Title: Immersive Quest Blood Transfusion for nursing

Goal: The purpose of this training is to provide a virtual practice environment for nursing students on
how to properly administer packed red blood cells (PRBC) product to a patient.

Objective: By the end of this practice participant will be able to:

1. Choose the correct order for PRBC administration

2. Select the appropriate equipment needed for PRBC administration
3. Perform a two-nurse verification process for PRBC administration
4. Examine patient and supplies for PRBC administration
5. Recognize nurse role during and after PRBC infusion

Evidence Based Protocol: Blood Transfusion - StatPearls - NCBI Bookshelf (nih.gov)

Additional Resource: Blood transfusion | NHS inform

YouTube: (5) Blood Transfusion - Clinical Nursing Skills | @LevelUpRN - YouTube

Have participant to click on the correct order. The process has to be done in order. If the wrong order is
selected it is noted and another chance is given until the participant chooses the correct step. When
correct step is chosen, they are given access to complete steps in that portion. When steps are
complete participant must select next process in correct order and so on and so forth.

5. Prepare
4. Obtain 6. Infuse 7. Complete
1. Check 2. Gather 3. Two Nurse and Connect
Baseline Blood Per and
Order Equipment Verification Blood and
Vitals Protocol Document
Tubing

_____________________________________________________________________________________

1. Check
Order

Jessica Minor has been diagnosed with anemia and has an order to receive 1 unit of packed red blood
cells. As the nurse you have identified and educated your patient. The patient has signed a consent form
and you have verified the document. Patient has no known drug allergies and has been typed and
crossed matched according to doctor’s orders and facility procedures. You have checked the IV site for
patency and noted the documentation of a 16-gauge needle which was inserted on the previous shift.
Patient has been typed and cross matched for 0-
Reminder: Perform hand hygiene before patient contact and perform hand hygiene and put on gloves
when preparing blood product and tubing for connection to IV port.

**Question box in pink. Activity box in green.

What blood type can the patient receive?

1. A+
2. B+
3. AB-
4. 0-

2. Gather
Equipment

Have nurse select all supplies from the following list that should be in the room before obtaining blood
for transfusion. A box can show on screen to select needed supplies. As she selects supplies, these
materials can show up on bedside table. A box to select supplies can show:

What supplies does the nurse need to have available in the room?

Answer: 18 gauge or larger needle 16-20 placed for vein access

Y tubing with inline filter
500 ml bag of 0.9% NACL (Normal Saline)
Infusion pump
Blood pressure cuff
PRBC
Alcohol wipe
Wrong answer: 12-gauge needle access to patient
5% Dextrose

When should blood be started once retrieved from blood storage?

1. No more than 30 minutes after retrieval.

2. Anytime the nurse is able to get to the procedure.
3. Whenever the doctor tells her too.
4. Whenever she can find a second nurse to verify patient information.
 3. Two Nurse
Verification

*In this section you show a clip board with the patient information in a list as if the nurses are
verifying the information.

Two providers are needed to verify blood products and patient information at the bedside before
administration.

Have second nurse to read off patients: name, date of birth, and Dr’s order for blood type, ABO, Rh, unit
number, expiration date, and client identification numbers.

Have main nurse to check arm band for info read by first nurse and blood component for blood type,
ABO, Rh, unit number, expiration date, and client identification numbers.

4. Obtain
Baseline
Vitals

When should nurse obtain baseline vital signs for blood administration?

1. 5 minutes before
2. 1 hour before
3. Any time after transfusion begins
4. No baseline vitals are needed.

Have providing nurse obtain Baseline Vital Signs:

Blood pressure: 120/80

Pulse: 76
Temp: 99.4
Resp: 16
Pulse Ox: 97%
Lung sounds: Clear Bilateral
Urine output: Clear and Yellow
Skin Color: Normal, warm and dry to touch
 5. Prepare
and Connect
Blood and
Tubing

*See YouTube Video

Make sure clamps on Y tubing are closed. Connect 500ml bag of normal saline to Y tubing and prime the
line. (Run fluid slowly through line to remove air.) Priming can be done by hand or through infusion pump.
Hang bag to IV pole.

Connect blood product to second Y tube and prime the line with blood product. Hang bag from IV pole.

Clean IV port with alcohol swab and connect infusion tubing to IV port.

Infuse blood slowly (2-5 ml/minute) for the first 15 minutes.

6. Infuse
Blood Per
Protocol

The primary nurse must remain with the patient for the first 15 minutes.

True or False? Vital signs should be taken after first 15 minutes of transfusion, after 30 minutes of
transfusion, then every hour of transfusion, and at completion of transfusion.

True

This question can also be select all that apply.

What is the maximum time blood can be transfused?

1. 2 hours
2. 4 hours
3. 10 hours
4. 24 hours
 7. Complete
and
Document

When the transfusion is complete, close the clamp leading to the blood and open the clamp to the
Normal Saline bag allowing the line to flush.

Discard blood bag in proper biohazard waste container.

What must the nurse document when transfusion is complete?

Correct Items: blood type, unit, and mount of blood component administered, time infusion began and
ended, vital signs, how the client tolerated procedure, and reactions and interventions initiated, and
physician notification.

Incorrect Items: Pt name, Pt food intake, family members present in room