We currently receive RBCs collected in CPDA-1 and have had some complaints recently of blood that is very difficult to transfuse or as the nurses state the blood is very thick. I have heard that using a Y type transfusion set you can push saline back into the bag of blood so that the HCT is reduced thus allowing the blood to flow more easily. Does anyone do this at their facility and if so where would I be able to get information on how to do this.

I've seen a veteran nurse do this once when a bag wouldn't flow and viscocity might have been a problem ...

After priming the Y-tubing and spiking the blood bag, she shut the clamp below the drip chamber, took the unit off the IV pole and placed it low, then opened up the saline. It flowed into the bag without a problem. When she thought she had enough, she closed all the clamps, mixed it, and rehung the unit on the IV pole.

After opening up the appropriate clamps, we found out that the unit had clots in it -- hence the flow problem -- and we exchanged it for one that did not.

I'm pretty ignorant about nursing practices, but I was impressed!

This was fairly common practice back in the olden days when CPDA-1 was the best thing around. We used to tell nurses all the time they could dilute with upto 100ml of saline to help it flow better. It's pretty simple, they always hooked up a saline line to the Y set any way. All they had to do was to run some saline into the blood bag and mix it up. End of the sluggish flow problems. Find some nurse over 50 and I'll bet she can tell you all about it.

sir,

THere are three things to be kept in mind before doing this procedure. It is the volume which is increased as it may be a overload for the patient. The haematocrit value may decrease and sterility of the blood bag may be marred as we are opening a closed system.

I have never seen a unit of blood hung with out a sterile bag of saline attached to the "Y" set. The bag is spiked anyway to get it into the the patient. Running a little sterile saline (about 100cc) into the blood will cause no harm and if it improves the smooth flow of the transfusion all the better. The nurse will know their patient and if input/output is closely monitored they will take the saline into account. As far as affecting the hematocrit, I think that is far less of a concern that being able to get the blood into the patient in a timely, stress free manner. If you think about it, all they are doing is duplicating an additive unit at the time of transfusion. I see no difference between adding about 100cc to a CPDA-1 unit and hanging an AS-5 unit.