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Transfusion ?

Posted

What is the flow rate used for packed cells for the first 15 min.?

For the remainder of the infusion? 2 Hr infusion? 3Hr? 4Hr? I can't seem to locate this information...I know I must be overlooking something.Thanks for ANY information...:eek:

According to my Med Surg book:

First fifteen minutes - infuse no faster than 2 mL/min. Then, "After the first fifteen minutes, the rate of infusion is governed by the clinical condition of the patient and the product being infused. Most patients not in danger of fluid overload can tolerate the infusion of 1 unit of PRBC over 2 hours. The tranfusion should not take more than 4 hours to administer."

You also have to stay with the patient for the first 50 mL.

We stay with the patient the first 5 minutes of the blood transfusion, inform them to notify us of any changes in how they feel. We check vitals 15 minutes after the start of the tranfusion. The rate of the overall infusion is ordered by the MD. We have a lot of CHF patients and usually infuse over 3-4 hours.

jnette, ASN, EMT-I

Specializes in Hemodialysis, Home Health. Has 10 years experience.

hmmmmmmm... and MY medsurge book says (1st 15 min.) infuse no faster than 5 ml/hr. Interesting. Why such a difference? Also to stay with patient 1st 15 min.

OK, Old lady here .

You are looking for a transfusion reaction, that is why you are in there most of the first 15 minutes. Strange thing about transfusion reactions, the happen almost imediately, it should be in the first 5 minutes anyway. You infuse it at a nice slow steady pace. The first thing that will happen, you will hear a Giant Gasp, like a major wheeze, and hopefully the patient has a foley cuz you need to see what their urine looks like. If the urine is pink to red, bingo, it is an official transfusion reaction.

They will be red in the face and blochy all over.

You must shut the blood off, and disconest the blood tubing and start a slaine drip. Why not run the saling that is piggybacking the blood, cuz there is still blood in the tubing. No don't say, we know that, duh, well Duh, it will be on every major exam you take in your life. This is where 3 3 10cc syringes of saline come in handy, as you are screaming for someone to get an IV of saling started while you stay with the patient, You can flush the saline lock, or what ever you call the heparin lock gizmo in your institution, you can keep it open with the saline flushes, and follow the protocol in your hospital, some push benadryl, it doesn't matter, you can keep the lock open and ready for any emergency order you are given. BTW, transfusion reactions are extremely Rare.

Ok Boys and girls, why do we no longer transfuse whole Blood?

I will check back

jnette, ASN, EMT-I

Specializes in Hemodialysis, Home Health. Has 10 years experience.

Originally posted by BarbPick

Ok Boys and girls, why do we no longer transfuse whole Blood?

I will check back

To prevent fluid overload? Whole blood to be used only if significant blood loss (>25%). Am I right?

Aren't there more antigens in whole blood - placing patient at higher risk for transfusion reaction?

kellye

Specializes in peds/gyn/pp overflow/gastro.

My vote is with PJ.

CarVsTree

Specializes in Trauma ICU, MICU/SICU. Has 4 years experience.

Whenever possible, the transfusion consists of only the blood component that meets the patient's specific need, rather than whole blood. Giving a specific component is both safer and less wasteful.

Google :D

gwenith, BSN, RN

Specializes in ICU.

Okay now I have one - question that is:)

Do any of you "flush" the tubing between blood bags with saline and do you flush the line afterwards before disconnecting?

PJ's Mom, very good. Plasma will kill you. it is not fluid overload.

Most antigens and WBC's are in the plasma. We also have to use a leucocyte poor filter. All disease is carried on the white blood cell.

We used to have to use only "washed" red blood cells for patients who were in fragile shape, like cancer patients who's immune system is not fighting properly. Because of the leucocyte filter, it is no longer necessary to wash red blood cells.

They may have a headache in 2 weeks, of feel queezy the next day, but it is still foreign to the immune system of the receipient.

Barbara

Noney

Specializes in Critical Care.

Gwenith I hang new tubing with each unit, and we swicth back to regular IV tubing when we're done.

When giving FFP for high INR how many units do you usually give before recheching INR? I had a pt recently come though ER with an INR >10. Had orders for recheck after 8 units of FFP. I thought we should have checked after 4.

Noney

New protocol at my facility says no need to check vitals til 30 mins after the start of the transfusion! Scary, huh?

Originally posted by gwenith

Okay now I have one - question that is:)

Do any of you "flush" the tubing between blood bags with saline and do you flush the line afterwards before disconnecting?

We change the tubing after each unit.

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