Maintain IV patency during a blood transfusion by infusing 0.9% saline at the KVO rate after the first two units.

A simple IV line can sound boring, but in the middle of a blood transfusion it’s the difference between a smooth process and delays or trouble. When a patient is receiving multiple units of packed red blood cells, keeping that IV access clear and ready is a priority. Let me explain how a nurse can keep things flowing—safely and efficiently—during three PRBC units given over eight hours.

Why patency matters during a transfusion

A blood transfusion is time-sensitive work. The line needs to stay open so each unit can be delivered promptly and without interruption. If a line starts to clot or slow down, you’re faced with delays, potential reactions, and added stress for the patient. Patency isn’t a fancy extra; it’s a practical safeguard that ensures every drop of care reaches the patient.

The right move after the first two units

After each of the first two units has infused, the recommended action is simple and effective: infuse 0.9% normal saline at the keep vein open (KVO) rate. Here’s what that means in plain terms:

• 0.9% saline is used to flush and protect the line without altering the blood product. It’s compatible with all IV tubing and blood products.

• KVO stands for “Keep Vein Open.” It’s a tiny, controlled flow—usually a very slow rate on the IV pump—just enough to prevent clots and keep the pathway clear.

• Doing this between units helps ensure the line remains patent so you can start the next unit right away, minimizing delays and reducing the risk of needing an extra IV line.

Why this beats the other options

If you look at the alternatives, you can see why they aren’t the best fit for this situation:

• Changing the IV line after each unit (Option B) sounds like it would keep things clean, but it adds unnecessary disruption. Each line change carries a risk of infection, air introduction, or contamination, and it wastes time that could be spent delivering care.

• Flushing with heparin (Option C) isn’t typically recommended during blood transfusions. Heparin can interfere with the blood product and isn’t required for patency in this context.

• Using a blood transfusion filter just to maintain patency (Option D) is important for safety—filters catch debris and help reduce reactions—but they don’t replace the need to keep the line open between units.

In short, the best move is the quiet, dependable one: saline at a KVO rate to maintain patency.

A practical, friendly game plan for real-world care

If you’re managing a transfusion like this in a clinical setting, here’s a straightforward approach you can use (and adapt as you gain experience):

• Verify the patient’s IV access type and site. Make sure the line is patent, well-secured, and without signs of infiltration.

• Attach the first blood unit to the primary IV line using the correct blood administration tubing and a blood filter as per hospital protocol.

• Start the unit as prescribed, and monitor for any transfusion reactions: fever, chills, itching, shortness of breath, or changes in vital signs.

• When the first unit finishes, pause briefly, then flush the line with 0.9% saline at the KVO rate before starting the second unit. This keeps the line clear and ready.

• Repeat the process after the second unit: saline at the KVO rate to maintain patency as you prepare for the third unit.

• After the third unit, discontinue the blood product line following protocol, then flush the line with saline at a maintenance rate if further IV therapy is planned.

• Throughout the process, document the infusion times, volumes, and any patient responses. Clear notes help the whole team stay aligned and ready for anything.

A quick mental checklist you can reuse

• Is the IV line patent and secure?

• Is the saline infusion set to a KVO rate between units?

• Are the blood products connected with the correct tubing and filter?

• Are vitals monitored and any reactions watched for?

• Is documentation up to date?

A few tangential notes you’ll appreciate

• The KVO rate isn’t a one-size-fits-all number. It’s a minimal flow designed to prevent clotting and keep the pathway available. In most hospitals, it’s a very small continuous rate—long enough to preserve patency, short enough not to flood the line with fluids.

• The use of saline between units also helps maintain a consistent infusion rate. This can be particularly important if a patient is also receiving other IV medications or fluids.

• If a line clogs or loses patency despite saline, it’s appropriate to reassess the access. Sometimes a new IV may be needed, but that decision should come from the clinical team based on the patient’s condition and the line’s status.

• The safety line isn’t just about the infusion. It’s about being prepared for anything that might come up during transfusion—new symptoms, a rapid change in blood pressure, or a late-arriving reaction.

A touch of human experience

Nursing isn’t only about following rules; it’s about steady hands and calm minds when things shift. When a patient needs three units in eight hours, the small step of a gentle saline flush between units can remove a potential hurdle. It’s the kind of detail that shows up in patient stories later—not as a lecture on protocol, but as a moment of consistent care that helped keep them comfortable and safe.

Bringing it back to the safety video you’ll see

If you’ve watched the ATI Safety segment that covers these scenarios, you’ll recognize the emphasis: maintain line patency, minimize interruptions, and stay vigilant for reactions. The message isn’t about techy trivia; it’s about practical, patient-centered care. The saline-KVO approach after the first two units is a clear, careful choice that supports timely transfusion while protecting the patient’s wellbeing.

Final thoughts

During a transfusion of multiple units, the easiest, most reliable way to keep things moving is to use 0.9% saline at the KVO rate after each of the first two units. It’s simple, it’s effective, and it reduces unnecessary complications. The goal isn’t to complicate the process but to keep the path clear so every unit can be delivered exactly as intended.

If you’re exploring real-world nursing scenarios, this approach offers a solid baseline. It blends the science—saline compatibility, patency, and reaction monitoring—with the everyday human touch that makes patient care feel intentional and competent. And that blend—that calm, practical confidence—is what good nursing is all about.