University of Saint Anthony

(Dr. Santiago G. Ortega Memorial)

Iriga City

HEALTH CARE EDUCATION

PERFORMANCE CHECKLIST

ADMINISTERING A BLOOD TRANSFUSION.

Name: ________________________________Course/Year: ________ Score: _________

Clinical Instructor:________________________ Signature of Clinical Instructor:_________
Legend: 4 – Action is correct, complete and performed in
proper order and time
3 – Action is correct, complete, but not in order and
performed action slowly or very fast
2 – Action is incorrect or incomplete and performed
action very slowly or very fast
1 – Action is not performed but mentioned
0 – Did not perform the procedure

Grading: Knowledge – 35%

Skills – 35%
Attitude – 30%

PROCEDURE 4 3 2 1 COMMENTS
1. Determine whether patients knows for
transfusion. Ask if patient has hand had a
transfusing or transfusion reaction in the past.
2. Explain skill to patient. Make sure there is a
signed consent for transfusion, if required by
agency. Advise patient to report ant chills, itching
rash, or unusual symptoms.
3. Perform hand hygiene and put on clean gloves.
4. Hang container of 0.9% normal saline with
blood administration set to initiate IV infusion and
follow procedure for administration of blood.
5. Start IV with a no. 18 or 19 catheter. Keep IV
line by starting flow of normal saline.
6. Obtain blood product from blood bank as
required by agency:
7. Complete identification and checks as required
by agency.
A. Identification number

B. Blood group and type

 C. Expiration date
D. Patient’s name
E. Inspect blood for clots
8. Take baseline set of vital signs beginning
transfusion.
9. Start infusion of product.
A. Prime in-line filter with blood.
B. Start administration slowly (no more than
25-50 ml for the first 15 minutes). Stay with
patient for first 5 to 15 minutes of transaction.
C. Check vital sign at least every 15 minutes for
the first half hour after start of transfusion.
Follow the instruction’s recommendation for
vital sign during the remainder of the
transfusion.
D. Observe patient for flashing, dyspnea,
itching, hives, or rash.
E. Use a blood -warming device. If indicated,
especially with rapid transfusion through a
central venous catheter.
10. Maintain prescribed flow rate as ordered or as
deemed appropriate by the patients overall
condition, keeping in mind the outer limits for safe
administration. Assess frequently for transfusion
reaction. Stop blood transfusion and aloe saline to
flow if you suspect a reaction. Notify physician and
blood Bank.
11. When transfusion is complete, infuse 0.9%
normal saline.
12. Record administration of blood and patient’s
reaction as ordered by agency. Return Blood
transfusion bag to blood bank according to agency
policy.

___________________________ ______________________________

Student’s Signature CI’s Name and Signature