Blood Transfusion Procedures and Reactions

Purpose: Assessing lab values is crucial in determining the need for blood transfusions.

Verify the Order
- Must have a physician's order before proceeding with the transfusion.
Obtain Patient Consent
- Ensure written consent is acquired from the patient before transfusion.
Assess Patient's Condition
- Check vital signs, urine output, skin color, and any history of transfusion reactions.
Obtain Venous Access
- Utilize a central line or at least a 20-gauge needle to ensure adequate flow and prevent occlusion.
Obtain Blood Products
- Fetch the ordered blood products from the blood bank.
Verify Blood Products
- With another registered nurse, verify patient’s identity by:
  - Name
  - ID number
  - Check blood compatibility
  - Note the expiration time of the blood products.
Transfusion Timing
- Transfuse as soon as possible after initiating safety checks; blood must be hung within 30 minutes of retrieval from the blood bank, or it must be returned to refrigeration.

Determine Client's Allergies
- Important to know any allergies that may affect transfusion.
Check Crossmatch
- Review any previous transfusion reactions using blood records.
Infusion Timing
- Blood must be administered within 30 minutes of receiving it from the blood bank.
Medication Policy
- Never add any medications to blood products.

Verify Client's ID
- Confirm the identity of the patient.
Doctor's Order
- Check physician's order for the transfusion.
Blood Bag Labeling & Records
- Cross-check labels on the blood bag and blood bank transfusion record.
Baseline Vital Signs
- Record baseline vitals and monitor as per facility policy.
Equipment
- Use a #18G or #20G gauge needle for venous access.
- Administer normal saline IV solution concurrently.
- Ensure a blood administration set with a filter is available.
Potential Reactions Monitoring
- Severe transfusion reactions typically occur within the first 15 minutes, especially during the first 50cc of infusion.
Blood Tubing Maintenance
- Change blood tubing after 4 hours of use.

Supplies Required
- Utilize 0.9% normal saline; no other fluids should be administered as hemolysis can occur.
- Ensure IV tubing is primed with normal saline only, not blood.
- Blood administration must occur using Y-tubing with a filter to catch aggregates and contaminants.
- Medications may never be added to blood products.
Initial Checks
- Record initial vital signs and temperature prior to starting the transfusion.
Time Frame for Transfusion
- A blood product must be transfused within 4 hours after removal from refrigeration.
Verification Steps
- Double-check the following with another RN:
  - Patient’s name
  - Blood bank ID number
  - ABO and Rh compatibility
  - Unit number
  - Expiration date of blood product.

IV Access and Observation
- Initiate a large bore IV access with an 18G or 20G needle.
- Assess for any history of previous blood transfusion reactions.
Blood Products Inspection
- Upon obtaining blood products from the bank, check for:
  - Cloudiness
  - Discoloration
  - Excessive bubbles.
Handling Blood Bags
- Do not puncture the blood bag; the spike is sharp and designed for ease of access.
Patient Monitoring
- Remain with the patient for the first 15-30 minutes to monitor for hemolytic reactions, which most frequently occur within the initial 50 mL of the infusion.
- Monitor vital signs closely, as any changes may indicate a transfusion reaction.

Fluid Administration
- Infuse blood product at a prescribed rate; rapid infusion can lead to fluid overload, a serious complication.

Discontinue Infusion
- Once the transfusion is complete, discontinue the infusion, place the blood bag in a plastic bag, and send it to the blood bank along with a carbon copy of the transfusion record.
Documentation Requirements
- Accurately document the following:
  - Type of product infused
  - Product number
  - Volume infused
  - Time of infusion
  - Any adverse reactions noted during the transfusion.
Fluid Output Record
- Document the amount of blood (in cc) in the Intake & Output (I&O) records.

Normal saline is essential for priming during blood transfusions.
Avoid priming with blood to ensure no loss of blood product.
Infuse one unit of blood at a time for safety.
Special considerations for geriatric patients may include administering only half a unit at a time to prevent hypervolemia.
Utilize specialized Y-tubing for administering blood.
Acute hemolytic reactions are considered the most severe type of transfusion reaction.

Management of Shock
- Initiate treatment for shock if symptoms present.
Blood Sample Collection
- Draw blood samples for further testing.
Vital Signs Maintenance
- Maintain blood pressure and prepare to administer IV colloid solutions if necessary.
Accurate I&O Record
- Document intake and output accurately during the reaction.
Additional Blood Transfusion
- Do not transfuse additional blood or blood products until new cross-matched units are provided by the blood bank.
Administration of Medications
- Administer antipyretics as prescribed to manage symptoms.
Transfusion Restriction
- Do not restart any transfusion until a physician's order has been received.
Immediate Actions for Acute Reactions
- If acute reactions occur:
  - Stop the transfusion immediately.
  - Maintain IV access with normal saline only.
  - Notify the blood bank and physician without delay.
  - Recheck identity tags and numbers of the blood product.
  - Monitor vital signs and urine output vigilantly.
  - Treat symptoms as directed by the physician.
  - Save the blood bag and the tubing; send them back to the blood bank for investigation.
  - Complete required transfusion reaction reports and document the events in the patient's medical chart.