Blood Transfusion Procedures – Steps for safe blood transfusion, cross-matching blood, monitoring for transfusion reactions, and proper documentation.
Blood Transfusion Procedures: Safe Administration and Monitoring
Blood transfusion is a critical procedure for replacing lost blood or treating conditions like anemia. To ensure patient safety, strict protocols must be followed to minimize risks, including transfusion reactions and mismatches. Here’s an overview of the steps for performing a safe blood transfusion:
1. Pre-Transfusion Preparation
a. Physician’s Order
- Ensure a physician’s order is in place, specifying the type and amount of blood product to be transfused (e.g., whole blood, packed red blood cells, platelets, plasma).
b. Patient Consent
- Obtain informed consent from the patient after explaining the risks, benefits, and alternatives of the transfusion.
c. Patient Identification
- Confirm the patient’s identity using two identifiers (e.g., name, date of birth) to ensure that the correct blood product is administered.
2. Cross-Matching and Blood Compatibility
a. Blood Type Matching
- Blood types must be compatible between the donor and recipient to prevent serious transfusion reactions.
- ABO compatibility: Blood groups (A, B, AB, O) should be matched.
- Rh compatibility: The Rh factor (+ or -) must also be compatible.
b. Cross-Matching
- A cross-match test is performed to confirm that the donor’s blood is compatible with the recipient’s.
- This involves mixing a small amount of the recipient’s serum with donor red cells to ensure no agglutination (clumping) occurs.
3. Blood Collection and Storage
- Blood Bank Protocol: Retrieve the blood product from the blood bank just before transfusion. Blood should be administered within 30 minutes of removal from storage.
- Inspect the Blood Bag: Check the blood bag for any signs of damage, discoloration, or clots before administration.
4. Transfusion Procedure
a. Prepare the Equipment
- Use a blood administration set with an in-line filter to remove clots and debris.
- Prime the tubing with normal saline (0.9% NaCl) to keep the vein patent before and after transfusion.
b. Vital Signs Baseline
- Obtain baseline vital signs (e.g., temperature, heart rate, blood pressure, respiratory rate, oxygen saturation) before starting the transfusion.
c. Administer the Blood
- IV Access: Ensure that the patient has appropriate IV access (preferably a large-bore needle for faster administration).
- Blood Identification: Verify the blood product with another nurse (double-checking blood bag label, patient’s identity, and blood compatibility) before starting the transfusion.
- Start Slow: Begin the transfusion slowly for the first 15 minutes while closely monitoring the patient for any adverse reactions. This is the most critical period for detecting reactions.
5. Monitoring During Transfusion
a. Monitor for Transfusion Reactions
- Stay with the patient during the first 15-30 minutes to observe for signs of transfusion reactions:
- Febrile Reaction: Fever, chills, headache.
- Allergic Reaction: Rash, itching, hives, shortness of breath.
- Hemolytic Reaction (rare but severe): Back pain, chest pain, dark urine, hypotension.
- Anaphylactic Reaction: Severe respiratory distress, hypotension, angioedema.
- Transfusion-Related Acute Lung Injury (TRALI): Sudden onset of respiratory distress and hypoxia.
b. Record Vital Signs
- Check and record the patient’s vital signs:
- Before the transfusion begins (baseline).
- 15 minutes into the transfusion (for early reactions).
- Every 30 minutes to 1 hour thereafter.
- At the completion of the transfusion.
c. Flow Rate
- Adjust the flow rate based on the patient’s condition and the prescribed amount of blood to be given over a specific time.
- Typically, a unit of packed red blood cells is administered over 2-4 hours.
6. Post-Transfusion Care
a. Completion of Transfusion
- Once the transfusion is complete, flush the IV line with normal saline to ensure all blood is cleared from the tubing.
- Dispose of the blood administration set and empty blood bag per facility protocol.
b. Final Vital Signs and Monitoring
- Obtain and document final vital signs after the transfusion.
- Continue to monitor the patient for delayed reactions, which may occur hours or even days later.
c. Monitor for Delayed Reactions
- Delayed hemolytic reactions: Occurs days after transfusion; monitor for jaundice, dark urine, or decreased hemoglobin levels.
- Infections: Though rare, blood-borne infections can occur.
- Iron overload: Can occur in patients receiving multiple transfusions (e.g., thalassemia, sickle cell disease).
7. Documentation
Proper documentation is essential for ensuring patient safety and legal compliance:
- Record the time the transfusion started and ended.
- Document the blood product administered (type, unit number, amount).
- Document vital signs and any adverse reactions or interventions performed.
- Record the patient’s response to the transfusion.
- If a reaction occurs, notify the physician immediately and document the event thoroughly.
8. Transfusion Reactions and Their Management
a. Febrile Non-Hemolytic Reaction
- Symptoms: Fever, chills, headache.
- Management: Stop the transfusion, notify the physician, administer antipyretics, and monitor closely.
b. Allergic Reaction
- Symptoms: Urticaria, itching, hives, mild respiratory distress.
- Management: Stop the transfusion, administer antihistamines (e.g., diphenhydramine), and restart at a slower rate if symptoms subside.
c. Acute Hemolytic Reaction
- Symptoms: Fever, chills, back pain, chest pain, hypotension, dark urine.
- Management: Stop the transfusion immediately, notify the physician, maintain IV access with normal saline, and treat shock (e.g., fluids, vasopressors).
d. Anaphylactic Reaction
- Symptoms: Severe respiratory distress, hypotension, angioedema.
- Management: Stop the transfusion, administer epinephrine, provide airway support, and treat for shock.
e. Transfusion-Related Acute Lung Injury (TRALI)
- Symptoms: Sudden dyspnea, hypoxemia, non-cardiogenic pulmonary edema.
- Management: Stop the transfusion, provide oxygen, and support respiratory function (e.g., mechanical ventilation if necessary).
Summary
- Safe blood transfusion involves careful preparation, proper identification, and close monitoring of the patient throughout the process.
- The first 15-30 minutes are crucial for detecting and managing transfusion reactions.
- Proper documentation and prompt response to any reactions ensure the safety and well-being of the patient.