Platelet and FFP transfusion and use of 0.9% NaCl

[SBriggs]

Members of my nursing staff recently asked me if FFP and platelets needed to be infused with 0.9% NaCl.  I am really unclear about what to tell them as I know that 0.9% NaCl is the only acceptable IV solution to be administered with blood or blood component, but I do not know the specifics of running 0.9% NaCl with platelets or FFP. 

 

When I reviewed the Technical Manual and the Lippincott Nursing procedures there is a lot of verbage suggesting the use of 0.9% with blood OR blood components - but there just isn't that black and white answer. 

 

Does anyone have any suggestions? 

[SMW]

I would be a little bit curious about why they're asking the question so you may want to get additional clarification. For example:

 

Plasma and platelets could be infused using a straight administration set and would not necessarily need to be infused using a Y-type administration set with the 0.9% saline in one lead and the blood product in the other lead.  However with the straight type of administration set a significant volume of the product may remain in the filter housing and lines once the product bag is empty so the patient would not be getting the full benefit of the infusion.  If the plasma or platelet administration set is going to be flushed, 0.9% saline is the product that would need to be used.

 

On the other hand, particularly prior to additive Red Blood Cells, it was common practice to use a Y-type administration set with 0.9% saline in one lead, the blood product in the other lead, and then to add some of the saline directly into the RBC bag to dilute the product a bit so it would not be so viscous and run easier and faster through the filter housing and set.  Since the viscosity is not an issue with plasma and platelets it would not be necessary or recommended to add saline directly into these product containers. however it would be advantageous to use the saline to flush the line at the end of the transfusion.

[carolyn swickard]

^{If the national saline shortage is still in place - that is probably why they are asking.  We were doing a hospital wide survey to make sure we knew what things normal saline had to be used for (no alternatives) and what things they could substitute other fluids for to infuse.}