BLOOD TRANSFUSIONS

BLOOD TRANSFUSIONS Nursing Procedures and Policies

BEFORE THE TRANSFUSIONRemember to… • Identifyyour patient • Assess patient’s history with transfusions and previous reactions • Note concurrent health problems • Obtain medical order for pretransfusion medication if necessary • Check that the patient’s blood has been typed and cross-matched • Check the ABO group and Rh type compatibility

BEFORE THE TRANSFUSIONRemember to… • Begin IV line with normal saline • Review the signs and symptoms of a transfusion reaction with the patient • Advise patient to report any chills, itching, hives, swelling, rash, shortness of breath, fever, low back pain, nausea, or anything unusual • Use blood within 30 minutes after its arrival from the blood bank • Establish a baseline • Obtain vital signs • Auscultate lungs • Assess for JVD

BEFORE THE TRANSFUSION • 2 nurses must verify the following with the medical record, patient ID band, and the blood product label: • Medical order for blood transfusion • Informed consent • Patient identification number • Patient name • Blood group and type • Expiration date • Inspection of blood product for clots or unusual color

FIRST 15 MINUTES OF TRANSFUSION • Begin running the transfusion slowly • 10 gtts/min • Stay with patient • Observe patient for adverse effects • i.e. flushing, dyspnea, itching, hives, rash, or any unusual comments • At the end of15 minutes, reassess vital signs

AFTER THE FIRST 15 MINUTES OF TRANSFUSIONIf no adverse effects occur… • Increase the flow rate as ordered • Assess frequently for any signs of adverse reaction • i.e. restlessness, hives, nausea, vomiting, torso or back pain, shortness of breath, flushing, hematuria, fever, chills, etc. • Infuse blood within 4 hours after its arrival from the blood bank to prevent risk for bacterial contamination • Monitor vital signs at regular intervals

IF YOU SUSPECT A REACTION... • STOP blood transfusion • Quickly replace the blood tubing with new IV tubing primed with normal saline • Slowly administer normal saline for IV infusion at 40 mL/hour • Carefully assess the patient • Obtain vital signs and compare with baseline • Assess respiratory status • Assess for changes in mental status • Make note of adverse reactions • Notify MD and blood bank

TRANSFUSION REACTIONS • Allergic reactions are the most common type of transfusion reaction

TRANSFUSION REACTIONS

AFTER THE TRANSFUSION • Obtain vital signs • Dispose properly of used materials • Document: • Blood transfusion • Type of blood product • Patient’s reaction throughout transfusion • Vital signs • Lungs sounds • Patient’s subjective response • Complications • Transfusion volume

References Blood transfusion bag [Online image]. (2009). Retrieved from http://americaninvetors.blogspot.com/ 2009/02/blood-transfusion.html Blood transfusions [Online image]. Retrieved from http://magazine.nursing.jhu.edu/2012/05/blood- transfusion IV normal saline [Online image]. Retrieved October 20, 2013 from http://www.keyhostnet.com/ safetynett5/index.php?route=product/product&product_id=153 Nurses at the heart of transfusion safety [Online image]. (2011). Retrieved from http:// thebloodytruth.com/nursing-the-art-and-science-of-safe-transfusion Redding, D. J. (2006). 060427-M-0000C-001 [Online image]. Retrieved October 20, 2013 from http:// www.1stmlg.marines.mil/Photos/tabid/8621/igphoto/252242/Default.aspx Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth’sTextbook of Medical-Surgical Nursing (12th ed., pp. 967-972). China: Wolters Kluwer Health. Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of Nursing (7thed., pp. 1458-1460, 1482-1485). Philadelphia, PA: Wolters Kluwer Health. [Untitled image of blood bag and patient]. Retrieved from http://www.daviddarling.info/ encyclopedia/B/blood_transfusion.html [Untitled image of sharps container]. Retrieved October 20, 2013 from https:// www.armstrongmedical.com/index.cfm/go/product.detail/sec/1/ssec/8/cat/5/scat/ 14/fam/2305

BLOOD TRANSFUSIONS