>> This stands for keep vein open, and is usually about 30 milliliters per hour. Giving too much lactated Ringers can cause swelling and edema. The contents of the other solutions will cause the cells to hemolyze. It is used for replacing fluids and electrolytes in those who have low blood volume or low blood pressure. The glycemic index (GI) is a value used to measure how much a specific food increases your blood sugar levels. Ideally, the solution helps to maintain or achieve fluid balance in your body. This potentially life-saving procedure can help replace blood lost due to surgery or injury. Giving large amounts of pure water directly into a vein would cause your blood cells to become hypotonic, possibly leading to death. Hypotonic solutions are also contraindicated in patients with or at risk of developing cerebral edema. Patients with elevated lactate and creatinine concentration are signs that they may not be receiving an adequate amount of volume. Here are 14 reasons for constant hunger. Saline solution: A bag of saline. http://creativecommons.org/licenses/by-nc-nd/4.0/. 3 0 obj 1-612-816-8773. Crystalloid fluids are administered parenterally via an intravenous infusion. Broadly,intravenous fluids can fall into two separate categories: crystalloids and colloids. 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. In addition to fluid overload, too much lactated Ringers solution could affect your electrolyte levels. Buffered solutions contain molecules that metabolize in vivo to bicarbonate. Tell the nurse immediately if you develop: The needle and IV line will be removed. << No significant differences in infusion time or filter weight using WB or PRBC with NS or LR were seen. Is lactated Ringers compatible with blood products? How to Market Your Business with Webinars. 1 0 obj 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. 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. The Surviving Sepsis Campaign Bundle: 2018 update. This can sometimes cause renal vasoconstriction, affecting blood flow to the kidneys. White blood cells White Blood Cells help fight infection, bacteria and other substances that enter the body. This includes sodium and potassium. Epub 2019 Jun 30. Water is a necessary ingredient of the body and comprises more than two-thirds of total body weight. A blood transfusion is a safe procedure that can help treat several conditions. PDF Infusion: IV Start and Blood - Veterans Affairs Eisenhut M. Causes and effects of hyperchloremic acidosis. The risk of this complication becomes particularly elevated in patients with impaired kidney function (acute kidney injury, chronic kidney disease, etc. Specializes in NICU, PICU, Transport, L&D, Hospice. In most clinical settings, crystalloids are the choice of fluid for many indications forfluid resuscitation, maintenance, or as a solvent for medication delivery. All rights reserved. Normal saline and lactated Ringers are two IV fluids commonly used in hospital and healthcare settings. A blood transfusion provides blood or blood components if you've lost blood due to an injury, during surgery or have certain medical conditions that affect blood or its components. Rapid correction of hyponatremiamay cause central pontine myelinolysis, a devastating neurologic condition. There are many potential problems related to saline. Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA. 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. The implementation of normal saline is standard during resuscitation, and administration can be at various concentrations. There are many potential problems related to saline. 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. Can Ringer's lactate be used safely with blood transfusions? http://www.nhlbi.nih.gov/health/health-topics/topics/bt. Normal saline is the preferred solution for 1. hypochloremic metabolic alkalosis 2. diluting packed red blood cells prior to transfusion (because of calcium and lactate in ringers lactate its prohibited ). It can therefore be used to wash out a wound. Our members represent more than 60 professional nursing specialties. J Pharm Pract. Blood transfusions are generally considered safe, but there is some risk of complications. Blood safety basics. Lactated Ringer's/Hartman's solution (lactate buffered solution). Purchase short-term access on a pay-per-article or pay-per-issue basis. 3 0 obj Ringer's lactate is compatible with the rapid infusion of AS-3 preserved packed red blood cells. Saline is more likely to cause renal blood flow disturbances. Therefore, we prefer balanced salt solutions for most intraoperative uses. Epub 2021 Jul 9. By continuing to use our website, you are agreeing to our, Copyright 2023 American Association of Critical-Care Nurses. << It consists of colloid therapy as well as crystalloid therapy. In comparison to other types of fluids (e.g., hypertonic, hypotonic), there is less of an osmotic effect. Epub 2016 Feb 25. Can J Anaesth. Jung KT, et al. endobj eCollection 2021. Why is normal saline the only solution used for blood transfusions Saline IVs have even found a place outside the hospital, as a trendy hangover remedy. 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]. 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. They decrease osmotic pressure by diluting the blood. A blood transfusion also can help if an illness prevents your body from making blood or some of your blood's components correctly. In: StatPearls [Internet]. We evaluated the impact of coinfusion with dextrose-containing fluids (DW) on markers of RBC quality. Ideally, a urine output target of 0.5 mL/kg/hrindicates adequate hydration butmay not be useful to determine volume status inpatients with renal impairment. [2] Normal salinecontains electrolytes (sodium and chloride ions) which dissociate in solution. It is a crystalloid fluid administered via an intravenous solution. These include causing hyperchloremic acidosis, hyperkalemia, hemodynamic instability, renal malperfusion, systemic inflammation, and hypotension. Only solution that can EVER hang with blood is 0.9% normal saline, will need at least a 250ml bag. http://creativecommons.org/licenses/by-nc-nd/4.0/ 6 When to use saline to flush the tubing? 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). 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). Surg Gynecol Obstet. << An identification check will ensure you receive the correct blood. Saline is more likely to cause severe hypotension in renal transplant patients. HHS Vulnerability Disclosure, Help Mayo Clinic is a not-for-profit organization. Crystalloids are aqueous solutions of mineral salts or other water-soluble molecules. Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock. /F5 16 0 R Normal saline 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. Chesney CR. [6], Unlike acetate buffered solutions, lactated crystalloid fluidshave the potential to induce hyperglycemia. Unauthorized use of these marks is strictly prohibited. There is no physiologic rationale for its use as a resuscitative fluid. Extracellular fluid replacement (e.g., dehydration, hypovolemia, hemorrhage, sepsis), Treatment of metabolic alkalosis in the presence of fluid loss. When monitoring the use of normal saline, there must be periodic assessments of the patients clinical and laboratory findings. /Count 5 Normal saline is the IV fluid used alongside the administration of blood products. For example, 5% dextrose in water will hemolyze red cells. This creates a net positive electrical . /GS7 11 0 R Therefore, if an adverse effect does occur, discontinuation of the infusion is strongly suggested. to facilitate the flow of IV medication during surgery. You'll be seated or lying down for the procedure, which usually takes one to four hours. Without proper management, the consequences of adverse effects increase. 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. Contact your health care provider if you develop shortness of breath or chest or back pain in the days immediately following a blood transfusion. LISS is used in blood bank testing to potentiate reactions between antibodies and red blood cells. /ExtGState It is vital for the clinician to monitor these patients carefully and administer the minimum required volume to maintain volume homeostasis. This complication is particularly concerning in patients with impaired kidney function (acute kidney injury, chronic kidney disease, etc. 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. 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. 6 When to use IV fluid and blood transfusion? 2005-2023 Healthline Media a Red Ventures Company. You're curious, because the patient is. 5 0 obj x\YoH~7/H},cHb}Ycc/v "U_-B{{c/|&/C{B \Cg/v?_&K }/-~}v5 -y4oy8FW%||.h|]?_{'@/{\ \h The calculation of daily fluid requirements is achievable in various ways. O&i;+%p6tMe7Aruu={O=Nt~S;u]/a2>rx/a)ueCD{` Mm1f{ [u3wOo_M}C@o_ o 9okp4bRFGm=O"m9V#tFskc2 Ringer's lactate solution contains calcium ions. The risks and cost related to transfusion therapy have spurred a great deal of scientific inquiry in the past 15 years. Only normal saline should be used to prime the intravenous line, with no other solutions or medications used. [1], A hypotonic concentration of sodium chloride. Additionally, any new or worsening peripheral edema in the extremities is alsoa potential indication of excessive crystalloid fluid administration. <> Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. SPlR@ 7R$ KQY$BY$'{J~EuC"U]5* http://creativecommons.org/licenses/by-nc-nd/4.0/ 7 What are the safety considerations for blood transfusions? endobj Create well-written care plans that meets your patient's health goals. >> dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d3d29c8f-c326-4097-814a-7f4e08c67068, ijcmr.com/uploads/7/7/4/6/77464738/ijcmr_1756_v1.pdf, Everything You Need to Know About Making and Using Homemade Saline Solution, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, 9 Evidence-Based Health Benefits of Almonds, Glycemic Index: What It Is and How to Use It. The site is secure. [2]When deciding dosage, the provider must take into account various patient factors (e.g., weight, age, clinical presentation, laboratory findings). %PDF-1.5 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. Why is normal saline used for blood transfusions? Blood transfusion and Normal saline bag. - allnurses << Intravenous (IV) rehydration is a procedure used to treat moderate to severe cases of dehydration. >> Certainly normal saline can be used to flush the line after blood transfusion finishes. Providers shouldassess fornew or worsening crackles. Trials. Can Ringer's lactate be used safely with blood transfusions? Most commercially available crystalloid solutions are isotonic to human plasma. Additionally, the osmolarity is 308 mOsmol/liter, and it has a pH range of 4.5 to 7. 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 Signs and symptoms of fluid overload can undergo an evaluation with a comprehensive physical exam. Saline can be used to increase blood volume when a blood transfusion is not possible. Review the indications for using crystalloid intravenous fluids. Mild complications and rarely severe ones can occur during the transfusion or several days or more after. <> stream U!B gtt_~LggZ4Z3uEaDf_vVtk5(p`uXW* ksH6"8T@ 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. <>>> Pain, anxiety, hematuria, fever, headache, pruritus, rash or hives, nausea, and respiratory difficulties are common for non-hemolytic reactions. /Parent 3 0 R Background: Transfusion guidelines advise against coinfusing red blood cells (RBCs) with solutions other than 0.9% saline. >> Approximately 15 million blood and blood component transfusions occur annually within the United States, making it a common lifesaving and life-sustaining intervention, especially within intensive care, surgical, and trauma units. There are two main types of volume expanders: crystalloids and colloids. The following are primary indications for the use of normal saline infusion that have been approved by the FDA: Additionally, it has a use as a priming solution for various procedures (e.g., hemodialysis procedures) and to initiate and terminate blood transfusions. /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] If a patient needs blood, there are a few types of . Hyperchloremia was significantly associated with increased mortality. Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Epub 2009 Apr 2. The fluid requirements of patientsweredetermined to be related to a patient's caloric demand by Drs. 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. Drinking hot water is a great way to stay hydrated, and it might have extra health benefits. Crit Care Nurse 1 June 2013; 33 (3): 8084. [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. [2]It is vital for the clinician to monitor these patients carefully and to administer the minimum required volume to maintain homeostasis. We use cookies to ensure that we give you the best experience on our website. One fact is clear; normal saline should be prescribed, just like all other medications, taking into account individual patient factors, disease processes, and other treatments. bone marrow can result in a low red blood cell count - called anaemia. People receive blood transfusions for many reasons such as surgery, injury, disease and bleeding disorders. Patientsshould receive a fluid challenge of 20 mL/kg over the first 30 minutes of treatment. 8600 Rockville Pike Calcium can induce coagulation of the blood products in the IV tubing and therefore inhibit their effective delivery. Hang the bag on the IV pole, and prime the tubing. Saline solution, which is a simple mixture of salt and water, has many handy uses, from clearing nasal passages, cleaning wounds, and rinsing contact. Holliday MA, Ray PE, Friedman AL. This potentially increases the risk of blood clots. When the solution goes into the vein, it goes inside cells as well as outside. Therefore, the clinician and nursing staff must perform monitoring and reassessment of the patient and coordinate the reporting of abnormal findings. How come lactated ringers or Normosol-R cannot be use with packed red cells. It is a crystalloid fluid administered via an intravenous solution. 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. In these patients, fluid overload is a considerable concern; this can lead to life-threatening pulmonary edema and the worsening of diastolic or systolic heart failure, leading to end-organ damage or evendeath. There are a variety of signs and symptoms of blood transfusion reaction for both hemolytic and non-hemolytic reactions. It may also be used to treat metabolic acidosis in cases other than those caused by lactic acidosis 3. Gershkovich B, English SW, Doyle MA, Menon K, McIntyre L. Choice of crystalloid fluid in the treatment of hyperglycemic emergencies: a systematic review protocol. Patients with congestive heart failure are at elevated risk for serious adverse effects of crystalloid fluid administration. 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. A doctor will consider factors such as your age, how much you weigh, your overall health, and how hydrated you already are. Three Reasons Not to Use Normal Saline or Crystalloids in Trauma Also, the patient's volume status is assessable by monitoring urine output. Search for other works by this author on: You do not currently have access to this content. Epub 2018 Feb 21. Sometimes a doctor may order IV fluids at a KVO rate. Saline can be used to increase blood volume when a blood transfusion is not possible. Specializes in Med nurse in med-surg., float, HH, and PDN. endobj In most clinical settings,normal saline isthe choice of fluid for many indications forfluid resuscitation, maintenance, or as a solvent for medication delivery. Choice of Fluid Therapy in the Initial Management of Sepsis, Severe Sepsis, and Septic Shock. /Type /Group There is no physiologic rationale for its use as a resuscitative fluid. Fluids should be administered, preferably via large-bore peripheral lines (18-gauge or larger) or through central access, which may also be used to deliver blood products if required. Normal saline can aslo be used as a flush -- to clean out an intravenous (IV) catheter. In 2012, the Surviving Sepsis Campaign guidelines recommended Early Goal-directed Therapy (EGDT) as the standard of care in managing patients in septic shock. Transfusions | Boundless Anatomy and Physiology | | Course Hero Their primary indication is for emergent replacement of serum solutes, such as in hyponatremia with neurologic symptoms. Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. and transmitted securely. This route is normally used in the acute care setting when a rapid infusion of fluids is necessary (e.g., hypovolemia). Which fluid is used to flush IV line after blood transfusion? Some people have medical conditions that mean their body cant handle the extra fluid well. What is a blood transfusion? It has high levels of sodium and chloride, levels that are higher than the blood. Safe Blood Administration for Nurses | RN.com Fluid overload can cause life-threatening pulmonary edema and the worsening of diastolic or systolic heart failure, leading to end-organ damage or evendeath. PMC Blood Transfusion: What is it, Benefits, Risks & Reactions, Time Ahmed Elsayed on LinkedIn: Must know information about Blood Blumberg N, Cholette JM, Pietropaoli AP, Phipps R, Spinelli SL, Eaton MP, Noronha SA, Seghatchian J, Heal JM, Refaai MA. 1998 Apr . ), and these patients should, therefore, receive treatment withjudicious useof intravenous fluids. 4 0 obj 5 0 obj You receive lactated Ringers solution in an IV. The three commonly used molecules are lactate, acetate, and gluconate. We also use the saline to flush through the blood in the tubing before changing tubings betweeen blood units. This keeps the PIV line clean and reduces the risk of infection or occlusion. Here chloride helps to facilitate the binding between oxygen and carbon dioxide to hemoglobin. Tonog P, Lakhkar AD. Transfusions of Packed Red Blood Cells (PRBCs) - Verywell Health 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. are relatively contraindicated in patients with hyperkalemia since these may exacerbate their condition, which in turncan lead to ventricular dysrhythmias. Saline Shortage (0.9% NaCl Solution) Background: It is standard practice at many hospitals to follow blood component transfusions with a normal saline (0.9% NaCl) flush. The body metabolizes this component to something called bicarbonate. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Duffy RA, Foroozesh MB, Loflin RD, Ie SR, Icard BL, Tegge AN, Nogueira JR, Kuehl DR, Smith DC, Loschner AL. Can you use normal saline in a blood transfusion? Mayo Clinic does not endorse companies or products. Which cannula is used for blood transfusion? Always refer to your agency policy for guidelines for preparing, initiating, and monitoring blood and blood product transfusions. <> /Lang (en-US) A blood transfusion also can help if an illness prevents your body from making blood or some of your . This effect usually isnt a concern unless a person gets a large amount of normal saline solution. There is no physiologic rationale for its use as a resuscitative fluid. Therefore, monitoring should focus on laboratory results and clinical evaluation (see Monitoring section). Christine Kessler; Priming Blood Transfusion Tubing: A Critical Review of the Blood Transfusion Process. Schumann R, Zaimi I, Shebaclo K, Gupta A. J Cardiothorac Vasc Anesth. << For inpatient units, document the date and time the . Hypertonic solutions such as 3% saline solutions contain higher concentrations of solutesthan thosefound in human serum. [Updated 2022 Oct 16]. Its also sometimes called Ringers lactate or sodium lactate solution. Identify the mechanism of action of crystalloid fluids. This article reviews all you need to. By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. If the fluid still wont drip, call ______________________________. Make a donation. 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. "Normal" saline is a hypertonic, acidotic fluid. Identify the indications for the various concentrations of normal saline. . (2016). Clinicians, including nurses, must recognize the indications on when to implement this IV solution and when there is a potential for untoward side effects from over-hydration. The saline priming of blood transfusion tubing is one such nursing practice that has long been guided by tradition. After completing an assessment, the nurse learns that the patient has a . Contraindications for the use of normal saline are evaluated clinically from patient to patient. The .gov means its official. /Type /Catalog allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 Therefore, the use of normal saline in critically ill patients is being re-investigated. Design and methods: << Blood bank guidelines should be revised to allow the use of LR in the rapid transfusion of PRBC. Bethesda, MD 20894, Web Policies [10]Although additional prospective studies are still needed. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. Subsequent volume dosing shoulddepend on the severityofhypovolemia and should be adjusted in increments of 500 mL, aiming for an ultimate central venous pressure of 8to 12 mmHg. Thus nursing reporting to the clinical team unexpected findings is paramount. Transfus Apher Sci. Volume expansion with crystalloid fluids may cause iatrogenic fluid overload. The osmolarity is 154 mOsmol/liter and a pH range similar to the 0.9% concentration.[1][2]. % 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. Specifically, one must observe any changes in electrolyte concentrations, volume status, and acid-base disturbances. 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. 2 Specific blood administration tubing is required for all blood transfusions. Healthline Media does not provide medical advice, diagnosis, or treatment. We avoid using tertiary references. Some conditions require more than one blood transfusion. It should not be used for heart failure , pulmonary edema, and renal impairment, or conditions that cause sodium retention as it may risk fluid volume overload. Intravenous Fluid Resuscitation - Critical Care Medicine - Merck Additionally, water plays an equally important role. National Heart, Lung, and Blood Institute. Rowell SE, Fair KA, Barbosa RR, Watters JM, Bulger EM, Holcomb JB, Cohen MJ, Rahbar MH, Fox EE, Schreiber MA. Crystalloid fluidsare the first choice for fluid resuscitationin thepresence of hypovolemia, hemorrhage, sepsis, and dehydration. [1]However, revised guidelines in 2018 have called into question the efficacy ofEGDT. [2]Since this time,their initial formula has been modified to provide clinicians with guidelines for administering maintenance crystalloid fluids. Why normal saline is used in blood transfusion - knowledgeburrow.com Q: Should blood tubing be primed with or without normal saline before administration of blood products? Why is normal saline used for blood transfusions? Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Intravenous fluids arecommonly administered during resuscitation. ), which permits others to distribute the work, provided that the article is not altered or used commercially. The blood typically comes from donors. Blood bank recommendations specify that Ringer's lactate solution (LR) should be avoided while transfusing blood. There are many potential problems related to saline.