why is normal saline used with blood transfusions

This site needs JavaScript to work properly. This complication is particularly concerning in patients with impaired kidney function (acute kidney injury, chronic kidney disease, etc. % Lactate and gluconate are hepatically metabolized to bicarbonate, while acetate is predominantly metabolized peripherally by skeletal muscle. The revised guidelines now state that fluid provision should be in a 1-hour bundle by administering 30 mL/kg crystalloid for hypotension or lactate 4 mmol/L. The SMART and SMART-SURG trials demonstrated a decreasedrate of AKI but not overall survivalamong critically ill patients who received Ringer's lactate, a balanced, lactate-buffered crystalloid over normal saline. Blood Products, Crystalloids, and Rapid Infusion: An Experimental Study With Magnesium. Specifically, one must observe any changes in electrolyte concentrations, volume status, and acid-base disturbances. << 2 Which IV fluid is compatible with blood products? PRBC transfusion is typically given in situations where the patient has either lost a large amount of blood or has anemia that is causing notable symptoms. bone marrow can result in a low red blood cell count - called anaemia. Enter a Melbet promo code and get a generous bonus, An Insight into Coupons and a Secret Bonus, Organic Hacks to Tweak Audio Recording for Videos Production, Bring Back Life to Your Graphic Images- Used Best Graphic Design Software, New Google Update and Future of Interstitial Ads. E\V+'sVv3* Z}%gyKumx]:}*t^{ScS>|eS~&I{=KdCipIk+u.vqv)m,` K.%JI6hr9xS>_~{.9,np2+z1lS|n~NDAT7GQV;4`u1%z~tC-uxB1 p; J Al$x. There are many potential problems related to saline. 0.9% NaCl (Normal Saline) - Perhaps not so normal after all? [5]Due to the net acidosis,this physiological change will also cause an increase in serum potassium levels due to the transcellularshiftof potassium from within the cell into the extracellular space. Therefore, the clinician and nursing staff must perform monitoring and reassessment of the patient and coordinate the reporting of abnormal findings. Blood transfusion and Normal saline bag. - allnurses After five hours of the NS infusing, the nurse obtains a set of vital signs and notes that the patient's breathing, heart rate, and blood pressure has increased. There are many potential problems related to saline. "Normal" saline is a hypertonic, acidotic fluid. official website and that any information you provide is encrypted /CS /DeviceRGB In 2012, the Surviving Sepsis Campaign guidelines recommended Early Goal-directed Therapy (EGDT) as the standard of care in managing patients in septic shock. [11], Despite its ubiquity in clinical scenarios, normal saline requires an interprofessional approach to dosing and administration among physicians, specialists, nurses, and pharmacists, all working collaboratively as an interprofessional team to optimize patient outcomes. << Learn what this procedure involves. 1991 Jul;173(1):9-12. /GS8 10 0 R Jung KT, et al. Pharmacies instead mix normal saline with the following IV solutions: Because lactated Ringers has calcium in it, some doctors dont recommend using it when a person gets a blood transfusion. Mayo Clinic does not endorse companies or products. %PDF-1.5 Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Sign up for Email: Get Your Free Resource Coping with Cancer. 19 0 obj This potentially increases the risk of blood clots. Fluid manufacturers put slightly different components in normal saline compared to lactated Ringers. With the administration of large volumes of normal saline, hyperchloremia occurs. The dose for lactated Ringers depends on the circumstances. 2021 Mar 31;8:639848. doi: 10.3389/fvets.2021.639848. (2019). Providers shouldassess fornew or worsening crackles. The fluid requirements of patientsweredetermined to be related to a patient's caloric demand by Drs. It is vital for the clinician to monitor these patients carefully and administer the minimum required volume to maintain volume homeostasis. What are the disadvantages of normal saline? Which cannula is used for blood transfusion? Blood IV tubing - one tubing for the blood and one for the saline. How to Market Your Business with Webinars? (2016). r0MCP+fg~FsFrxV9mzB Qrh{"Y99I##Z9zUx*}4iAZf+tkRB/KawI"lmFUQQQ'0kUZJbB-Aje&IN?BQZi:S{O3"yQR*V)2lQNjOlV>=ZAL>z#ON9 Crystalloids containing potassium (Lactate Ringer's solution, Hartmans solution, etc.) Its also sometimes called Ringers lactate or sodium lactate solution. Transfusions of Packed Red Blood Cells (PRBCs) - Verywell Health [Level 5]. This study guide will help you focus your time on what's most important. The risks and cost related to transfusion therapy have spurred a great deal of scientific inquiry in the past 15 years. 2 Do you have to prime blood tubing with saline? Why is normal saline the only solution used for blood transfusions(PRBC's). By definition, it is an aqueous solution of electrolytes and other hydrophilic molecules. [Updated 2022 Aug 7]. After completing an assessment, the nurse learns that the patient has a . /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] Design and methods: You might develop a bruise around the needle site, but this should go away in a few days. Hypotonic concentrations of sodium chloride (0.45%) are best for parenteral maintenance fluids rather than aggressive intravascular volume repletion. Fluid Stewardship During Critical Illness: A Call to Action. Theurine output also requires monitoring. Ringer's lactate. LISS is used in blood bank testing to potentiate reactions between antibodies and red blood cells. n = 25) and packed red blood cells (PRBC, n = 26) were rapidly admixed with normal saline (NS), Lactate solution and LR with 1 g (LR-1), 2 g (LR-2), and 5 g (LR . Administered by the RN Normal Saline is the *only* compatible solution to hang with the blood or blood https://www.cdc.gov/bloodsafety/basics.html. There are a variety of signs and symptoms of blood transfusion reaction for both hemolytic and non-hemolytic reactions. Saline is more likely to cause severe hypotension in renal transplant patients. /Parent 3 0 R Contraindications for the use of normal saline are evaluated clinically from patient to patient. Patients receiving large volumes of crystalloid fluids shouldbe monitored for electrolyte imbalances caused by crystalloid fluid administration.[10]. Saline can be used to increase blood volume when a blood transfusion is not possible. Paediatric blood administration sets are appropriate for small volume transfusions. PDF Infusion: IV Start and Blood - Veterans Affairs Rapid correction of hyponatremiamay cause central pontine myelinolysis, a devastating neurologic condition. << Other clinical applications include acting as a solution for intravenous medication delivery, delivering maintenance fluid in patients with limited or no enteral nutrition, blood pressure management, and increasing diuresis to avoid nephrotoxic drug or toxin-mediated end-organ damage. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. Therefore, if an adverse effect does occur, discontinuation of the infusion is strongly suggested. Fluid resuscitation after severe trauma injury : U-shaped associations between tetrastarch dose and survival time or frequency of acute kidney failure. Chang R, Holcomb JB. This can sometimes cause renal vasoconstriction, affecting blood flow to the kidneys. Duffy RA, Foroozesh MB, Loflin RD, Ie SR, Icard BL, Tegge AN, Nogueira JR, Kuehl DR, Smith DC, Loschner AL. The saline priming of blood transfusion tubing is one such nursing practice that has long been guided by tradition. Blood bank recommendations specify that Ringer's lactate solution (LR) should be avoided while transfusing blood. [6], Unlike acetate buffered solutions, lactated crystalloid fluidshave the potential to induce hyperglycemia. << Background: It is standard practice at many hospitals to follow blood component transfusions with a normal saline (0.9% NaCl) flush. Drinking hot water is a great way to stay hydrated, and it might have extra health benefits. >> /MediaBox [0 0 612 792] 1 Why do we use normal saline with blood transfusion? Hypertonic solutions such as 3% saline solutions contain higher concentrations of solutesthan thosefound in human serum. /StructParents 0 Enter a Melbet promo code and get a generous bonus, An Insight into Coupons and a Secret Bonus, Organic Hacks to Tweak Audio Recording for Videos Production, Bring Back Life to Your Graphic Images- Used Best Graphic Design Software, New Google Update and Future of Interstitial Ads. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. We also use the saline to flush through the blood in the tubing before changing tubings betweeen blood units. Medical uses of lactated Ringers to treat dehydration. rBn= Centers for Disease Control and Prevention. Hawkins WA, Smith SE, Newsome AS, Carr JR, Bland CM, Branan TN. [2]When deciding dosage, the provider must take into account various patient factors (e.g., weight, age, clinical presentation, laboratory findings). IV Normal Saline at KVO Place patient sitting upright Oxygen Consider diuretics, analgesics and aminophylline (cardiac asthma) FEBRILE REACTION (NON-HEMOLYTIC) Most common reaction with blood transfusions Caused by mild immune type reaction to material (WBC, platelets, etc.) 8600 Rockville Pike National Library of Medicine When the solution goes into the vein, it goes inside cells as well as outside. For example, 5% dextrose in water will hemolyze red cells. << Access free multiple choice questions on this topic. Access free multiple choice questions on this topic. Clinicians should investigate for pulmonary edema (e.g., new or worsening crackles on lung exam), as well as any new or worsening peripheral edema in the extremities. Within these compartments,sodium plays a significant role in sustaining homeostatic concentrations and the distribution of water. 67b@ L)$kH50} /F5 16 0 R While normal saline (0.9% NaCl solution) is the most frequently usedcrystalloid fluid, many other formulations can provide improved clinical outcomes in specific patient populations. The differences in particles mean that lactated Ringers doesnt last as long in the body as normal saline does. and transmitted securely. /F1 13 0 R In: StatPearls [Internet]. Can Ringer's lactate be used safely with blood transfusions? Additionally, if infusing normal saline in large quantities, chloride ions will be vastly increased within the blood. http://creativecommons.org/licenses/by-nc-nd/4.0/. Use of Ringer's Lactate with Emergency Blood Transfusion An ideal urine output target of 0.5 mL/kg/hrindicates adequate hydration butmay not be useful to assess volume status inpatients with renal impairment. If the doc wants lasix after/inbetween it will be ordered. If the implementation of normal saline results in dilution of serum electrolyte concentrations, overhydration, congested states, or pulmonary edema, then its use is strongly discouraged.[1]. The process. All rights reserved. These soundsmay indicate pulmonary edema secondary to volume overload. Other commercially available crystalloid fluids include: A crystalloid fluid is an aqueous solution of mineral salts and other small, water-soluble molecules. A doctor will consider factors such as your age, how much you weigh, your overall health, and how hydrated you already are. endobj INTRAVENOUS SOLUTIONS Of the various intravenous solutions, only isotonic saline (0.9%) is recommended for use with blood components. Why is normal saline the only solution used for blood transfusions Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. Intravenous Therapy All health care practitioners who administer blood or blood products must complete specific training for safe transfusion practices and be competent in the transfusion administration process. endobj /StructTreeRoot 4 0 R What Are the Benefits of Drinking Hot Water? Q: Should blood tubing be primed with or without normal saline before administration of blood products? With hypotonic fluid (eg, 0.45% saline), even less remains in the vasculature, and, thus, this fluid is not used for resuscitation. Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. The almond is a popular tree nut that is loaded with important nutrients. Due to normal saline's well-known side effects, there have been concerns regarding its use in critically ill patients. 2 0 obj 4 Intravenous immunoglobulin (IVIG) is only compatible with D5W. We avoid using tertiary references. 1998 Apr . Before Semler MW, Self WH, Wang L, Byrne DW, Wanderer JP, Ehrenfeld JM, Stollings JL, Kumar AB, Hernandez A, Guillamondegui OD, May AK, Siew ED, Shaw AD, Bernard GR, Rice TW., Isotonic Solutions and Major Adverse Renal Events Trial (SMART) Investigators. Primes blood administration set with normal saline without letting fluid drip from the end Clipboard, Search History, and several other advanced features are temporarily unavailable. With the administration of large volumes of normal saline, hyperchloremia occurs. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). /Tabs /S Ideally, the solution helps to maintain or achieve fluid balance in your body. 5 0 obj Epub 2019 Jun 30. Extracellular fluid replacement (e.g., dehydration, hypovolemia, hemorrhage, sepsis), Treatment of metabolic alkalosis in the presence of fluid loss. <> Balanced crystalloids versus saline in the intensive care unit: study protocol for a cluster-randomized, multiple-crossover trial. The https:// ensures that you are connecting to the <>/XObject<>/Pattern<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> DOI: Lactated Ringers - sodium chloride, sodium lactate, potassium chloride, and calcium chloride injection, solution. Clinicians should avoid using crystalloids containing dextrose (D5%W, D10%W, D5% 0.45% NS, etc.) It can therefore be used to wash out a wound. Here chloride helps to facilitate the binding between oxygen and carbon dioxide to hemoglobin. Holliday and Segar which indicate that one can use the "100-50-25" or "4-2-1" rules. Mayo Clinic is a not-for-profit organization. Some of the reasons why a person may get this IV solution include: Lactated Ringers is often the IV solution of choice if you have sepsis or an infection so severe your bodys acid-base balance is thrown off. Albert K, van Vlymen J, James P, Parlow J. We hang the saline in case a reaction occurs, then we can maintain the line after stopping the blood. http://www.pathology.med.umich.edu/bloodbank/manual/bbch_6/index.html. Additionally, the infusion of more than one liter of isotonic (0.9%) sodium chloride per day may supply more sodium and chloride than physiological levels, which can lead to hypernatremia, as well as hyperchloremic metabolic acidosis. 16.6B: Plasma and Blood Volume Expanders - Medicine LibreTexts Identify the indications for the various concentrations of normal saline. First resuscitation of critical burn patients: progresses and problems. Thanks, if possible could you post a site where I can find that information. Last medically reviewed on January 9, 2020. Disclaimer. Some lactated ringers solutions include dextrose, a type of glucose. Safe Blood Administration for Nurses | RN.com doi: https://doi.org/10.4037/ccn2013417. The mass-based formula uses what is known asthe "4-2-1" rule: Example: 100 kg patient: 20 kg (40 + 20 mL/hr) + 80 kg (80 mL/hr) = 140 mL/hr, Additional formulas for fluid administration have been developed for specific clinical scenarios (e.g., the Parkland Formula for fluid maintenance in burn patients).[3]. IV Fluids (Intravenous Fluids): The 4 Most - NCLEX Practice Tests Gershkovich B, English SW, Doyle MA, Menon K, McIntyre L. Choice of crystalloid fluid in the treatment of hyperglycemic emergencies: a systematic review protocol. << It can come in various concentrations; the two specifically addressed are 0.9% and 0.45%. And to wash the eye following a chemical burn. 1 0 obj Crystalloid fluids are a subset of intravenous solutions that are frequently used in the clinical setting. /S /Transparency Monitoring. U!B gtt_~LggZ4Z3uEaDf_vVtk5(p`uXW* ksH6"8T@ Intravenous fluids arecommonly administered during resuscitation. Three Reasons Not to Use Normal Saline or Crystalloids in Trauma If fluid is not dripping: Check that all clamps are open. [12] [Level 1]. Additionally, water plays an equally important role. Additionally, the osmolarity is 308 mOsmol/liter, and it has a pH range of 4.5 to 7. Accessed Feb. 7, 2017. Answered: The physician has ordered one liter of | bartleby The distribution of water depends mainly on the concentration of these electrolytes within various compartments. Ringer's lactate is largely used in aggressive volume resuscitation from blood loss or burn injuries; however, Ringer's lactate is a great fluid for aggressive fluid replacement in many clinical situations, including sepsis and acute pancreatitis. And to prime the tubing. Pragmatic Critical Care Research Group. x\YoH~7/H},cHb}Ycc/v "U_-B{{c/|&/C{B \Cg/v?_&K }/-~}v5 -y4oy8FW%||.h|]?_{'@/{\ \h Manufacturers dont intend for people to drink lactated Ringers solution. Which fluid is used to flush IV line after blood transfusion? It may also be used to treat metabolic acidosis in cases other than those caused by lactic acidosis 3. A transfusion provides the part or parts of blood you need, with red blood cells being the most commonly transfused. Dextrose Water: This solution contains dextrose, a form of glucose. stream Kellum JA, Song M, Almasri E. Hyperchloremic acidosis increases circulating inflammatory molecules in experimental sepsis. It is used for replacing fluids and electrolytes in those who have low blood volume or low blood pressure. This stands for keep vein open, and is usually about 30 milliliters per hour. The dose for lactated Ringer's depends on the circumstances. Lactated Ringer's/Hartman's solution (lactate buffered solution). This route is normally used in the acute care setting when a rapid infusion of fluids is necessary (e.g., hypovolemia). S- Initiate blood transfusion therapy per protocol Learning Objective 3: Demonstrate effective communication when caring for the patient receiving blood transfusion therapy a. . In addition to fluid overload, too much lactated Ringers solution could affect your electrolyte levels. Semler MW, Self WH, Wang L, Byrne DW, Wanderer JP, Ehrenfeld JM, Stollings JL, Kumar AB, Hernandez A, Guillamondegui OD, May AK, Siew ED, Shaw AD, Bernard GR, Rice TW; Isotonic Solutions and Major Adverse Renal Events Trial (SMART) Investigators; Pragmatic Critical Care Research Group. Mar 16, 2007 The main reason you cannot utilize LR because the calcium in the LR will bind to the citrate in the blood and cause clumping of the RBCs this is also why you give 1gram of calcium after every 4 transfusions, becuase the citrate that is infused will bind to calcium in the body. A doctor will consider factors such as your age, how much you weigh, your overall health, and how hydrated you already are. Whole blood (WB, n = 25) and packed red blood cells (PRBC, n = 26) were rapidly admixed with normal saline (NS), Lactate solution and LR with 1 g (LR-1), 2 g (LR-2), and 5 g (LR-5) CaCl2/L solutions for assessment of infusion time, filter weight, and clot formation. Christine Kessler; Priming Blood Transfusion Tubing: A Critical Review of the Blood Transfusion Process. Similarly, the balance of water is primarily under the control of the lungs and kidneys. << We hang the saline in case a reaction occurs, then we can maintain the line after stopping the blood. Rowell SE, Fair KA, Barbosa RR, Watters JM, Bulger EM, Holcomb JB, Cohen MJ, Rahbar MH, Fox EE, Schreiber MA. The donated blood that's been stored in a plastic bag enters your bloodstream through the IV. Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. You're curious, because the patient is. << What do you need to know about intravenous therapy? There is no physiologic rationale for its use as a resuscitative fluid. Normal saline infusion is used for extracellular fluid replacement (e.g., dehydration, hypovolemia, hemorrhage, sepsis), treatment of metabolic alkalosis in the presence of fluid loss, and for mild sodium depletion. Read this article to learn about the different types of blood transfusions and why a person might need one. We also use the saline to flush through the blood in the tubing before changing tubings betweeen blood units. Normal saline has a higher concentration of chloride ions (154 mmol/L)than in human serum (98to 106 mmol/L). Normal saline is the IV fluid used alongside the administration of blood products. Fluids are drugs: type, dose and toxicity. In some cases, you can donate blood for yourself before elective surgery, but most transfusions involve blood donated by strangers. ), and these patients should, therefore, receive treatment withjudicious useof intravenous fluids.[2]. Additionally, any new or worsening peripheral edema in the extremities is alsoa potential indication of excessive crystalloid fluid administration. Specializes in ICU. As you load him into the ambulance, your partner tells you he is spiking a 1-liter bag of 0.9% sodium chloride, also known as normal saline (NS). Delivery of fluid should be administered through large-bore peripheral lines or via central-line access. Purchase short-term access on a pay-per-article or pay-per-issue basis. This includes sodium and potassium. Unable to load your collection due to an error, Unable to load your delegates due to an error. Adverse effects of normal saline may occur secondary to solution or technique of administration. When to use saline flush or blood general allnurse? In most clinical settings,normal saline isthe choice of fluid for many indications forfluid resuscitation, maintenance, or as a solvent for medication delivery. Review appropriate monitoring parameters for normal saline. As a side note, lactated Ringers is also slightly different from whats called simply Ringers solution. Because there is less sodium in lactated Ringers than there is in the blood, your sodium levels could become too low if you get too much. 6 0 obj Osmotic pressure is a measurement of the balance of solutes (such as sodium, calcium, and chloride) to solvents (for example, water). Why do we use normal saline with blood transfusion? StatPearls. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. Studies performed on dogs have shown that even small volumes of acetate-containingcrystalloids cansignificantly increase the serum concentration of acetate to 10to 40 times the physiologic level. endobj Study design and methods: A pool-and-split design was used to allow conditions to be tested on each pool within 2 hours of irradiation. endobj Indications for sodium chloride infusions also include pharmaceutic aids and diluents for the infusion of compatible drug additives. No significant difference in clot formation between NS and LR with WB or PRBC was found, but the presence of visible clot was increased in the LR-5 group (P = 0.013, WB, and P = 0.002, PRBC). The Y-set must not be used for maintenance IV solutions or antibiotics. This is a detailed article about almonds and their health benefits. Front Vet Sci. Blood donors urgently needed in Rochester. Other commonly used intravenous solutions will cause varying degrees of difficulty when mixed with red cells. Blumberg N, Cholette JM, Pietropaoli AP, Phipps R, Spinelli SL, Eaton MP, Noronha SA, Seghatchian J, Heal JM, Refaai MA. [4]The dilution of serum bicarbonate through non-buffered crystalloids (e.g., normal saline) may also contribute to acidosis. Besides metabolic acidosis, clinical research has shown that high volumes of normal saline can cause hyperchloremia-inducedrenal afferent arteriole constriction, which cancause a decrease in the glomerular filtration rate. These conditions include: If people with these medical conditions are getting lactated Ringers (or any other IV fluid), a medical professional should closely monitor them to ensure they arent getting too much fluid. Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. >> Therefore, patients receiving large volumes of normal saline require monitoring for electrolyte imbalances. This can be a beneficial effect to avoid fluid overload. Eisenhut M. Causes and effects of hyperchloremic acidosis. Normal saline is the only compatible solution to use with the blood or blood component. The saline priming of blood transfusion tubing is one such nursing practice that has long been guided by tradition. The osmolarity is 154 mOsmol/liter and a pH range similar to the 0.9% concentration.[1][2]. The site is secure. So far, no good replacement for human blood is available. You may be hungry all the time for several reasons, including diet, stress, or medical conditions. Without proper management, the consequences of adverse effects increase. Normal saline solution can be administered only via intravenous access. Use a multi-set administration set if multiple units are to be transfused. The extra calcium could bind with the preservatives added to blood by blood banks for storage. Doctors use IV saline to replenish lost fluids, flush wounds, deliver medications, and sustain patients through surgery, dialysis, and chemotherapy. Ringer's Lactate Article - StatPearls >> Bethesda, MD 20894, Web Policies /Kids [5 0 R 6 0 R 7 0 R 8 0 R 9 0 R] However, there are few studies either evaluating or quantifying increased coagulation during rapid infusion of LR and blood. This potentially life-saving procedure can help replace blood lost due to surgery or injury. Results: The body metabolizes this component to something called bicarbonate. The .gov means its official. Its only meant for irrigation or IV use. 2020 Dec;33(6):863-873. doi: 10.1177/0897190019853979. Matjovi M, Hork J, Harazim M, Karvuni T, Radj J, Novk I. A single copy of these materials may be reprinted for noncommercial personal use only. Patients with congestive heart failure are at anincreasedrisk for detrimental effects of normal saline administration. Chapter 30 Blood transfusions.docx - Chapter 30 Blood Raghunathan K, Shaw AD, Bagshaw SM. J Pharm Pract. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 Prime the line with saline and attach to IV pump before you even pick up the blood from blood bank. Significant deviations from normal concentrations may require tailoring of the electrolyte pattern in these or alternative solutions. [1]However, revised guidelines in 2018 have called into question the efficacy ofEGDT.