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Presented by: Jonna Bobeck BSN, RN, CEN
* Describe purpose of Level One Rapid Infuser
* Discuss set up and use
* Explain patient preparation and assessment
* Describe troubleshooting
* Discuss massive transfusion
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* Warm and quickly infuse large amounts of
blood and/or fluids
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* Aseptic technique
* Proper device use
* Crystalloid and colloid solutions
* Sequelae of massive transfusion and fluid
resuscitation
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* Level one infuser
* Disposable fluid administration sets
* IV fluids or blood products as prescribed
* Non sterile gloves
* Large bore IV access times 3
* Monitoring equipment
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* Vital signs
* LOC
* Core temperature
* Lab values
* IV patency
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* Patient and family teaching
* Minimum 2 large bore IV sites
* Monitor BP, SPO2, Cardiac rhythm
* Warm patient
* Foley catheter
* Obtain blood sample
* ABG
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* Remove air from fluid bag
* Close clamps of administration set
* Spike bag
* Open clamps and invert drip chamber to fill ½
full
* Prime the rest of the line
* Gas vent will self prime (gently tap against the
level one cabinet to release trapped air)
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* Flip toggle switch to “-” position
* Push heat exchanger in to socket 1
* Slide top socket and snap heat exchanger into
number 2
* Place gas vent into number 3
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* Clamp
* Turn off
* Replace bag
* Close door
* Turn on and resume infusion
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* Disposable light
* Water level light
* Overtemp alarm
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* Vital signs
* Core temperature
* IV integrity
* Hemodynamic parameters
* Urine output
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* Purpose: low blood volume due to hemorrrhage
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* Hypotension
* Major obvious blood loss
* Continued bleeding
* Surgeries where there is high risk of blood loss
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* Physician responsibility
* Nurse responsibility
* Blood bank
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Test
Tube
Volume
ABO/Rh Type and antibody
screen. Immediate spin or full
crossmatch as indicated
Lavender *Signed dated and labeled
before leaving patients bedside.
(should be drawn before any
transfusion
ABG
Heparinized ABG syringe
4ml
0.5-2 ml
Frequency
Turnaround Time
72 hours
Uncrossmatched blood is immediately
available upon request. Type specific (10-15
minutes). Complete antibody screen and
crossmatch (30-45 minutes)
Additional crossmatched units (Immediate
Spin)
5-10 minutes
15 minutes
10 minutes
Na+, K +, CA+ (ionized)
CBC
PT, PTT,
Fibrinogen
D-dimer
Green top tube
0.5-5ml
Purple EDTA
4 ml
Blue citrate
3.0ml (may be collected
from arterial line if line is
properly cleared)
30 min
30 minutes
Blue citrate
3 ml
1 hour
Separate Purple EDTA
4ml
30 minutes
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* Clinical coordinator
* Nursing
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* Hct of 27-30%
* INR < 1.7 seconds
* Fibrinogen > 100mg/dl
* Platelet count of > 100,000/dl
* Core temperature of > 35 degrees Celsius
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* Pullman Regional Hospital, Initials. (2009).
Massive transfusion protocol Retrieved
from \\prhs5\groups\Policies and
Procedures\Patient Care
* Schulman, C. (2000). Rapid infuser for massive
fluid resuscitation. Retrieved from
http://www.georgiahealth.edu/som/path
ology/documents/Massive Fluid
Resuscitation-RapidInfuser.pdf
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