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Difficulty: MediumPharmacological and Parenteral Therapies

A client with symptomatic anemia requires a transfusion of packed red blood cells (PRBCs). The client's only intravenous (IV) access is a 20-gauge peripheral catheter currently infusing 5% dextrose in water (D5W) at 75 mL/hr. What is the most appropriate action by the nurse?

  1. A
    Delegate the assessment of the client's vital signs and monitoring for adverse reactions during the first 15 minutes to an unlicensed assistive personnel (UAP).
  2. B
    Connect the PRBC transfusion tubing to the lowest Y-site port of the primary D5W infusion line to run them concurrently.
  3. Stop the continuous D5W infusion, flush the IV catheter with 0.9% sodium chloride, and administer the PRBCs with 0.9% sodium chloride.Answer
  4. D
    Calculate the required drip rate to ensure the entire unit of PRBCs infuses slowly over a 6-hour period to prevent fluid overload.

Answer

The most appropriate action is to stop the continuous D5W infusion, flush the IV catheter with 0.9% sodium chloride, and administer the PRBCs with 0.9% sodium chloride.
Packed red blood cells (PRBCs) are exclusively compatible with 0.9% sodium chloride (normal saline). Administering blood with solutions containing dextrose, such as D5W, causes hemolysis (rupture) of the red blood cells, which can trigger a severe or life-threatening reaction. Because the client has only one IV access site, the nurse must stop the incompatible D5W infusion, completely flush the line with 0.9% sodium chloride to clear any remaining dextrose from the catheter, and then administer the transfusion safely using normal saline as the primer and flush.

Step-by-Step Solution

1
Identify the fluid compatibility of the prescribed blood product.
Packed red blood cells (PRBCs) are only compatible with 0.9% sodium chloride (normal saline).
Solutions containing dextrose, such as D5W, cause hemolysis of red blood cells, while solutions like Lactated Ringer's contain calcium that can cause the blood to clot.
2
Evaluate the client's current intravenous access.
The client has a single IV line currently infusing an incompatible fluid (D5W).
The nurse must use the existing access safely or establish a new line.
3
Formulate a safe administration plan.
Stop the D5W infusion, thoroughly flush the line with 0.9% sodium chloride, and administer the blood using only 0.9% sodium chloride.
Flushing the line completely removes the incompatible dextrose solution, preventing a dangerous in-line hemolytic reaction and allowing safe blood administration through the single access site.

Key Concept

Blood Product Administration Safety and IV Fluid Compatibility
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Topics

Pharmacological and Parenteral Therapies

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