The correct answer is 3. Run normal saline at a keep-vein-open rate. This keeps the vein open while not introducing additional fluid or substances.

1. Administration of Blood Products
Edith O Perez
RN,BSN,MSN,FNPc

2. Type of Blood Components
 Packed red blood cells (RBCs)
 Evaluation of effective response determined by resolution of
anemia and increase in erythrocyte count
 250-350 ml within 4h
Whole Blood
 300-550 ml /hr within 4h
 Replace red cell mass and plasma volumen
 Expected to rise Hgh 1g/100ml and Hct by 3 %
 Platelets
 Evaluation of effective response determined by improvement in
platelet count, normally assessed 1 hour and 18 to 24 hours
after transfusion
 Maximum infusion time is 15-30 minutes.

3. . Type of Blood Components
HERI 305 640 8459
 Cryoprecipitates
 Evaluation of effective response determined by improvement in
clotting factors, particularly factor VIII and fibrinogen
 White blood cells (WBCs)
 Evaluation of effective response assessed by monitoring white
blood cell and differential counts
 Fresh frozen plasma
 Replace plasma without RBC, resolution of hypovolemia, pt
with bleeding problems, Management of bleeding or to prevent
bleeding prior to an urgent invasive procedure in patients
requiring replacement of multiple coagulation factors
 200-250ml
 Must go through blood giving set (has a filter).
 Infusion time is15- 30 minutes per bag.
 All units must be given within 4 hours of defrosting.

4. Types of Blood Donations
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 Autologous
 Donation of client’s own blood before scheduled procedure
72 h before the procedure
 Blood salvage
 Autologous donation that involves suctioning blood from
blood cavities, joint spaces, or other closed body sites
 Designated donor
 Donation of blood from recipient, who selects his or her own
compatible donors

5. Compatibility
HERI 305 640 8459
 Recipient blood samples drawn, labeled at bedside, dated,
timed; client states name for verification, compared with
identification band
 Recipient’s ABO type and Rh type identified
 Antibody screen done to determine presence of antibodies
other than anti-A and anti-B
 Crossmatching completed, found to be compatible if no RBC
agglutination occurs
 Universal RBC donor, O negative; universal recipient, AB
positive
 Clients with RH-positive blood can receive RBC transfusion
from an Rh-negative donor if necessary; however, an RH-
negative client should not receive Rh-positive blood

7. Infusion Pumps
HERI 305 640 8459
 These may be used to administer blood products if designed to
function with opaque solutions
 Always consult manufacturer guidelines for controller or pump
 Special manual pressure cuffs may be used to increase flow rate, but
pressure should not be higher than 300 mm Hg
 Standard sphygmomanometer cuffs not to be used to increase flow
rate

8. Blood Warmers
HERI 305 640 8459
 May be used to prevent hypothermia and adverse reactions when
several units of blood administered
 Only use devices tested for this purpose
 Do not warm blood products in microwave or hot water

9. Precautions and Nursing
Responsibilities
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– Blood must be administered as soon as possible after being received from
blood bank, within 15 minutes
– Check blood bag for date of expiration; inspect bag for leaks, abnormal
color, clots, bubbles
– Blood administration sets should be changed every 2-4 hours or
according to agency policy
– Blood should not be infused rapidly unless platelets, which may be
infused rapidly, with caution
– No medications should be added to blood bag or piggybacked into blood
transfusion
– Only normal saline should be infused or added to blood components
– Measure vital signs, lung sounds before and after 15 minutes of
transfusion, then every hour until completed
– Only two RNs may check blood bag against client’s blood identification
band

10. Complications
HERI 305 640 8459
• Transfusion reactions
 Types of transfusion reactions include:
 Febrile non hemolytic
 acute hemolytic
 delay hemolytic
 allergic
 febrile or bacterial reactions (septicemia),
 transfusion-associated graft-versus-host disease
(GVHD).

11. HERI 305 640 8459

12. Acute Hemolytic
HERI 305 640 8459
 Occur within 15 minutes of transfusion initiation
 Nauseas, vomiting, lower back pain, hypotension,
decreased urinary output, hematuria, increased
sensation heat, increased temperature
apprehension,bronchoespasm,DIC
 Interventions include:
 Stopping the transfusion
 Change tubing
 Keeping vein open with 0.9% normal saline
 Notifying health care provider and blood bank
 Monitoring client closely, preparing to administer
emergency medications (e.g., antihistamines,
vasopressors, corticosteroids)
 Sending urine specimen to laboratory
 Returning all blood tubing and bags to blood bank

13. Complications
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 Delay transfusion reaction:
 2 -14 days
 Monitor for signs of delayed reactions
(which may occur up to 1 year following
transfusion)
 these include fever, mild jaundice,
decreased hematocrit level

14. Febrile non Hemolytic
HERI 305 640 8459
 Fever > 1C above the baseline
 Flushing, chills
 Headache
 Muscle pain
 Stop the transfusion
 Administer antipyretics
 Monitor temperature every 4 h

15. Allergic Reaction
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 Local erythematic
 Hives
 Urticaria
 Itching
 Pruritus
 Severe allergic reaction: Coughing, respiratory
distress, wheezing, hypotension, LOC, possible
cardiac arrest
 Stop the Blood transfusion
 Notify MD
 Anthistaminic

16. Unconscious
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 Monitor for signs in unconscious client; these
include weak pulse, fever, tachycardia or
bradycardia, hypotension, visible
hemoglobinuria

17. Circulatory overload
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 Monitor for signs; these include cough,
dyspnea, chest pain, wheezing,
hypertension, tachycardia
 Interventions include slowing rate of
infusion, placing client upright with feet in
dependent position, notifying health care
provider, administering oxygen, diuretics,
and morphine sulfate as prescribed,
monitoring for dysrhythmias

18. Septicemia
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 Monitor for signs; these include rapid
onset of chills and high fever,
 vomiting, diarrhea, hypotension, shock
 Interventions include notifying health
care provider
 obtaining blood cultures and cultures from
blood bag
 administering oxygen
 IV fluids, antibiotics, vasopressors, and
corticosteroids as prescribed

19. Iron overload
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 Assess for altered hematological values
 Vomiting and diarrhea
 Hypotension
 Interventions include administering
deferoxamine (Desferal) as prescribed to
remove iron in the kidney
 Educating client that urine will turn red as
iron is excreted

20. Complications
 Disease transmission
 Hepatitis C is commonly transmitted disease
 Other transmitted diseases may include hepatitis
B, HIV, Epstein-Barr virus, cytomegalovirus,
malaria
 Hypocalcemia
 Monitor for hyperactive reflexes, paresthesia,
cramps, positive Trousseau’s and Chvostek’s
signs
 Slow transfusion rate, notify health care
provider if signs occur

21. Hyperkalemia
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The older the blood, the greater the
risk for hyperkalemia, because
hemolysis causes potassium release
Monitor for muscle weakness,
paresthesias, abdominal cramps,
diarrhea, dysrhythmias
Slow transfusion rate, notify health
care provider if signs occur

22. Question
HERI 305 640 8459
The nurse determines that a client is having a
transfusion reaction. After the nurse stops the
transfusion, which action should the nurse take
next?
1.Remove the intravenous (IV) line.
2.Run a solution of 5% dextrose in water.
3.Run normal saline at a keep-vein-open rate.
4.Obtain a culture of the tip of the catheter device
removed from the client.