Transfusion needle size and infusion rate?

[Wendy Beltrami]

Hi all...

Just doing a little survey... for those of you who have been transfusion dependent for a while. What size needle is used for your transfusions and at what rate is the product infused?

For example:
20 gauge needle, 300 ml unit of prbcs infused over 1 1/2 hours at rate of about 275.

AND

Platelets- not on pump, just gravity... needle size 20 unit complete in about 25 min.

These are the rates/sizes that were used for Grant's last transfusion, however it has not always been so... in the past, smaller needles, slower infusions...

Thoughts from others? (Yes, I know that pediatric patients are often treated differently but he is not exactly pediatric size any more)

Wendy/mom to Grant

[Neil Cuadra]

Do you and Grant have a preference, Wendy?

[Birgitta-A]

Hi Wendy,
Unfortunately I have never asked about the needles but I know that they are special because I have a port. They give 2 units of prbc in four hours. I have got platelet transfusions twice and they used special needles because the platelets should be flushed - otherwise they coagulate.
Kind regards
Birgitta

[Wendy Beltrami]

Hi Neil and all,

No, we don't have a preference and frankly never gave it much thought until recently. Grant is being "transitioned" from pediatrics to adult status. His last transfusions were done at a faster rate and using a bigger needle. He tolerated it well and it was a DREAM for us to finish about 2 hours faster than usual. However, when Grant questioned the nurse about why she was using a larger needle for his IV, she mentioned that a needle smaller than 20 could damage the blood product. Grant and I looked at each other and were somewhat horrified to think that he had been getting transfused for almost 2 years using a smaller needle and wondering how much product had actually been damaged in that process.
I flew home and googled a bit and found that for pediatric patients, it is common to use a 22 for rbcs and that it is fine as long as the infusion is slower. Still, it made me wonder... sometimes, depending on the nursing staff and the situation and how antsy Grant is getting by the time the 3rd bag comes along, the rate has been increased.
So, long story shorter... we are curious to see whether this last transfusion will last him a little longer since it was transfused using a larger needle.

I also read that platelets can sometimes be damaged if they are put on a pump instead of being fed by gravity. I think he has always had them gravity fed, but I am curious to hear from others and also to hear from someone who can address these issues.

I've mentioned this before, but I would really like to see a presentation at this year's conference from Red Cross or some large blood bank about freshness and irradiating, single donors vs. pooled donors and now also about needle sizes and infusion rates. Also, premedicating... why sometimes bags of platelets are SO much larger than others, differences in colors of platelets, etc. There are SO MANY questions that people have... These need to be people who REALLY know the answers, not just someone who works at the blood bank. It surprises me that hematologists often don't know the answers or never thought to even ask the questions and I'm not sure where to find the person that DOES know the answers to all these questions.

Wendy/mom to Grant.

[Birgitta-A]

Hi Wendy
You probably found the same sites as I when you Googled needle size transfusion. According to one of the sites it is OK with smaller needles if you use gravity “forcing the red blood cells through the smaller size catheter could result in some cell damage. Allowing them to flow by gravity allows time for the cells to change shape as they naturally do when flowing through small capillaries”.
http://hadawayassociates.blogspot.co...ansfusion.html

One of the other sites repeated this: “Care must be taken to avoid excessive pressure and resulting hemolysis when very narrow devices are used”. http://www.clinlabnavigator.com/tran...loodadmin.html
Kind regards
Birgitta

[BBTALKER]

needle sizes are fairly standardized. It is best to use a larger core needle, so as not to hemolyze the red cells as they pass through the needle. In Pediatrics, it is sometimes difficult to use this size, so a 22g needle is more likely to be utilized. When utilized it is best to run the transfusion more slowly, so thhe red cells pass without any turbulence in the catheter.
Infision rates vary widely. The unitial rate of transfusion is always slower, so the transfusionist may recognize any adverse effects. Typically this can be anywhere from 100-120ml /hour. It is important to note that severe reactions can occur wiith infusion of 10mls of blood, hence the slow rate. Once the 15 minute vitals are taken and the patient oes not experience any adverse event or syptoms, the rate can be increased . The unit needs to be infused less than 4 hours from the release from the blood bank or transfusion service. This is to combat bacterial growth when the blood is at room temp.. As far as platelet color, there is sometimes a greenish pigment to the platelt bag .This is ususlly a pigment and does not effect the platelts or the transfusion. Sometimes there is some red cell contamination. This too is OK, as long as the unit does not contain a trmendous amount of red cells. The bag size is typically 50 ml as a concentrate or 250-300 mls as a single donor unit. Each should raise the platelt count a specific amount.
Best of Luck