Tuesday August 1, 2006


Q; Which order you should add while writing orders for pRBC transfusion beside rate ?


Answer; "Please insert 18 gauge IV catheter if possible for pRBC transfusion".

In adult patient if available, pRBC should be transfused preferably through atleast 18 gauge catheter. This is not a guideline or a necessity but an 18-G catheter provides good flow rates for cellular components.

On the flip side, drawing blood from smaller catheter can produce hemolysis and lead to over-diagnosis of hyperkalemia and possible patient safety issue. As the catheter gets smaller, hemolysis goes up 1.

24 gauge (100% chance of hemolysis),
22 gauge (25% chance of hemolysis),
20 gauge (15% chance of hemolysis),
18 gauge (10% chance of hemolysis),
14 -16 gauge (0% chances of hemolysis).


Related: Do you have a blood transfusion protocol in your ICU?.

See this Blood Transfusion Protocol from stanford, designed to minimize the over and unnecessary pRBC transfusions.



Reference:

1. A comparison of hemolysis rates using intravenous catheters versus venipuncture tubes for obtaining blood samples - J Emerg Nurs.1996 Dec;22(6):566-9