By Betsy Todd, MPH, RN, CIC, AJN clinical editor.
Most of us have had the unhappy experience of replacing a patient’s perfectly good IV with a 19- or 20-gauge catheter in preparation for transfusion. The Question of Practice column in our December issue, “Changing Blood Transfusion Policy and Practice,” explores the rationale behind the long-time practice of using only large-bore catheters for blood transfusions.
After one patient’s particularly harrowing series of sticks to place a “large enough” catheter, a small team of oncology nurses asked themselves, “What evidence supports the use of a 20-gauge-or-larger catheter for blood transfusions?”
Most of these nurses had little experience with formal literature searches. Under the guidance of their clinical nurse specialist, they formulated a “PICOT” question (Population, Intervention, Comparison intervention, Outcome, and Time):
In adults receiving blood transfusions (P), what is the effect of using a smaller-than-20-gauge catheter (I) versus using a 20-gauge-or-larger catheter (C) on hemolysis or potassium level or both (O) within 24 hours of transfusion (T)? (Many of us were taught that a larger-bore catheter is necessary in order to prevent hemolysis during transfusion. Potassium is released when red blood cells rupture.)
The nurses set out to explore the literature and the guidelines of authoritative sources such as the Infusion Nurses Society. But they weren’t left to work on this question in their “spare time.” Their clinical nurse manager scheduled time off for the team’s work, set up meeting space, and even arranged for financial support for a poster presentation of their results.
Read the December article (free until January 15) to learn what they found. This is the kind of article that we at AJN love to publish. Clinical staff identified a practice issue, their nursing leadership actively supported its exploration, and nurses worked together to come up with “best practices” for their center.