Dialysis and Transfusions

[jnadeau]

Does anyone have a caution statement in their Blood Administration Procedure to "assure patient's hemodialysis access has blood flows > or = 300 ml/min before requesting any blood products from the Blood Bank?  Many dialysis patients don't have that level of blood flow.  What will transfusing blood with less flow do to the patient's access (or the transfusing blood)?  

[jshepherd]

We do not have a statement like this in our policy. That said, this feels like a nursing directive, and shouldn't be part of a blood bank policy. It sounds pretty specific, and since we know all patients don't read the instruction manual, this statement could be very restrictive when it's not meant to be. I would recommend generalizing this more into something like "flows must be adequate for transfusion".  

[Neil Blumberg]

Why would you want to transfuse blood at such a high rate?  Perhaps I'm misunderstanding, but I would never transfuse a patient who wasn't exsanguinating at 300 ml/min.  And having that level of flow isn't necessary for transfusion, so I'm a bit clueless about why you picked that number. It's a dialysis issue, not a transfusion issue, no?  Vascular access is not the transfusion service's purview, in general, so I'm not clear why you are concerned.  Have you had lots of red cells returned because they didn't have vascular access?

[jnadeau]

No Dr. Blumberg - not the transfusion rate - the dialysis access flow rate evidently needs to be adequate to do the dialysis and also add in blood using an infusion pump as usual.  The SOP (which is not mine) states a start rate of 75 ml/hr for the first 15 min, if vital signs are within normal limits/pt's baseline, adjust over 45 min and transfuse the remaining blood product within ONE hour".  

This is unfortunately coming to the blood bank because anything with blood product infusion (and reinfusion) stumbles into our purview - e.g. cell saver, nuclear med reinfusions.