The administration of blood products begins with the absolute identification of the patient and the unit to be transfused. Blood products are generally infused through large bore intravenous tubing (16 gauge or greater) to prevent hemolysis and permit rapid infusion if needed. Normal saline is the only crystalloid fluid compatible with PRBCs. Saline is usually given with the blood to dilute it and facilitate infusion. If multiple units of blood are to be given or are being given rapidly, warmed saline can be given concurrently (warmed to 39° to 43°C) or the blood itself can be warmed in an electric blood warmer. Blood will hemolyze if warmed to more than 40°C. Except in emergency settings, the infusion of blood is started slowly over the first 30 min, when reactions are most likely to occur. Patients without cardiovascular disease can be given a unit of PRBCs over 1 to 2 h. Those with a risk of hypervolemia should receive each unit over 3 to 4 h. Micropore filters should be used when giving any blood product in order to filter microaggregates of platelets, fibrin, and leukocytes. Rapid infusion of blood in the emergency setting may be facilitated by the use of pressure infusion devices that apply pneumatic pressure (up to 300 mmHg) to the blood unit.
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