When is the best time for blood transfusion?

Nurses General Nursing

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I worked the day shift. I come in to receive report on my patient load of 5:1. The night shift nurse informs me of a critical hemoglobin and that my patient needed a blood transfusion. She was aware doing the night shift of this critical low hemoglobin during the night shift. Just want to hear thoughts. What time is the best time for a transfusion?

Nursing is a 24/7, not just your shift. If the intervention cannot be reasonably be completed on your shift, it will have to be the responsibility of the next shift.

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I don't get the patient not getting PRBC with an Hb of 5.

To be fair, "5" was my imaginary number, not the patient's Hgb in this case (I hope!).

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Specializes in Critical Care and ED.
Nursing is a 24/7, not just your shift. If the intervention cannot be reasonably be completed on your shift, it will have to be the responsibility of the next shift.

Not if it's an emergent task though. If the patient is sitting there hypoxic for 8 hours because the nurse never got around to putting on a nasal cannula, would that be acceptable? No. A low Hb is similarly urgent. Hb carries 02...that means tissues and organs are hypoxic. It's all about prioritizing care. Not acceptable in my book. See my post above.

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Specializes in Renal, Phone Triage, End Stage Renal, Acute Dialys.

No the Hgb iwas not 5 but approximately 6-6.3 but they did not know where the bleeding was coming from. PRBC is one of those nursing task that it's either now or right now. Not a hurry up and wait .

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Specializes in Geriatrics, Dialysis.

I work in a SNF and we don't hang blood. The usual timeline for a transfusion for us is at minimum 8 hours and nobody thinks twice about it. First we get the initial lab order, draw the blood and then somebody has to hand deliver the specimen to the lab located at a hospital close by. Then we wait until the lab value is reported, if it's a critical value the lab has to call it over and physically speak to a nurse to report it instead of just faxing results. This part of the process is dependent upon how fast the lab works and how quickly they call us after getting the lab results. The we need to call the MD to report the critical lab, this can be a quick or a pretty slow response depending on the time of day and the MD we call. Some are known to respond to pages right away, some not so much. Then we need to process the order and contact the hospital to schedule the transfusion. Depending on their caseload and the severity of the critical lab we can be either sent to outpatient or inpatient, then the type and cross needs to be scheduled before the actual transfusion. Depending on the severity of the critical lab which takes into account not only on that lab value but the residents baseline the type and cross might be done then the resident sent back to us until the transfusion the next day as an outpatient or they may do the type and cross and then keep the resident there until the transfusion is complete.

Cripes, I didn't realize how involved all that was until I typed in out. Sorry for the overly long explanation!

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Specializes in Renal, Phone Triage, End Stage Renal, Acute Dialys.

I am happy to hear all of the comments on this crucial topic. Thanks everyone.

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I am happy to hear all of the comments on this crucial topic. Thanks everyone.

So polite of you to end with a thoughtful thank you to all responders. So few posters do this.

Thank you for your thank you.

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Specializes in Pediatric Critical Care.
So polite of you to end with a thoughtful thank you to all responders. So few posters do this.

Thank you for your thank you.

Thank you for thanking the OP for their thank you.

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Specializes in IMC, school nursing.

I would always tell my coworkers that nursing is a 24 hour job, but that doesn't mean you have to work that long. I will gladly pick up the slack coming on. Take advantage too often, such as this case, and I will say "please hang that and monitor for x minutes before you leave". It is not fair to continually dump. I have only had 4 nurses I had to do this with in 28 years at the critical care position I had.

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Specializes in Critical Care.
No the Hgb iwas not 5 but approximately 6-6.3 but they did not know where the bleeding was coming from. PRBC is one of those nursing task that it's either now or right now. Not a hurry up and wait .

It seems what your asking is if we can reliably assume that the blood transfusion was not appropriately prioritized by the previous nurse, and the answer is that no, it is quite possible the previous nurse prioritized correctly and your basing your assumption that they didn't prioritize correctly based on your own incorrect prioritizing practice of making a blood transfusion an automatic top-of-the-list priority.

Obviously there are far more factors that come into play than what has been shared, but you would need to consider the severity which you initially described as a "critical" low, although 6-6.3 is not a "critical" result based on commonly used critical result definitions. The number however is completely relative based on the clinical findings (clearly evident active bleeding, symptomatic, S/S of dangerously poor perfusion, etc). We also don't know the myriad of other issues competing with the blood transfusion. It's quite possible that even though the transfusion was ordered many hours ago that the actual window the nurse had to start the transfusion may have had legitimately higher priorities.

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Specializes in Renal, Phone Triage, End Stage Renal, Acute Dialys.

No I was not assuming. I just asked for thoughts on the right time? Also I made getting the transfusion started my priority because it was ordered and the task had not been completed. We do not know where the bleeding was coming from. I do not like it when the physician questions something that was previously ordered and not completed and then the patient ultimately has to be transferred to the ICU or something else happens. I have seen this all to many times. Thanks for your input and have a great night.

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Specializes in Critical Care.
No I was not assuming. I just asked for thoughts on the right time? Also I made getting the transfusion started my priority because it was ordered and the task had not been completed. We do not know where the bleeding was coming from. I do not like it when the physician questions something that was previously ordered and not completed and then the patient ultimately has to be transferred to the ICU or something else happens. I have seen this all to many times. Thanks for your input and have a great night.

Having been 'ordered and not completed' just adds it to the overall careplan, it doesn't somehow cause it to no longer be subject to appropriate prioritizing based on nursing judgement.

Wanting to avoid having to discuss the basic premises of nursing with an MD is not an acceptable reason to abandon the appropriate decision making and prioritization process, if anything it's how errors in appropriate prioritization occur.

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