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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is caring for a client who requires a transfusion of packed red blood cells (PRBCs) for symptomatic anemia. The client has a single 1818-gauge peripheral intravenous (IV) catheter, which is currently infusing Lactated Ringer's solution at 75 mL/hr75 \text{ mL/hr}. Which of the following is the most appropriate action by the nurse?

  1. A
    Connect the blood administration set directly to the lowest Y-port of the continuous Lactated Ringer's infusion to avoid extra needle sticks.
  2. Discontinue the Lactated Ringer's infusion, flush the catheter with 0.9%0.9\% sodium chloride, and administer the blood using a dedicated Y-type tubing primed with 0.9%0.9\% sodium chloride.Answer
  3. C
    Delay the blood transfusion until the Lactated Ringer's infusion is complete to prevent the risk of circulatory overload.
  4. D
    Instruct the unlicensed assistive personnel (UAP) to flush the IV catheter with 0.9%0.9\% sodium chloride while the nurse verifies the blood product.

Answer

Discontinue the Lactated Ringer's infusion, flush the catheter with 0.9% sodium chloride, and administer the blood using a dedicated Y-type tubing primed with 0.9% sodium chloride.
The correct action demonstrates an understanding of IV compatibility and safe blood administration. Packed red blood cells (PRBCs) must only be administered with 0.9%0.9\% sodium chloride (Normal Saline). Because the client has an appropriate 1818-gauge catheter in place, the nurse should stop the incompatible Lactated Ringer's, flush the line thoroughly with Normal Saline to prevent mixing, and then safely infuse the blood product.

Step-by-Step Solution

1
Identify the primary clinical need.
The client requires a PRBC transfusion for symptomatic anemia, making it the priority intervention over the maintenance IV fluid.
Symptomatic anemia requires immediate restoration of oxygen-carrying capacity.
2
Assess IV compatibility.
Lactated Ringer's is identified as incompatible with PRBCs.
The calcium in Lactated Ringer's binds with the citrate in banked blood, which can cause severe clotting in the tubing.
3
Determine the safest administration method.
The nurse must stop the incompatible fluid, clear the line with a compatible fluid (0.9% sodium chloride), and administer the blood.
This prevents mixing of incompatible substances while utilizing the existing, appropriately sized 18-gauge catheter.

Key Concept

Blood Product Compatibility and Administration Safety
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Topics

Pharmacological and Parenteral Therapies

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