An gauge needle is standard, but a needle or catheter as small as gauge can be used for transfusion if necessary. The smaller the gauge, the slower is the flow rate and the higher is the risk of clotting. Care must be taken to avoid excessive pressure and resulting hemolysis when very narrow devices are used.
Diluting red cells with saline or asking the Transfusion Service to split a unit and giving only half at a time may help if the flow rate is too slow. Special bedside filters may be provided by the Transfusion Service when pre-storage leukocyte-reduced red cells or platelets are not available.
Red cell and platelet filters do not use the same technology for leukocyte removal and are not interchangeable. Some are designed to attach to standard infusion sets; others come with a set already attached. Most leukocyte-removing filters are designed for gravity drip use and have special priming requirements, so it is essential to check the manufacturer's directions before use. Mechanical pumps may be useful for controlling the very slow infusion rates required by neonatal and pediatric patients, but care is needed to avoid hemolysis.
Only pumps specifically approved for blood transfusion should be used. Some pumps can be used with standard infusion sets; others require special software. Pressure Bags Pressure bags are needed only in emergency situations when blood must be transfused rapidly, such as 5 minutes per unit. The bag should be inflated only until blood flow through the drip chamber is continuous, about mm Hg. Pressure approaching mm Hg may cause the red cells to Iyse and the blood bag seams to split.
Blood warmers are used to prevent cardiac arrhythmia associated with the rapid infusion of large volumes of cold blood. Specific indications include:. Blood should not be warmed to a temperature that causes hemolysis. Only temperature-controlled and monitored in-line devices are acceptable for use, and some require special software. The blood warmer must have a visible thermometer and, ideally, an audible alarm.
The warmer should be set up according to the manufacturers' directions and its temperature checked periodically during use. Isotonic electrolyte solutions that do not contain calcium may mix with blood if the FDA approves the solution for such use or if there is adequate documentation of safety. Some solutions should not contact blood in the bag or tubing.
Solutions containing glucose e. Ringer's Lactate may cause blood to clot. Infusion Rates Packed red blood cells can be diluted with 0. Adsol units usually do not require further dilution, because they have already been diluted by the addition of preservative. The transfusion of blood or blood products see Figure 8. The primary indication for a red blood cell RBC transfusion is to improve the oxygen-carrying capacity of the blood Canadian Blood Services, A health care provider order is required for the transfusion of blood or blood products.
RBC transfusions are indicated in patients with anemia who have evidence of impaired oxygen delivery. For example, individuals with acute blood loss, chronic anemia and cardiopulmonary compromise, or disease or medication effects associated with bone marrow suppression may be candidates for RBC transfusion. In patients with acute blood loss, volume replacement is often more critical than the composition of the replacing fluids Canadian Blood Services, Transfusions can restore blood volume, restore oxygen-carrying capacity of blood with red blood cells, and provide platelets and clotting factors.
The most common type of blood transfusion is blood that is donated by another person allogeneic. Transfusion therapy is considered safe, and stringent precautions are followed in the collection, processing, and administration of blood and blood components.
However, transfusions still carry risks such as incompatibility, human error, and disease transmission, and blood transfusion must be taken seriously at all times. Incompatibility can be decreased by using irradiated red blood cells or leukocyte-reduced blood.
The majority of blood transfusion complications are a result of human error Perry et al. Compatibility testing is vital for all recipients of blood or blood products. For more information on these, refer to the online resources at the end of this chapter. It is vital to understand what types of blood groups are compatible for transfusions Canadian Blood Services, Some groups of individuals, mainly Jehovah Witnesses, will refuse blood transfusions or blood products based on religious beliefs.
These individuals will refuse transfusion of whole blood and primary blood components but may accept transfusion of derivatives of primary blood components such as albumins solutions, clotting factors and immunoglobulins. Always assess each individual preference to establish if a blood component is an acceptable treatment to manage their illness or condition Canadian Blood Services, When managing blood transfusions, it is important to prevent complications from occurring and to identify issues promptly to manage reactions effectively.
Transfusion reactions mild to life-threatening may occur despite all safety measures taken. It is imperative to know what signs and symptoms to look for, and to educate your patient on what to report and when to report potential transfusion reactions. Mild to severe reactions may include Canadian Blood Services, :. For more information on types of reactions, signs and symptoms, and treatments, review the article adverse events related to blood transfusions , or see the online resources at the end of this chapter.
If patient has a blood transfusion reaction, always follow agency policy to manage mild to severe blood reactions. In general, if a reaction occurs, follow the steps outlined in Checklist In preparation for a blood or blood product transfusion Alberta Health Services, a, b; Perry et al.
These steps must be completed before obtaining the blood or blood product from the blood bank. Consent is required for the transfusion of blood and blood components and products. All blood products must have a consent form signed prior to the transfusion. Consent is mandatory for all blood and blood product transfusions.
Follow agency policy if patient is unable to sign or consent to blood or blood product transfusions. Know the indications for the transfusion. Know why the patient is receiving the transfusion. Pretransfusion vital signs are a mandatory component of blood administration. Checklist 75 provides steps to administering blood and blood products safely in the acute care setting. Transfusion set must be Luer-locked to a 2. Compare the transfusion medical services TMS documentation with the patient record to verify:.
Must be completed by two trained staff members competent in blood transfusion administration process as set out by the agency. If there are any discrepancies, stop the process and contact the TMS for resolution and direction. Do not proceed. Only after recipient identification and product check is confirmed, invert product 5 to 10 times and insert spike of the blood administration set into the blood product container.
All verification numbers must match exactly. All identifying information attached to the blood bag must remain attached at least until completion of transfusion. Perform hand hygiene. Prime the blood product administration set:.
Some agencies use an EID to administer blood transfusions. Always check agency policy prior to transfusion. Most transfusion reactions occur within first 15 minutes of a transfusion. Infusing small amounts of blood component initially minimizes volume of blood to which patient is exposed, thereby minimizing severity of reaction. Skip to content Chapter 8. Intravenous Therapy. How many units of blood can be transfused through one blood administration set?
What are the steps to managing a blood transfusion reaction? Previous: 8. Next: 8. Share This Book Share on Twitter. Disclaimer: Always review and follow your hospital policy regarding this specific skill.
If a reaction is mild e. Most other transfusion reactions require the transfusion to be stopped immediately. A blood transfusion reaction may occur 24 to 48 hours post-transfusion. Each separate unit presents a potential for an adverse reaction. Follow emergency transfusion guidelines when dealing with an emergency blood or blood product transfusion. Be aware of which types of blood or blood products cause the most types of transfusion reactions.
Be aware of the types of patients at high risk for blood or blood product transfusion reactions. Always have emergency equipment and medications available during a transfusion. For example, epinephrine IV should always be readily available. Additional Information. The severity of a blood transfusion reaction is related to the amount of product infused and the amount of time it has been infusing. Keep IV line open with 0.
Keeps IV site patent for emergency medications if required. Complete cardiovascular and vital signs assessment. Assessment monitors the type and severity of reaction. In addition to assessment: Maintain good urinary output. Avoid fluid overload.
Manage DIC disseminated intravascular coagulation or hemorrhage if clinically indicated. Provide supportive measures as required oxygen, etc. Contact physician for medical assessment and to inform about reaction. The physician responsible for the patient must be informed of all transfusion reactions. Check vital signs every 15 minutes until stable.
Vital signs must be monitored to identify improving or worsening condition. Obtain blood and urine samples as soon as possible. Blood and urine samples can help identify the type of blood transfusion reaction. Clerical errors account for the majority of blood transfusion reactions.
Keep all blood and IV tubing for further testing by the blood bank for verification of blood product and patient identification. These professional bodies are responsible for reporting and recording incidents of reactions.
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