مريض يحتاج وحدتين من كريات الدم الحمراء، وعنده كانيولا واحدة ٢٠G يجري عليها محلول جلوكوز ٥٪. ما الإجراء الصحيح؟

A client needs 2 units of red cells and has a single 20-gauge IV with D5W running. What is the correct action?

1. Insert a 24-gauge cannula in the other arm to use for blood only
2. Piggyback the blood into the D5W line, since both solutions are isotonic
3. Prime a blood set with 0.9% saline and flush the cannula before starting
4. Run lactated Ringer’s with the blood to stop it clotting in the line

Answer: C) Prime a blood set with 0.9% saline and flush the cannula before starting. Normal saline 0.9% is the only solution given with blood. Dextrose causes red-cell clumping and haemolysis, and Ringer’s contains calcium, which triggers clotting. A 20-gauge cannula suits an adult, so a smaller one would only slow the transfusion.