Balanced Crystalloids versus Saline in Critically Ill Adults. Saline is not physiological Despite its name, saline is neither normal nor physiological. Patients with congestive heart failure are at anincreasedrisk for detrimental effects of normal saline administration. S- Initiate blood transfusion therapy per protocol Learning Objective 3: Demonstrate effective communication when caring for the patient receiving blood transfusion therapy a. . According totheir recommendations, fluids should be aggressively administeredat a rate of 30 ml/kg in the first hour ina setting of hypotension or a lactateconcentration greater than4 mmol/L. Saline versus balanced crystalloids for intravenous fluid therapy in the emergency department: study protocol for a cluster-randomized, multiple-crossover trial. Instead, the solution will increase the fluid volume in your body. If you continue to use this site we will assume that you are happy with it. Christine Kessler; Priming Blood Transfusion Tubing: A Critical Review of the Blood Transfusion Process. Mayo Clinic does not endorse companies or products. Singh S, et al. Blood donors urgently needed in Rochester. Normal saline is a cornerstone of intravenous solutions commonly used in the clinical setting. << Intravenous (IV) rehydration is a procedure used to treat moderate to severe cases of dehydration. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. 2022 Apr;36(4):1040-1046. doi: 10.1053/j.jvca.2021.07.006. 1 0 obj There are many potential problems related to saline. Crystalloid fluids are the first choice for fluid resuscitation in the presence of hypovolemia, hemorrhage, sepsis, and dehydration. [1], A hypotonic concentration of sodium chloride. Fluid manufacturers put slightly different components in normal saline compared to lactated Ringers. Could anyone please explain some other functions of normal saline bag used in blood transfusion? Therefore, if an adverse effect does occur, discontinuation of the infusion is strongly suggested. Fluid overload can cause life-threatening pulmonary edema and the worsening of diastolic or systolic heart failure, leading to end-organ damage or evendeath. It is a crystalloid fluid administered via an intravenous solution. Compared to human serum, saline has a nearly 10% higher Na concentration and 50% higher Cl concentration. Lactate and gluconate are hepatically metabolized to bicarbonate, while acetate is predominantly metabolized peripherally by skeletal muscle. Surg Gynecol Obstet. Naturally, there are two methods of administration for normal saline: First 10 kg weight = 1000 mL (100 mL/kg x 10), Second 10 kg weight = 500 mL (50 mL/kg x 10), Remaining 30 kg weight = 750 mL (25 mL/kg x 30), First 10 kg weight =4 mL/kg/hr x 10 = 40 mL/hr, Second 10 kg weight = 2 mL/kg/hr x 10 = 20 mL/hr, Remaining 30 kg weight = 1 mL/kg/hr x 30 = 30 mL/hr, The use of normal saline can contribute to iatrogenic fluid overload. >> 3 See agency policy for using EID for the administration of blood products. Giving large amounts of pure water directly into a vein would cause your blood cells to become hypotonic, possibly leading to death. /Filter /FlateDecode Blood IV tubing - one tubing for the blood and one for the saline. Similarly, the balance of water is primarily under the control of the lungs and kidneys. gO. Prime the line with saline and attach to IV pump before you even pick up the blood from blood bank. There are many potential problems related to saline. Manufacturers dont intend for people to drink lactated Ringers solution. Transfus Apher Sci. In theory, the calcium in Ringer's lactate. A single copy of these materials may be reprinted for noncommercial personal use only. endobj In patients who require a blood transfusion, blood products should utilize a separate IV setup. Sometimes Ringers solution also has more glucose (sugar) in it than lactated Ringers. We hang the saline in case a reaction occurs, then we can maintain the line after stopping the blood. Chang R, Holcomb JB. Also, the patient's volume status is assessable by monitoring urine output. 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. Patients with congestive heart failure are at elevated risk for serious adverse effects of crystalloid fluid administration. 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. A prospective, randomized, comparison study on effect of perioperative use of chloride liberal intravenous fluids versus chloride restricted intravenous fluids on postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass grafting surgeries. /Contents 19 0 R %PDF-1.5 Advertising revenue supports our not-for-profit mission. Its only meant for irrigation or IV use. A nurse will monitor you throughout the procedure and take measures of your blood pressure, temperature and heart rate. For inpatient units, document the date and time the . 2 0 obj Healthline Media does not provide medical advice, diagnosis, or treatment. This potentially life-saving procedure can help replace blood lost due to surgery or injury. Why is normal saline the only solution used for blood transfusions? Common practices utilize the formulas created by Drs. /GS8 10 0 R We also use the saline to flush through the blood in the tubing before changing tubings betweeen blood units. There are two main types of volume expanders: crystalloids and colloids. White blood cells White Blood Cells help fight infection, bacteria and other substances that enter the body. 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. <> There is no physiologic rationale for its use as a resuscitative fluid. Outline interprofessional team strategies for improving outcomes and decreasing adverse effects of normal saline when it is used in critically ill patients. Duffy RA, Foroozesh MB, Loflin RD, Ie SR, Icard BL, Tegge AN, Nogueira JR, Kuehl DR, Smith DC, Loschner AL. ]cC@A BnCPzaJ6. Blood safety basics. Safety considerations: 1 No medications may be added to blood units or through IV tubing. RIij-C.tvNKh%rMCYmI 78HKkt ^'M?C z\ ?$<93b%ef9j%d@F9D#%cc)>p/7Cca)$M-mc@/m>/JIt4Bg64Oy iyQ`+ /pyu-j )##|s`X;,+sHB kFG,-#R?#[ "zPBawM:yHs3/s@1u d:O+ 74 y ')]\XLol.v[aX<84O.,("^P 8]4\q)qhx G, LFG"5'n2J]g@0%e1\J~A9(~Gj _`e- kjk%%thu]]zNX%ee%U#i9ye5eRKX\QU]KJa5}R /Resources What is a blood transfusion? This route is normally used in the acute care setting when a rapid infusion of fluids is necessary (e.g., hypovolemia). Another important ion ischloride, which serves as a buffering agentwithin the lungs and tissues. How come lactated ringers or Normosol-R cannot be use with packed red cells. Q: Should blood tubing be primed with or without normal saline before administration of blood products? >> endobj U!B gtt_~LggZ4Z3uEaDf_vVtk5(p`uXW* ksH6"8T@ Under normal testing conditions, red blood cells have a negative surface charge, and sodium ions (Na +) in saline solutions aggregate around the red cell surface. Must know information about Blood Transfusions! 5 Can you use normal saline in a blood transfusion? ), which permits others to distribute the work, provided that the article is not altered or used commercially. << [reM}gEI$A4>(>f>~;;OM?ll^we9/nzz~:i1N>x4 Qn#)xcsp8JCeGo6w-7ygNad]>z[BDAg Pain, anxiety, hematuria, fever, headache, pruritus, rash or hives, nausea, and respiratory difficulties are common for non-hemolytic reactions. The following are objective findings that the provider and nursing staff must review: The management of normal saline requires evaluation alongside the patients clinical status. x\YoH~7/H},cHb}Ycc/v "U_-B{{c/|&/C{B \Cg/v?_&K }/-~}v5 -y4oy8FW%||.h|]?_{'@/{\ \h This activity reviews the mechanism of action, adverse event profile, toxicity, dosing, pharmacodynamics, and monitoring of crystalloid fluids pertinent for interprofessional team members for treating hypovolemia and other indications. HHS Vulnerability Disclosure, Help The Y-type blood transfusion tubing may be used with 2 units of blood. 4 Intravenous immunoglobulin (IVIG) is only compatible with D5W. 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. National Heart, Lung, and Blood Institute. Lactate is a metabolically active compound that isutilized during gluconeogenesis to produce glucose. Eisenhut M. Causes and effects of hyperchloremic acidosis. These include causing hyperchloremic acidosis, hyperkalemia, hemodynamic instability, renal malperfusion, systemic inflammation, and hypotension. Normal saline is compatible with blood; ringer's lactate, dextrose, hyperalimentation and other intravenous solutions with incompatible medications are not compatible with blood and blood products. For example, 5% dextrose in water will hemolyze red cells. Intravenous fluids arecommonly administered during resuscitation. Contact your health care provider if you develop shortness of breath or chest or back pain in the days immediately following a blood transfusion. Paediatric administration Blood administration sets containing an integral 170-200 micron filter should always be used. /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] \1CPr=uE.6hPFhz`[`nQx"s#8*}UWcA3S^%cjz}hI8hmS1J[y` x2@'cXYNexWo2rDrS$)2868"dyG\WP|H+1/sJ,$+i=I'ukro9WzG+/! Accessed Feb. 7, 2017. What Are the Benefits of Drinking Hot Water? Balanced crystalloids versus saline in the intensive care unit: study protocol for a cluster-randomized, multiple-crossover trial. Phlebotomy can also be used in people with sickle cell anemia who require lifelong blood transfusion to prevent strokes. Blood banks screen donors and test donated blood to reduce the risk of transfusion-related infections, so infections, such as HIV or hepatitis B or C, are extremely rare. Thisguideline has a rating of 'strong recommendation.'. Fluid resuscitation after severe trauma injury : U-shaped associations between tetrastarch dose and survival time or frequency of acute kidney failure. There is no physiologic rationale for its use as a resuscitative fluid. Tell the nurse immediately if you develop: The needle and IV line will be removed. How to Market Your Business with Webinars? Within each 100 mL of 0.45% sodium chloride Injection USP, there is 7.7 mEq of sodium ions and 7.7 mEq of chloride ions. Normal saline solution can be administered only via intravenous access. [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. /Type /Page It can also be used during surgery to irrigate the bladder or a surgical site. eCollection 2021. [7][8] Pharmacists should have input on the implementation of IV fluids, make suggestions to the ordering physician based on the clinical situation, and provide counsel to nursing regarding dosing and administration. Identify the indications for the various concentrations of normal saline. This includes sodium and potassium. There are a variety of signs and symptoms of blood transfusion reaction for both hemolytic and non-hemolytic reactions. As a result, the hydrogen ion concentration in the serum would increase to maintain electrochemical neutrality. The blood typically comes from donors. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Unfortunately, current guidelines mandate that only normal saline be administered with blood products because of the danger of creating emboli. http://www.redcrossblood.org/learn-about-blood/blood-transfusions/the-process. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Specializes in Med nurse in med-surg., float, HH, and PDN. You receive lactated Ringers solution in an IV. Contraindications for the use of normal saline are evaluated clinically from patient to patient. Within each 100 mL of 0.9% sodium chloride Injection USP, there is 15.4 mEq of sodium ions and 15.4 mEq of chloride ions. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. <> Thanks. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 Blood transfusions are generally considered safe, but there is some risk of complications. Therefore, we prefer balanced salt solutions for most intraoperative uses. Monitoring. /MediaBox [0 0 612 792] A doctor will consider factors such as your age, how much you weigh, your overall health, and how hydrated you already are. to keep a vein with an IV catheter open. However, there are few studies either evaluating or quantifying increased coagulation during rapid infusion of LR and blood. When a person receives fluids intravenously (through an IV bag, for example), a saline solution is sometime used. This potentially increases the risk of blood clots. Lactated Ringers solution has a lot of the same electrolytes that blood naturally does. r0MCP+fg~FsFrxV9mzB Qrh{"Y99I##Z9zUx*}4iAZf+tkRB/KawI"lmFUQQQ'0kUZJbB-Aje&IN?BQZi:S{O3"yQR*V)2lQNjOlV>=ZAL>z#ON9 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. Your blood will be tested before a transfusion to determine whether your blood type is A, B, AB or O and whether your blood is Rh positive or Rh negative. Such monitoring canalso help identify worsening neurologic function as a potential indicator of cerebral edema or central pontine myelinolysis. FOIA 3 0 obj Spike the bag of 0.9% normal saline with one of the Y-tubing spikes. With hypotonic fluid (eg, 0.45% saline), even less remains in the vasculature, and, thus, this fluid is not used for resuscitation. We hang the saline in case a reaction occurs, then we can maintain the line after stopping the blood. The Y-set must not be used for maintenance IV solutions or antibiotics. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) rBn= For this reason, some doctors use lactated Ringers when treating medical conditions such as sepsis, in which the body becomes very acidic. Patients should undergo assessment for signs and symptoms of dehydration and fluid overload. Without proper management, the consequences of adverse effects increase. /F3 18 0 R Chesney CR. << Being isotonic also means that when you get IV lactated Ringers, the solution wont cause cells to shrink or get bigger. Background: Blood bank recommendations specify that Ringers lactate solution (LR) should be avoided while transfusing blood. << 1-612-816-8773. Ringer's lactate. Broadly,intravenous fluids can fall into two separate categories: crystalloids and colloids. An official website of the United States government. "Normal" saline is a hypertonic, acidotic fluid. These include causing hyperchloremic acidosis, hyperkalemia, hemodynamic instability, renal malperfusion, systemic inflammation, and hypotension. Hypotonic solutions are also contraindicated in patients with or at risk of developing cerebral edema. All rights reserved. 2017 Apr 13;18(1):178. doi: 10.1186/s13063-017-1923-6. No significant differences in infusion time or filter weight using WB or PRBC with NS or LR were seen. There are many potential problems related to saline. Holliday and Segar in 1957. Background: It is standard practice at many hospitals to follow blood component transfusions with a normal saline (0.9% NaCl) flush. Jung KT, et al. Blumberg N, Cholette JM, Pietropaoli AP, Phipps R, Spinelli SL, Eaton MP, Noronha SA, Seghatchian J, Heal JM, Refaai MA. Chang R, Holcomb JB. Background: Its indications include both adult and pediatric populations as sources of hydration and electrolyte disturbances. 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. Also, lactated Ringers contains the additive sodium lactate. ( When the solution goes into the vein, it goes inside cells as well as outside. ), and these patients should, therefore, receive treatment withjudicious useof intravenous fluids.[2]. If the doc wants lasix after/inbetween it will be ordered. 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. /Type /Group Normal saline versus Normosol-R in sepsis resuscitation: A retrospective cohort study. This serves the dual purpose of administering to the patient any residual blood left in the administration set (up to 40 mL), and it flushes the line for later use. This is the practice at my hospital, let me know if you have seen different and why. With the administration of large volumes of normal saline, hyperchloremia occurs. Careers. Last medically reviewed on January 9, 2020. A blood transfusion is a safe procedure that can help treat several conditions. Additionally, the osmolarity is 308 mOsmol/liter, and it has a pH range of 4.5 to 7. Fluid therapy for children: facts, fashions and questions. Normal saline Hence, excessive administration of lactated crystalloids may be of concern in patients with diabetes.[6]. Patients with elevated lactate and creatinine concentration are signs that they may not be receiving an adequate amount of volume. <>/XObject<>/Pattern<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/blood-transfusion-and-donation/how-blood-transfusions-are-done.html. Additionally, any new or worsening peripheral edema in the extremities is alsoa potential indication of excessive crystalloid fluid administration. Epub 2019 Jun 30. It is used for replacing fluids and electrolytes in those who have low blood volume or low blood pressure. . Rapid correction of hyponatremiamay cause central pontine myelinolysis, a devastating neurologic condition. So far, no good replacement for human blood is available. Blood bank guidelines should be revised to allow the use of LR in the rapid transfusion of PRBC. 0.9% NaCl (Normal Saline) - Perhaps not so normal after all? Food and water consumption are essential components to life. This is a base that can help make the body less acidic. It consists of colloid therapy as well as crystalloid therapy. endobj Tell your health care provider if you've had a reaction to a blood transfusion in the past. A: Christine Kessler, RN, MN, CNS, ANP, BC-ADM, replies: Many hospital transfusion protocols and related nursing practices have been based more on tradition and assumptions than on scientific evidence. Doctors may also use lactated Ringers as an irrigating solution. Review appropriate monitoring parameters for normal saline. /Lang (en-US) Special care is prudent when administering fluids to patients with congestive heart failure or those with significant renal impairment (e.g., CKD-V dialysis-dependent patients). Saline IVs have even found a place outside the hospital, as a trendy hangover remedy. The most commonly used crystalloid worldwide is normal saline which is used in the management and treatment of dehydration (e.g., hypovolemia, shock), metabolic alkalosis in the presence of fluid loss, and mild sodium depletion. These effects include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation, and hypervolemia. Bookshelf /F2 12 0 R Such cases may require a pressure apparatus to the bag of fluid to achieve a higher infusion rate. Saline is more likely to cause renal blood flow disturbances. [11][9] [Level 2], Established guidelines for crystalloid fluidunder various clinicalconditions are not yet extant. The saline priming of blood transfusion tubing is one such nursing practice that has long been guided by tradition. 7 What are the safety considerations for blood transfusions? Red blood cell transfusion is used to replace the blood removed rather than saline solution as discussed above. /F4 17 0 R Design and methods: [Level 5]. Tonog P, Lakhkar AD. This is a detailed article about almonds and their health benefits. A blood transfusion is a routine medical procedure in which donated blood is provided to you through a narrow tube placed within a vein in your arm. The Impact of Pre-Hospital Administration of Lactated Ringer's Solution versus Normal Saline in Patients with Traumatic Brain Injury. Hyperchloremia was significantly associated with increased mortality. There is no physiologic rationale for its use as a resuscitative fluid. /Font Osmotic pressure is a measurement of the balance of solutes (such as sodium, calcium, and chloride) to solvents (for example, water). And to prime the tubing. Only solution that can EVER hang with blood is 0.9% normal saline, will need at least a 250ml bag. Blood transfusions are usually done in a hospital, an outpatient clinic or a doctor's office. Other commercially available crystalloid fluids include: A crystalloid fluid is an aqueous solution of mineral salts and other small, water-soluble molecules. Universal blood donor type: Is there such a thing? To minimize the risk of possiblecontaminations,the final solution should be inspected for ambiguity or precipitation immediately after mixing, before administration, and periodically during administration. When to use saline flush or blood general allnurse? 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. The risks and cost related to transfusion therapy have spurred a great deal of scientific inquiry in the past 15 years. Patients receiving large volumes of crystalloid fluids shouldbe monitored for electrolyte imbalances caused by crystalloid fluid administration.[10]. Mechanism of Action in the donors blood Search for other works by this author on: You do not currently have access to this content. 2 Specific blood administration tubing is required for all blood transfusions. Raghunathan K, Shaw AD, Bagshaw SM. A comparison of LR and NS with rapid infusion rates of blood showed no significant difference between infusion time, filter weight and clot formation. Normal saline is a hypertonic, acidotic fluid. /Group Schumann R, Zaimi I, Shebaclo K, Gupta A. J Cardiothorac Vasc Anesth. Due to normal saline's well-known side effects, there have been concerns regarding its use in critically ill patients. This content does not have an English version. Buffered solutions contain molecules that metabolize in vivo to bicarbonate. Bethesda, MD 20894, Web Policies Learn what this procedure involves. PMC Water freely travels outside the vasculature, so as little as 10% of isotonic fluid remains in the intravascular space. [2]Since this time,their initial formula has been modified to provide clinicians with guidelines for administering maintenance crystalloid fluids. 2. According to B. Braun Medical, one of the companies that manufactures lactated Ringers, every 100 milliliters of their solution includes the following: These components can vary slightly by manufacturer. Read this article to learn about the different types of blood transfusions and why a person might need one. . Can Ringer's lactate be used safely with blood transfusions? Researchers are working on developing artificial blood. Do not add medications directly to a unit of blood during transfusion. Mayo Clinic is a not-for-profit organization. The differences in particles mean that lactated Ringers doesnt last as long in the body as normal saline does. 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 . An intravenous (IV) line with a needle is inserted into one of your blood vessels. Normal saline is compatible with blood; ringers lactate, dextrose, hyperalimentation and other intravenous solutions with incompatible medications are not compatible with blood and blood products. This activity also highlights the mechanism of action, adverse event profile, and other key factors (e.g., administration, monitoring, relevant interactions) pertinent for members of the interprofessional team in the management of critically ill patients. The treatment of hemolysis includes the administration of normal saline after the transfusion is stopped and all the tubing is changed to . Appointments & Access Contact Us /F6 15 0 R Normal saline has a higher concentration of chloride ions (154 mmol/L)than in human serum (98to 106 mmol/L). A blood transfusion also can help if an illness prevents your body from making blood or some of your . Open the upper clamp on the normal saline side of the tubing, and squeeze the drip chamber until fluid covers the filter and fills one-third to one-half of the drip chamber. [10]Although additional prospective studies are still needed. The dose for lactated Ringer's depends on the circumstances. #A(sl JeO}J7Op=}8Dc 4d`DLh-#3s*}::`FG(-,)|RVkt/!1-+#7Xar&g U~i \\0)&G&&bM 2020 Dec;33(6):863-873. doi: 10.1177/0897190019853979. Getting a blood transfusion. 1991 Jul;173(1):9-12. Is lactated Ringers compatible with blood products? It used for acute blood loss . There are several reasons why you may receive this IV fluid if you need medical care. Purchase short-term access on a pay-per-article or pay-per-issue basis. Indications that a patient may receive inadequate volume include elevated lactate and creatinine concentrations in the absence of an alternate cause. Some nurses never use normal saline to prime the infusion line, as they use blood to prime the line. It has high levels of sodium and chloride, levels that are higher than the blood. Matjovi M, Hork J, Harazim M, Karvuni T, Radj J, Novk I.