A client is to receive a transfusion of packed red blood cells (PRBCs). Which solution would the nurse use to prime the blood intravenous (IV) tubing?

• A. Lactated Ringer solution
• B. 5% dextrose and water
• C. 0.9% normal saline
• D. 0.45% normal saline

Answer: (C)

priming IV tubing for packed red blood cells requires an isotonic solution that preserves red cell integrity and does not interfere with the blood product’s citrate anticoagulant. 0.9% normal saline is isotonic to plasma and does not contain calcium, so it won’t reverse the citrate or cause osmotic stress to the red cells.

Lactated Ringer’s contains calcium, which can interact with the citrate anticoagulant in stored blood and promote clotting in the tubing or bag. Solutions with dextrose or hypotonic solutions can cause red blood cell hemolysis or unsafe osmotic shifts, so they’re not appropriate for priming blood products.

Thus, 0.9% normal saline is the correct choice for priming PRBCs.