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Difficulty: MediumPharmacological and Parenteral Therapies

A client on a medical-surgical unit has a hemoglobin level of 6.8 g/dL (68 g/L) and is prescribed a transfusion of packed red blood cells (PRBCs). The client has a single 20-gauge peripheral intravenous (IV) catheter, which is currently infusing a continuous maintenance fluid of 5% dextrose in water (D5W) at 75 mL/hr. What is the most appropriate action by the nurse?

  1. Stop the continuous D5W infusion, flush the IV catheter with 0.9% sodium chloride, and initiate the blood transfusion.Answer
  2. B
    Attach the blood administration set to the lowest Y-site of the active D5W infusion.
  3. C
    Start the blood transfusion immediately and take the first set of vital signs 15 minutes after initiation.
  4. D
    Request a prescription for a central venous access device, as a 20-gauge catheter is too small for PRBCs.

Answer

The nurse must stop the D5W infusion, flush the line with 0.9% sodium chloride, and then administer the PRBCs.
Blood products can only be safely infused with 0.9% sodium chloride (normal saline). Solutions containing dextrose (like D5W) or lactated Ringer's will cause red blood cells to hemolyze or clot. When a client only has one adequate IV site (a 20-gauge is appropriate for blood), the nurse must stop the incompatible continuous fluid, clear the catheter completely with a normal saline flush, and then initiate the transfusion.

Step-by-Step Solution

1
Identify the compatibility of the prescribed blood product with the current continuous IV fluid.
Packed red blood cells (PRBCs) are incompatible with 5% dextrose in water (D5W).
Dextrose solutions cause red blood cell hemolysis and clumping.
2
Determine the adequacy of the current IV access for the prescribed therapy.
A 20-gauge peripheral IV catheter is adequate for PRBC administration in an adult.
18- to 20-gauge catheters provide sufficient lumen size to prevent mechanical damage to the red blood cells during infusion.
3
Formulate a safe administration plan utilizing the single IV access.
The nurse will stop the D5W, flush the line with 0.9% sodium chloride (normal saline) to clear the dextrose, and then connect the blood administration set.
Normal saline is the only IV fluid compatible with blood products. Flushing the line ensures no incompatible fluid comes into contact with the PRBCs.

Key Concept

Blood products must only be administered with 0.9% sodium chloride to prevent hemolysis, and a 20-gauge IV is sufficient for administration.
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Topics

Pharmacological and Parenteral Therapies

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