blood transfusion

4. Facts……………..
• About 40 percent of the population has type O blood. People who
have O’ blood type are called universal donors.
• Type O blood is used for emergencies when there's no
time to test a person's blood type.
• People who have type AB blood are called universal recipients. This
means they can get any type of blood.
• If you have Rh-positive blood, you can get Rh-positive or Rh-
negative blood.
• But if you have Rh-negative blood, you should only get Rh-negative
blood.
• Rh-negative blood is used for emergencies when there's
no time to test a person's Rh type.

5. Ordering : of Blood and Blood Products:
• By a physician and written in patient's medical record.
• Shall be requested in a special Blood Transfusion Form.
• Request form shall contain the patient's identification details (full
name, gender, age, nationality and medical record number).
• Ordering physician should specify:
• Urgency of the transfusion, including date and time of
transfusion.
• The blood or blood component to be administered.
• The quantity to be given.
• Reason for transfusion.

6. Pre-Transfusion Samples Collection:
• Extreme caution !!! in identifying patients and ensuring that the
pre-transfusion samples are collected from the correct patient.
Sample collection and labeling (for cross-matching):
• Use plain tube (Red + EDTA tube )for sample collection
• Confirm patient's identity by patient's name and patient's medical record
number.
• Two (2) staff shall verify the patient's identity prior to blood drawing.
• Following the collection of blood and before leaving the patient/the tubes
containing sample shall be legibly labeled with:
• Patient's full name, medical record number (if not a second identifier)
• Date , time of collection and name of SN and signature
Venous Access : Blood and Blood products may be administered through:
• Peripheral cannula:
• Gauge 18-20 is recommended for adults.
• Gauge 22-24 for pediatrics
• Central Venous Access

7. • Use a standard blood transfusion set (filter membrane
of 170-200 micron filter).
• When blood is administered by a syringe to infants or
neonates, the blood shall be drawn into the syringe via
standard membrane filter set.
• prime the set only with normal saline or blood
component.
• Change the set on completion of the RBC transfusion.
• Administration set used for Red cells should never be
subsequently used for platelet transfusion.
• Blood transfusion set shall not be "piggy backed"
into other lines.

8. Concurrent Fluids and Medications:
 0.9% Normal Saline only
Incompatible Fluids:
• Electrolyte and colloid solutions containing calcium
• 5% Dextrose in water or hypotonic sodium solutions
Medication shall not be added to any blood component !!
• If drug need to be administered via same IV line, the
transfusion shall be stopped and the line flushed with
normal saline and flush the line again after administration of
the drug.

9. • Informed Consent must be signed by patient
or relative before the start of blood
transfusion.
Collection and handling of Blood bag ??
- Shall be collected by a nurse
- Nursing Supervisor should be contacted to
collect or arrange for collection of blood
from the blood bank, by a registered nurse in
case he/she is not available.
- shall be transported only with the use of
blood box.
- shall bring with him/her the patient's file if
needed for the collection of blood in blood
bank.
- The patient identification details in the
patient's file shall be verified against data on
the collection slip.

10. Identify Blood or blood product unit by checking,
• The details of the blood transfusion report form.
• The details on the compatibility/patient label
attached to the component.
• The expiration date.
What to Inspect blood and components:
• The integrity of the pack.
• Evidence of hemolysis in the plasma.
• Evidence of unusual discoloration or turbidity.
• Presence large clots, gas bubble, and extraneous
material. If there is evidence of any of the
above, the component should not be received.
• After confirming , by both staff the nurse shall
sign in the blood collection slip including the
time and date.

11.  Before starting a transfusion:
Check the product (bedside ) by a
physician and two (2) RN against request
form and the identification details of the
patient.
What to check :
# Patient's full name,
# MR no. and
# Ask patient to state his name if
conscious and well oriented.
Check compatibility tag attached to
the blood bag :
* ABO Group
* Rhesus Factor
* Unit Number
* Expiry date
If any discrepancy is noted between
information DO NOT HANG AND
ADMINISTER THE BLOOD
What If blood product is not
transfused immediately ?
 They should be sent back to the
blood bank within 30 min from
time of issue.
 Blood and blood products should
not be kept in the ward
refrigerator.
Platelet concentrates should not
be kept refrigerated
• Should keep at room temperature
between 20 oC to 25 oC with
continuous agitation.
• Must be administered rapidly
(20-30 minutes) as soon as
they are available.
• Blood and blood products should be
transfused within half an hour after
collection from blood bank.

12. Hot water, microwave, or electronic infusion
pump
Assessment of Patient:
• Baseline vital signs; circulatory and respiratory
status of patients. And Skin status (e.g. rash)
• Baseline laboratory studies, such as CBC, type cross
– match and coagulation profile ( PT,PTT<INR).
• Any history of blood transfusions and reactions
(including type of reaction, treatment, and patient's
response to treatment) if any.
• Compatibility of patient to blood (by matching
blood sheet to patient's name bracelet).

13. Product
Pore Size/Type Filter
Tubing and Filter
Change Schedule
Usual Length of Transfusion
Whole Blood Standard blood
administration tubing
1 units / 4 hours 2-4 hours (must be infused within
4 hours of leaving Blood Bank).
Packed Red
Blood Cells
(PRBC)
Standard blood
administration tubing
1 units / 4 hours
“
Platelets Standard blood
administration tubing
1 unit 30-40 minutes (must be infused
within 4 hours of pooling).
Platelets
Apheresis
Standard blood
administration tubing
1 unit
30 minutes (must be infused
within 4 hours of leaving Blood
Bank).
Fresh Frozen
Plasma (FFP)
Standard blood
administration tubing
1 unit
30 minutes (must be infused
within 4 hours of leaving Blood
Bank).
Cryoprecipitate Standard blood
administration tubing
1 unit 30 minutes (must be infused
within 4 hours of pooling).

14. How often will you monitor Vital signs
Remain with patient 1st 15 min for close
observation.
• - Check V/S every 5min for the first 15 min.
• - Then every 15 min for 1hr, then
• - every 30 min for 4 hrs, then
• - 4hrly post transfusion.
Closely observation for :
 Fever with or without chills,
 Headaches,
 Nausea/vomiting,
 Skin rash,
 Change in color of urine (concentrated or red color)
Check vital signs independently for each unit of blood product

16. Transfusion reaction
Type of
Reaction
Cause Symptoms Nursing considerations
Allergic
reaction
Hypersensitivi
ty
Hypersensitivity to
antibiotics in
donor’s blood
Urticaria, pruritus,
fever, anaphylactic
shock
Stop blood , restart
0.9%NaCl, notify
physician , supportive
care; benadryl, oxygen
Hemolytic
reaction
Incompatibility Nausea, Vomiting
,pain in lower back,
hypotension,
tachycardia,decreased
U/O, Hematuria
Stop blood , supportive
care; benadryl, oxygen,
airway management.
notify physician
Febrile
reaction
Antibodies to
donor platelets, or
leukocytes
Febrile, chills, nausea,
headache,tachycardia,
palpitations
Stop transfusion & notify
physician.
Bacterial
reaction
Contaminated
blood products
Tachycardia,
hypotension, fever,
chills,shock
Stop blood ,Obtain blood
culture, Antibiotics
IV fluids Notify
physician

17. Transfusion
reaction :
Step by step
management
Stop blood
component
transfusion
immediately
Keep cannula in
place &
Change the
administration set.
Maintain IV access
with 0.9 % Sodium
chloride.
Inform The
physician in
charge or on call
& administer
medication if
ordered
Nursing
Supervisor is to be
informed
Fill-up a Blood
transfusion
Reaction Form ,
release form and
submit to Blood
Bank.
The blood bag with complete
transfusion set, Blood sample
in red tube , EDTA Tube and
Urine sample should be sent
to the blood bank.
Write an OVR and submit
it to Nurse Supervisor

18. Documentation of Transfusion
• Complete documentation in Nurses notes.
• Purpose of the transfusion, procedure, symptoms of an
adverse reaction.
• Transfusion Procedure:
• Complete "infusion record" (product label) and place in the patient
record.
• Document volume infused and vital signs in Intake and Output
Sheet.
• Documentation of administration, including the beginning and ending
times of transfusion, patient education, all patient monitoring data
(vital signs, etc.) and patient response to transfusion.
• If any reaction developed, fill up Transfusion Reaction Form
and complete OVR

19. Last Slide
It’s Over