IV chat – May 25

We apologize that we didn’t have an IVchat on May 25 because @infusionnurse who moderates the chat was attending the INS Annual Meeting in Louisville, KY and wasnt able to get decent internet connection.

@IVchat will resume on June 8, 2011 at 8PM ET.

If you have topics or questions for IVchat, please post here or send by twitter to either @IVchat or @infusionnurse.

Hope to chat with you on June 8…

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2 thoughts on “IV chat – May 25

  1. I came across an article from New England Journal of Medicine http://bit.ly/mzcjF8 (via @NEJM) about a case involving a young child that had suffered a severe allergic reaction to donated blood because the donor had eaten peanuts the night before.

    What preventative measures (specifically regarding the patient’s known food allergy risk) can an RN take to protect the patient PRIOR to administering blood in this instance? Perhaps request an order to infuse Benadryl beforehand? Anything else? Would this request be considered “ridiculous” since these reactions are rare?

    In light of the article and since there are quite a few people out there who suffer from food allergies, it might help to encourage Blood Banks to inquire about specific foods that the donor has consumed in the past 24 hours that could potentially elicit allergic reactions in some sensitive people. Perhaps these bags could then be marked, “blood may contain nuts or wheat remnants…?” If nothing else, it’s a quick and easy way for nurses to determine which bag might not be safe for a certain patient, right?

    Thank you for any information you may have. It is much appreciated.

    Sian Defren

    Jacobs, J., Baumert, J., Brons, P., Joosten, I., Koppelman, S., van Pampus, E. (2011). Anaphylaxis from Passive Transfer of Peanut Allergen in a Blood Product. New England Journal of Medicine, 364, 1981-1982. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMc1101692

  2. Very interesting article and thank you for posting it here.

    Donor screening and testing has improved tremendously since 1985 when we saw increased transmission of diseases via blood transfusions. Donor screening is an important part of the donation process and perhaps should include questions that would help identify donors who ingested potential allergens that could transfer undigested prior to donation. As the article suggested, the incidence of passive transmission is low (rare) and until it escalates, unfortunately the blood banks will probably not change its screening and collection procedures. (flashback of the early HIV/AIDS days when blood supply wasnt safe)

    Premedication with diphenhydramine and acetaminophen is prescribed by many physicians to prevent the most common transfusion reactions – Febrile non-hemolytic and allergic reactions. It is however unknown whether or not it is effective and good practice. One study reported with the low incidence of febrile and allergic reactions associated with blood transfusions, their evidence suggest that premedication is not effective, and the costs and risks of premedication conclude that routine premedication before transfusion is not good prophylaxis, and bad practice. Other studies suggest that pre-medication doesnt decrease the over all risk of transfusion reactions but may decrease the risk of febrile nonhemolytic transfusion reactions to leukoreduced blood products.

    I had the same concerns as you did during the days when our blood supply wasnt safe. How can we protect our patients until the blood donation, screening and collection were changed? Prior to transfusions, assessing our patients for allergies and past history of transfusion reactions; vigilant monitoring during transfusions and being prepared to manage potential reactions are key measures we can do for our patients.

    Thank you!
    Cora Vizcarra RN, CRNI – moderator @IVchat #IVchat
    @infusionnurse

    Articles mentioned:

    Geiger T. Howard S. Acetaminophen and Diphenhydramine Premedication for Allergic and Febrile Non-hemolytic Transfusion Reactions: Good Prophylaxis or Bad Practice. Transfus Med Rev. 2007 January; 21(1): 1–12. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868404/

    Kennedy st al..A prospective, randomized, double-blind controlled trial of acetaminophen and diphenhydramine pretransfusion medication versus placebo for the prevention of transfusion reactions. Transfusion. 2008 Nov;48(11):2285-91
    http://www.ncbi.nlm.nih.gov/pubmed/18673350

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