Patients who have suffered large blood loss from trauma or surgery–or who have a low hemoglobin level because of a disease process–may receive a blood transfusion. When to transfuse blood depends on several factors such as the person’s vital signs, hemoglobin level, current injury or disease process and the presence of underlying health problems. Hospitals across the country follow standardized procedures for a blood transfusion to promote patient safety.
A staff member ensures a blood transfusion patient has at least an 18 gauge IV catheter in place, according to Kathleen Ouimet Perrin, Ph.D, author of “Understanding the Essentials of Critical Care Nursing.” The nurse uses a 500 milliliter bag of sterile normal saline to flush IV blood tubing and the patient’s IV site before connecting the blood tubing.
Obtain Patient Consent
The nurse obtains informed consent before initiating the blood transfusion. The nurse explains the procedure, all possible risks, and the signs and symptoms of a transfusion reaction to the patient.
The Canadian Blood Services recommends that red blood cell compatibility testing be done when possible to give the patient blood that matches his type. In life-threatening situations, Type O negative blood is given because it is the universal donor.
The hospital blood bank creates special labels with a unique patient identification number and applies one to the transfusion record, a red patient identification bracelet and all allocated matching blood units. Lab personnel draw blood from the patient to type and cross match the patient’s blood and label all blood tubes with the corresponding blood bank identification number. Once the type and cross match results confirm the patient’s blood type, lab personnel label matching blood units with the assigned blood bank identification number and notify the nurse that the blood is ready.
Two nurses verify that the blood bank ID number on the unit of blood matches the ID number on the patient’s wrist band. Both nurses sign on the transfusion record that this has been done.
The nurse measures the patient’s temperature, heart rate, respiratory rate and blood pressure before initiating the blood transfusion and then every 5 minutes for the first 15 minutes. Vital sign changes during the transfusion, especially an increase in temperature, indicate a possible blood transfusion reaction.
The nurse starts the blood transfusion within 30 minutes of checking the unit of blood out of the lab because blood needs to be refrigerated. The nurse will return the blood to the lab if circumstances call for delaying the transfusion. The blood bank discards the unit of blood if it has been out of the fridge for more than 30 minutes.
The nurse transfuses the blood at a rate of 1 to 2 milliliters per minute for the first 15 to 30 minutes and remains with the patient during this time because transfusion reactions often occur in the first 30 minutes. The nurse has 4 hours to transfuse the blood. After 4 hours, the nurse discards any remaining blood.