Transfusion Reaction

merlee · Nov 16, 2011

We never started a new site, just fresh lines.

Do-over, ASN, RN · Nov 16, 2011

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.

Been there,done that, ASN, RN · Nov 16, 2011

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 · Nov 16, 2011

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 · Nov 16, 2011

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 · Nov 16, 2011

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 · Nov 16, 2011

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 · Nov 16, 2011

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.

jasn · Nov 17, 2011

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 · Nov 17, 2011

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 · Nov 17, 2011

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.