components such as blood cells and plasma from one person (donor) to another person (recipient). • This involves two procedures – the collection of blood from the donor and the administration of blood to the recipient. Purposes • To restore the blood volume when there is sudden loss of blood due to haemorrhage. • To raise the haemoglobin level in cases of severe anaemia. • To treat deficiencies of plasma proteins, clotting factors and haemophilic globulin etc. Preparation of the articles A tray containing: • A blood transfusion set • Mackintosh with towel • Blood/ blood components with cover received from blood bank with the name of recipient • Alcohol swabs in a bowl • Disposable gloves. • Infusion stand (I.V stand) • Kidney tray Procedure • Check the doctor’s order, patient’s condition and history of transfusion/ transfusion reaction, reason for present transfusion, etc. • Check the availability of blood with blood bank and confirm blood has been typed and cross matched. • Identify patient. • Explain the procedure to the patient, need for transfusion, desired outcome, etc. Cont.., • Emphasize the need for patient to report unusual symptoms immediately. • Obtain informed consent from the patient. • Obtain blood from blood bank in accordance with agency policy. • If transfusion cannot begin immediately, return product to blood bank. • Blood out of refrigerator for more than 30 minutes, above 10⁰C cannot be reused. Cont.., • Never store blood in unauthorized area – like ward refrigerator since blood must be stored in refrigerated unit at carefully controlled temperature (4 ⁰C). • Encourage patient to empty bowel and bladder and assist to a comfortable position. • Ensure privacy. • Wash and dry hands. • Check vital signs and record. Cont..,
• Wear gloves.
• Insert I.V cannula (18G/ 19G) if not
already present in a large peripheral vein and initiate infusion of normal saline solution using blood transfusion set. Cont.., Inspect the blood product (by 2 nurses) for the following • Identification number • Blood group and type • Expiry date • Compatibility • Patient’s name • Abnormal colour, clots, excess air, etc. Cont.., • Warm blood if needed using special blood warmer or immerse partially in tepid water/ keep the blood at room temperature for 30 minutes. • If blood product found to be correct stop saline solution by closing roller clamp. • Remove insertion spike from saline container and insert spike into blood container. Cont.., • Start infusion of blood product slowly, at the rate of 25 to 30 ml per hour for the first 15 minutes. • Check the vital signs for every 15 minutes for first 30 minutes, or as per agency policy. • Increase infusion rate if no adverse reactions are noticed. The flow rate should be within the safe limits. Cont.., • Assess the condition of the patient every 30 minutes and if any adverse effect is observed stop transfusion and start saline. Send urine sample, blood sample and remaining blood product in container with transfusion set, back to the blood bank. • Complete transfusion and administer saline (as per doctor’s order) if no adverse reaction is observed. Cont.., • Dispose blood product container and set in appropriate receptacle. • Assist patient to comfortable position. • Wash hands. Record the following: • Product and volume transfused. • Blood group Rh type. • Time of administration and end time. • Name and signature of the nursing staff carrying out procedure and patient’s condition. Cont.., • If agency policy requires removal of label from blood bag and paste it on patient record. Special considerations: • Do not administer medication through the same line, where blood product is transfused. • Start another I.V line if medications are to be transfused, because of possible incompatibility and bacterial contamination. Cont.., • Blood transfusion should be completed over a period of 4 hours from the time of initiation. • Cover the blood bag with a towel when it hangs on the I.V pole. • Gently rotate the blood bag periodically to prevent clumping of cells. Cont..,
• Keep emergency drugs (e.g.
Antihistamines, Lasix, adrenaline, etc.) • When rewarming the blood by immersing in tap water, do not immerse the blood fully into the water as it may cause haemolysis. Nursing observation and management during blood transfusion S.I Reaction Signs and Nursing management No symptoms 1. Allergic • Hives, • Stop transfusion immediately reaction itching, and keep vein patent with anaphylaxis normal saline. • Notify physician fast. • Administer antihistamine parentally as necessary. 2. Febrile • Fever and • Stop transfusion immediately reaction: chills and keep vein patent with fever, • Headache normal saline. developing • Malaise • Notify physician. during • Treat symptoms. infusion Cont.., S.I Reaction Signs and Nursing management No symptoms 3. Haemolytic • Immediate • Stop transfusion transfusion: onset immediately & keep vein Incompatib • Facial patent with normal saline. ility of flushing • Notify physician stat. blood • Fever, chills • Obtain blood sample from product • Headache site. • Low- back • Obtain first voided urine. pain • Treat shock if present. • shock • Send remaining blood in bag, tubing and filter to lab. • Draw blood sample for serologic testing and send urine specimen to lab. Cont.., S.I Reactio Signs and Nursing N n symptoms management o 4. Circulator • Dyspnoea • Slow or stop y • Dry cough transfusion. overload • Pulmonary • Monitor vital signs. oedema • Notify physician . • Place patient in upright position with feet dependent. Cont.., S.I Reaction Signs and Nursing management No symptoms 5. Bacterial • Fever • Stop transfusion reaction: • Hypertension immediately. Bacteria • Dry, flushed • Notify physician. present in skin • Obtain culture of patient’s blood. • Abdominal blood and return blood in pain. bag to lab. • Monitor vital signs. • Administer antibiotics stat. Thank you all for listening