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?

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

Thanks again for your input and response.

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Specializes in Critical Care.
Thanks again for your input and response.

You're welcome for the input and response, but it's not a thank-you I can really accept. You have been fairly intent on only discussing the responses that agree with you're pre-determined conclusion and dismissing the responses that challenge those conclusions, which is not really an ethically tolerable stance to take as a nurse.

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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 .

I stand by my statement, then. You are simply wanting to hear that you are right considering you just answered your own question. You were not genuinely asking how long one should wait to transfuse.

I'm seeing avoidance and passive agressiveness in the way you handle coming on shift with things left for you that should have been high priority for the previous shift.

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Specializes in Emergency, Telemetry, Transplant.
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.

Exactly.

Recently there patient who has bone marrow condition, lives with a Hgb in the 6s, and gets transfusions regularly as an outpatient. This time, with her Hgb at 5.5 she was mildly symptomatic--a bit fatigued and SOB on exertion--otherwise was relatively stable. She had blood ordered, but no one was going to drop everything to hang it, when it could certainly wait and hour, 2 hours, until the next shift, etc. And I certainly hope than any nurse on the next shift would understand that other tasks were prioritized ahead of giving this pt blood.

It would be an entirely different story if the pt has a Hgb of 6.2, had a Hgb of 10.1 four hours ago and is now obtunded.

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Yikes! I've never been blamed for someone else not leaving on time.

I guess you're fortunate enough to work with professional and courteous people? I've had people say "well NuGuyNurse gave me crap about leaving x,y,z so I'm staying to finish up" - of course this conversation seems to occur without my knowledge until a few days later when management asks me to give the prior shift a break. And for the record, I'd never make anyone stay to clean up their mess, even though I should.

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Exactly.

Recently there patient who has bone marrow condition, lives with a Hgb in the 6s, and gets transfusions regularly as an outpatient. This time, with her Hgb at 5.5 she was mildly symptomatic--a bit fatigued and SOB on exertion--otherwise was relatively stable. She had blood ordered, but no one was going to drop everything to hang it, when it could certainly wait and hour, 2 hours, until the next shift, etc. And I certainly hope than any nurse on the next shift would understand that other tasks were prioritized ahead of giving this pt blood.

It would be an entirely different story if the pt has a Hgb of 6.2, had a Hgb of 10.1 four hours ago and is now obtunded.

Maybe I'm confused why you couldn't hang the blood in this situation?

When I am coming on the in the morning I have to receive report, quickly assess my patients, go to rounds, start morning meds, deal with doctors, have the family calling, potentially get an admission. Now if I had to walk and and have to start with a blood transfusion because the previous nurse felt that it would wait for the next shift I would be irritated. We all have things that need to get done on our shifts.

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Specializes in ER.

In my opinion 9 hrs is a totally unreasonable delay and the cause of that delay should be investigated by management.

I find it odd that people here seem to be attacking the OP for seeming to want affirmation for her outrage and concern over negligent patient care.

So what if this is a bit of a vent thread? The off going nurse failed the patient. If the problem was with lab, she should have been on the phone with them, not passively waiting.

The root cause of this delay of care needs to be investigated. This should not be avoided because of fear of retaliation, as some have suggested.

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Specializes in Emergency, Telemetry, Transplant.
Maybe I'm confused why you couldn't hang the blood in this situation?

This was not my patient, so I can't tell you the exact reason why it was not done....I can tell you that no pt harm resulted. It was an ER pt going to a floor, but suppose it happened between shifts on the floor. Some reasons blood might not have been hung: there may have been no tech to help the nurse, so he/she had to get pre-breakfast blood sugars...oops trays are early this day, so the nurse has to work on giving insulin. Oh, and that 90 year old man is crawling out of bed again. And the pt here for etOH withdraw is now tremulous and hallucinating.

Even though this pt's Hgb is low, the pt is stable and hanging blood will not necessarily be first priority. Sorry to the day shift nurse that he/she has to start their day with a tranfusion, but there is likely more the story than just the night shift nurse being lazy.

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Specializes in Emergency/Cath Lab.
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.

This on so many levels. The whole mentality of "this nurse didn't get this done" is stupid. So they didn't get it done, guess who will, YOU.

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