During a packed red blood cell transfusion, which action requires immediate intervention?

• A. Waiting 20 minutes after obtaining PRBCs before starting the infusion
• B. Priming the transfusion set with 5% dextrose in lactated Ringer's solution
• C. Starting an IV line with a 22-gauge catheter
• D. Telling the patient that PRBCs may cause a transfusion reaction

Answer: (B)

Priming a transfusion line with normal saline is essential for administering packed red blood cells. Blood products are stored with anticoagulants that can be disrupted by certain IV fluids. Using a dextrose-containing solution (5% dextrose in lactated Ringer’s) can damage the red cells or interfere with the stored product, increasing the risk of hemolysis or other transfusion complications. Therefore, this action requires immediate intervention so the line is flushed and primed with 0.9% saline before continuing.

The other choices are not immediate safety hazards: starting the transfusion with a 22-gauge line is generally acceptable for adults; delaying the start after obtaining PRBCs may affect product viability but isn’t an urgent safety issue; and informing the patient about possible transfusion reactions is appropriate education, not an urgent intervention.