Fundamentals of Nursing Q 422
A client has an order to receive one unit of packed RBCs. The nurse makes sure which of the following intravenous solutions to hang with the blood product at the client’s bedside?
A. 0.9% sodium chloride.
B. 5% dextrose in 0.9% sodium chloride.
C. Balanced Multiple Maintenance Solution with 5% Dextrose.
D. 5% dextrose in 0.45% sodium chloride.
Correct Answer: A. 0.9% sodium chloride.
0.9% sodium chloride is a standard solution used to follow infusion of blood products. Of the various intravenous solutions, only isotonic saline (0.9%) is recommended for use with blood components. Other commonly used intravenous solutions will cause varying degrees of difficulty when mixed with red cells.
Option B: 5% dextrose in water will hemolyze red cells. Intravenous solutions containing calcium, such as Lactated Ringer’s solution, can cause clots to form in the blood. Prior to blood transfusion, completely flush incompatible intravenous solutions and drugs from the blood administration set with isotonic saline.
Option C: Normal saline is the only compatible solution to use with the blood or blood component. Crystalloid solutions and medications may cause agglutination and/or hemolysis of the blood or blood components.
Option D: IV solution containing dextrose in water will hemolyze red cells. Only isotonic, calcium-free IV solutions should be added to, or come in contact with blood products. Calcium may bind with the citrate anticoagulant and promote clotting in the tubing. Excess glucose and/or dextrose causes hemolysis and shortens red cell survival. Studies have shown other IV solutions to be compatible with citrated blood components. However, these solutions should only be considered compatible in situations where the use of 0.9% NaCl would lead to undesirable metabolic abnormalities.