within which blood may be out of the control of the blood bank and returned for reissue.
One study showed that blood in a room temperature environment required
approximately 30 minutes to warm from 2C to above 6C.
(2) Sodium chloride injection USP (normal saline) is the only solution
suitable for use in the transfusion of blood products containing RBCs, platelets, or
leukocytes. "In vivo" hemolysis of RBCs exposed to various IV solutions seems to be
primarily dependent upon the amount of RBC swelling that occurs in vitro". Five percent
dextrose in water is not satisfactory for filling or flushing blood administration sets
because RBC clumping and swelling with subsequent hemolysis may occur. Lactated
Ringer's solution also is unsatisfactory because calcium in the Ringer's solution may
cause the formation of clots. Great care must be taken to ensure that drugs which are
toxic to blood components are not infused through the same administration set as the
(3) Sometimes it is difficult to infuse RBCs because the high hematocrit
decreases the flow rate. This problem can be avoided by adding normal saline to the
RBC units at the time the transfusion is started. The technique is as follows:
(a) A Y-type infusion set must be used.
(b) Perform the venipuncture and begin the infusion with normal saline
connected to one lead of the Y infusion set.
The second lead of the Y infusion set should be clamped closed.
(d) Connect the unit of RBCs to the second lead of the Y set.
Lower the unit of RBCs below the bottle of normal saline.
(f) Open the clamp on the lead to the RBCs and allow the desired
volume of saline to enter the unit of RBCs. This volume will usually be 50 to 100 ml.
Clamp the lead coming from the saline bottle.
(h) Hang the unit of RBCs diluted with saline beside the bottle of
(i) If it is desirable, the RBCs remaining in the infusion set at the end
of transfusion can be rinsed into the patient by opening the lead from the saline bottle.