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Initial Rate of Blood Administration

Does anyone have a reference that cites Best Practice for initial rate of blood administration for PRBC's?  Every resource I have reviewed states that the initial rate of blood transfusion should be "slow", nowhere can I find specific recommendations.  My previous experience is to start at a rate of 50-75 ml/hr for the first 15 minutes and then increase based on patient tolerance to infusion 1 unit of PRBC's over no greater than 4 hours.  Our hospital policy is to infuse PRBC's in a non-emergent situation over 2-4 hrs but it does not address the initial rate of infusion. 

jill nolte
 according to Infusion

 according to Infusion Nursing: An Evidence Based Approach, M. Alexander et al,  pg 558 the rate of infusion for prbc's is initially 5% to 10% of the total transfusion volume, given over 15 minutes (Landier et al, 1987; NIH, USDHHS, 1990).  If no adverse reaction is noted, the rate is then increased to 1 to 5 ml/kg/hr or as tolerated.  This is a chapter on peds but the procedure should be the same for adults.

(please forgive the incorrect format on the citation)

 I do not have a reference,

 I do not have a reference, but that is how I do it:

1. pretransfusion vital signs, then start the infusion at 50cc/hr for 15min;

2. repeat vital signs, if ok, increase rate to 100 to 125cc/hr (for non-shock type situations).

However, it can take some time for the blood to even visibly get to the vein, so that may cause 'issues' as the next set of vital signs is 30min; therefore, I just take them again in 15min.

At a rate of 125/hr the blood easily infuses within 4 hours as the total volume rarely exceeds 300ml (the volume that is at times written on the bag rarely correlates exactly with what many pumps claim is transfused; ie the bag may read 265ml yet when the bag is hung, pump cleared, when the bag is empty the pumps frequently read 300-325ml).

If there is not left ventricular dysfunction or other contraindications and 2 units are ordered, I may run it at 150/hr.

Nedless to say, I always start the rate at 50/hr in non-emergent (stable) situations.


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