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smarison
bllod given thru a 22 g
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
lynncrni
The INS standards of

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., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

smarison
Thanks for all of your
Thanks for all of your comments.  Susan
piccmasters
We also use ga.22 / if

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.

Kevin Travis Flint
Lippincott's Nursing
Lippincott's Nursing Procedures Book used by many as practice guidelines states 20g
afruitloop
There was a poster

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

lynncrni
Then this is not evidence

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., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

blodahl
I work in Oregon. A
I work in Oregon. A discussion with the medical advisor for Technical Manual from AABB for our state a few years ago related to me 20g or larger is preferred when giving units at faster rates over shorter time frames; however when vessels don't accomodate larger cannulae, and pt's condition doesn't require rapid infusion time, it is totally acceptable to run the blood at slower rates to accommodate the smaller cannula. It is when you try to infuse rapidly through smaller cannulas that hemolysis occurs. Our out-patient infusion room has drawn H&H before and after transfusions via 22g PIV running at 125ml/hr and found comparable increase in pt counts to those via 20g PIV infused at higher infusion rates. For pt's who may require even slower rates via a 24g cannula our P&P recommends requesting our blood bank divide the unit to ensure there isn't any need to waste part of the unit when the entire unit could not be infused within the 4-hour time limit for blood to be finished. We've not had issues with this recently though since we have US available now to help find vessels not easily seen or palpated ;o).

Barbara

lynncrni
And I would prefer to avoid

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., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Connie
In the Neonatal poulation we
In the Neonatal poulation we use a 24g all the time it can be done without hemolysis. A 24g can deliver up to 20ml/min=1200ml/hr (BD Insyte-N Autoguard) or 24ml/min=1440 (Jelco Catheter). If you can only get a 24 or 22g in to safely deliver the blood and have enough hemodilution or circulating blood around the catheter then that what needs to be placed. Having pharmacy split the unit is being very proactive. It saves the patient from being stuck with 18 or 20g over and over. It also saves time and money. I think its one of those old school thoughs we havent broken away form yet.
Gwen Irwin
The nursing myth about a 20

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.

Recent publications in JINS support this, as well.  Review the articles and look at hemolysis with small gauge catheters.
We have had patients with a 24 gauge catheter receive transfusion at 125ml/hour via a pump and had the expected 2 gm. increase in their H&H.
Gwen Irwin
Austin, Texas
Peter Marino
Staff R.N. with no

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.

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