Ok the last hospital I worked at we always gave blood thru a 22g PIV, or even a 24g if that was all the patients had. The current hospital I work at says it must be a 20g which with some this is very difficult. Anyone have any ideas? I thought INS stated a 22g but I haven't looked at any literature in a while. If any one has any info that would be great. Thanks
The INS standards of practice do not state a specific gauge size for blood transfusion. The resource you need is the Technical Manual from the American Association of Blood Banks. They are the final authority for all issues related to blood. The chapter on administration has a discussion about guage size and states a 22g is acceptable.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
We also use ga.22 / if that's the only size vein available. It completes the transfusion in 4hours packed red cells.
The only time we use ga. 20 if we see, vein are ready to accept this size.
Pedi veins may sometimes use ga 22, otherwise ga.24
However, other hospitals are not accepting this, so have their nurses sweat to get ga. 20 vein then. their written p/p, preferable ga. 20, so nurses are stuck to this statement, without considering what kind of vein the patient has.
There was a poster presentation last year (2007) at AVA on this by Gloria Aquilla from Pennsylvania. It was entitled something along the lines, "Does size matter?"
Her results were that it was indeed acceptable, withour hemolysis.
Cheryl Kelley RN BSN, VA-BC
Then this is not evidence based and the author did not follow AABB statements. I am referring to the entry about the Lippincott book.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Barbara
And I would prefer to avoid using a pump if your only catheter choice is a 24 gauge.
Lynn Hadaway, M.Ed., RN, BC, CRNI
www.hadawayassociates.com
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
The nursing myth about a 20 gauge catheter or larger for blood transfuson needs to be obliterated. Currently, the AABB manual does not specify any gauge catheter! It only states that if smaller gauge catheters are used to use precaution with using pressure measures for the transfusion, that might cause hemolysis (anesthesia cuffs that exceed pressure of pumps).
Regardless of the "importance" of Lippincott's Nursing Procedures Book, it is not based on the recent knowledge of catheter size and hemolysis.
Staff R.N. with no affiliation to any product or health care company(your basic front line grunt/wage slave)
Maybe the list could have a FAQ section?
http://www.iv-therapy.net/node/512
As I read it (please correct me if I'm wrong) Using the correct pump would actually be advantageous and delete the need for split units ,dilution and hemolysis fears. "Specific models of infusion pumps have been approved for use in blood transfusion. These pumps maintain a constant delivery of blood, and studies have indicated no significant evidence of hemolysis as the needle size varies. (11)"
"High-pressure flow through needles or catheters with a small lumen may damage red cells (8-10)"
The operative word here is may
"The transfusions via each catheter were performed without the application of a pneumatic pressure device, and after the application of an external pneumatic device (Speidel and Keller, Jungingen, Germany) at 150 mmHg and 300 mmHg.
In conclusion, although the application of an external pressure device results in the destruction of transfused RBCs, this effect is minor even under the most stringent conditions examined. Thus, external pressure application to expedite an RBC transfusion is likely to be a safe procedure for the majority of patients."
Granted the smallest was a 22 in this study.
So as Gwen pointed out (to be extra safe) do not apply external pressure while transfusing through 22 and 24's.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.