Why use compression bags when transfusing blood?

Editorial Team / Admin · May 9, 2016

Patients in ICU are critical- the purpose of those pressure bags is to get the blood in rapidly. What was going on with the patient? Did they currently have or recently had a major hemorrhagic event? What was the hemoglobin and hematocrit? What did the vitals look like?

If you think the pressure bags were a surprise, wait until you see a rapid infuser- it can get an entire unit of blood in within 90 seconds. Doesn't get used routinely, but for those patients where you transfuse 1 unit in only to have 2 pouring out from the GI bleed/penetrating trauma wound/etc, you've got to keep up with volume loss somehow.

mmm_016RN · May 9, 2016

Thanks for your reply. How come we couldn't just set the infusion pump at a high rate instead of using a bag?

guest769224 · May 9, 2016

Thanks for your reply. How come we couldn't just set the infusion pump at a high rate instead of using a bag?

The max our pumps go is 999 ml/hr. By gravity or compression bag is much quicker. It is called massive transfusion protocol.

Editorial Team / Admin · May 9, 2016

Thanks for your reply. How come we couldn't just set the infusion pump at a high rate instead of using a bag?

Most pumps will max out at 999mL/hour. That means it will take the average 350mL bag of blood about 21 minutes to infuse. That's too long for patients who need blood rapidly. Gravity with a pressure bag or a rapid infuser will get that blood in much faster.

akulahawkRN, ADN, RN, EMT-P · May 9, 2016

There are rapid infuser pumps. They can infuse blood very, very rapidly. They can be expensive and setup may take a little while. I can prime blood tubing extremely quickly and as long as there's blood ready to hang on a patient, with a pressure infuser, blood can be infused into the patient extremely rapidly. I've seen 1L of normal saline infuse into a patient through a 20g PIV in about 35 minutes. A unit of blood is typically around 350 mL and run wide open under gravity, it would infuse into a patient in about 12 minutes. Put the blood bag in a pressure infuser and that infusion time can be dropped by at least half. Most of the time I'll infuse blood via pump but if the patient is bleeding out, the patient very well could need blood faster than a standard pump can deliver it.

vampiregirl, BSN, RN · May 10, 2016

Great question, OP:) Not having worked in a setting where this occurs, I didn't know the answer either.

That's part of the fun of allnurses.com - learning interesting things about other areas of nursing!

Roy Fokker, BSN, RN · May 11, 2016

I've had a patient come in with both frank hematemesis and frank melena. Looked paler than the sheet he was placed on. 6 nurses swarming him and couldn't get a line. The attending couldn't even get a femoral CVC! Luckily the Surgical House Doc was down in the ER as he was consulted on a different case (it was like 0300 in the am). He wanders around the ED because he can't find anyone - nurses, doc, techs - because we're all busy in this room with this dude trying to bleed out and die on us.

He sets up and manages to get a subclavian triple lumen CVC (he casually commented after the procedure that he'd forgot to put on his glasses!) We didn't even wait for pressure bags - the surgeon, myself and another RN stood at the head of the bed and manually squeezed in three units of un-crossmatched blood while they were making arrangements to take him to the OR.

It was pretty hairy for a while.

So yes, in a pinch - your hands make decent pressure bags! :-)

I found out later that patient ended up getting massive amounts of PRBCs, platelets and FFP and after a week in ICU and stepdown, went home!

- Roy

akulahawkRN, ADN, RN, EMT-P · May 11, 2016

I've had a patient come in with both frank hematemesis and frank melena. Looked paler than the sheet he was placed on. 6 nurses swarming him and couldn't get a line. The attending couldn't even get a femoral CVC! Luckily the Surgical House Doc was down in the ER as he was consulted on a different case (it was like 0300 in the am). He wanders around the ED because he can't find anyone - nurses, doc, techs - because we're all busy in this room with this dude trying to bleed out and die on us.
He sets up and manages to get a subclavian triple lumen CVC (he casually commented after the procedure that he'd forgot to put on his glasses!) We didn't even wait for pressure bags - the surgeon, myself and another RN stood at the head of the bed and manually squeezed in three units of un-crossmatched blood while they were making arrangements to take him to the OR.
It was pretty hairy for a while.
So yes, in a pinch - your hands make decent pressure bags! :-)
I found out later that patient ended up getting massive amounts of PRBCs, platelets and FFP and after a week in ICU and stepdown, went home!
- Roy

Subclavian lines can be done (in a pinch) by feel, as long as you know the landmarks. I've been shown how to do them using long peripheral IV lines but it's quite rare for this to be done by anyone in EMS. I've done quite a few EJ lines over the years but have not heard of a subclavian line done in the field in California as these are out of scope for Paramedics to place.

edpimentel · May 16, 2016

Very good info. Haven't seen one yet. Does anybody have photo of this to share with us? Thanks!

Roy Fokker, BSN, RN · Jul 30, 2016

Subclavian lines can be done (in a pinch) by feel, as long as you know the landmarks. I've been shown how to do them using long peripheral IV lines

Did not known that! Awesome!

offlabel · Oct 4, 2016

Did not known that! Awesome!

Well, awesome until someone drops a lung:cool:... these lines are reserved for experts in central access.