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Matched Unit Blood Transfusion
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Megan Brashear, CVT, VTS (ECC), discusses how to set up, start administering, and how to monitor a patient during a transfusion of a matched unit of blood.
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Megan Brashear
CVT VTS(ECC)
Enrolled: 07/2011
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great video and demo
I have always set a transfusion up with saline but never knew why.
How do the other fluids affect the transfusion?
Megan - in donated blood products, calcium is chelated to prevent the red cells from clotting so the blood can be stored. If you mix that blood product with a calcium containing fluid it can cause clotting and/or hemolysis in the line which never goes well for the patient. Dextrose solutions should also not be mixed with blood products. To be sure that I am not mixing anything that can't be mixed, I always get a clean bag of saline which I know is isotonic, has no calcium in it, and will not affect the red cells in a negative way.
I'm curious about the use of a peristaltic type IV pump shown in this video. My understanding is that any type of pump use-either peristaltic, or a syringe pump (any "forcing" of cells) dramatically shortens the life of the rbcs. We do use pumps for FFP, but rbcs we free drip (which is no fun!)-but I'd love to go to using a pump if it's really not contraindicated? We don't run NaCl before and after rbcs either, but I like that concept! Might be time for a protocol update.
Hi Andrea, I run the blood bank here at Dove Lewis. You are correct that the best method for administration of red cell products is by gravity drip. Forcing the red cells through a pump can lyse the cells and the degree of loss through lysis depends on the type of pump you are using and the speed in which you are transfusing. These pumps (Heska brand) are not labeled for administering blood products, so if you are using them it would be off-label use. There are pumps specifically made for red blood cell transfusion on the human side but they haven't been tested well for animal use and they are costly. We often start out the animals on the peristaltic pump for the first half hour for monitoring purposes. When we increase the rate of the transfusion we will take the blood off the pump and drip it in. -- Jill G.
Do you always have to prime your line with saline? If so doesn't this contradict using any other type of fluid in the line as your blood product?
Caroline, you do not have to prime the line with saline, but especially packed red blood cells are quite thick (PCVs in the 80%) and having the line primed with saline can help them flow through the plastic easier, but is not required for a successful transfusion. 0.9% NaCl is the only type of crystalloid fluid that can be mixed with blood products, provided it has not additives (like KCl or dextrose). All other types of crystalloid fluids must be discontinued and the IV catheter/T-port/anything the blood will run through flushed with saline prior to the transfusion administration.