The nurse is preparing to hang a unit of blood on a client. The blood has been checked off with two RNs and the pre-infusion vitals recorded. The nurse is at the bedside monitoring the infusion. Shortly after beginning the infusion, the pump alarm sounds. The IV has infiltrated. No blood has yet reached the client. The client is a hard stick, and the nurse realizes that a line cannot be placed within the time frame to begin the infusion. Which action by the nurse is correct?

  • return the blood and the tubing to the blood bank for storage until an IV can be placed
  • place the blood bag and tubing in the medication refrigerator until an IV can be restarted
  • cancel the order for blood and notify the health care provider that the client has no access
  • wait until 30 minutes has passed while IV placement is attempted, and then waste the blood and chart it as expired
  • return the blood to the blood bank and notify the next shift when they arrive that they need to start an IV and administer the blood
Number 1 is correct.
Before blood is picked up, the nurse should check the IV for good blood return and verify that it is working. This saves time and is more efficient than picking up the blood first. Blood must be administered within 30 minutes of the time it leaves the blood bank. This does not leave a lot of time to restart an IV if needed. If the nurse determines that the blood cannot be started within the guidelines, the blood should be returned to the blood bank before it is spiked for administration. Once blood is spiked, there is potential for contamination. The blood should never be placed in the medication refrigerator on the unit; it must be returned to the blood bank. The nurse should not cancel the order and notify the provider that there is no access. All reasonable attempts must be made to restart the IV. If the client appears to need a PICC or other central line due to being a difficult stick, the nurse can notify the health care provider, but should not cancel an order for blood. The blood has been ordered for a reason. Blood should never be wasted. Once it is apparent that time is an issue, the blood should be returned to the blood bank before the last minute. Delaying administration and telling the next shift to start an IV is inappropriate. Blood is too important to delay to another shift, and the nurse has the duty to complete orders given on her shift. The client needing blood should never be without an IV for a long period of time, in case other fluids or emergency resuscitation is needed.