending the unit of blood product and all related tubing to the blood bank in the event of a suspected transfusion reaction.

I have been taught this, too. Where I work it is also policy to keep the finished bag of blood at the bedside for at least 2 hours post-transfusion (disconnected from the patient, of course).

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