Blood Transfusion in Skills Lab

Blood Transfusion

Procedure for administering a blood transfusion:

  • Patient Assessment/Preparation

    • Previous transfusion history - previous history of adverse reactions
    • Previous history of heart or renal disease - may need to give transfusion slower (also with pediatric and geriatric patients)
    • Assess IV site - 19 gauge for adults
      Adults 19 gauge
      Pediatric and Geriatric Patients Smallest may use is 22 gauge

      A 19 guage IV catheter is needed in order to minimize hemolysis and allow the transfusion to infuse within the four hour maximum time limit allowed for a unit of blood. If a smaller gauge is needed, the blood bank may be able to split the unit of blood so that it could be given over a longer period of time (by giving 1/2 a unit each time).

    • Baseline vital signs and assessment for skin rashes, dyspnea, wheezing, pain, chills, itching, or nausea.
    • Laboratory results: hemoglobin, hematocrit, electrolytes, fluid balance
    • Double check physician's order
    • Obtain informed consent as needed
    • Explain procedure to patient
  • Gather equipment, also check that transfusion report is on the patient's chart.

    • A filter must be used when administering blood components - standard blood sets have a 170-220 m filter. Tubing also comes in a set that has an in-line hand pump. Generally each unit of blood is administered with new tubing, although one set of tubing can be used for two units if the units are given consecutively (if the filter becomes clogged, the blood will not infuse quick enough and new tubing will have to be used).
    • Special leukocyte-removing filters are used when patients need leukocyte-reduced RBCs.
    • Only IV pumps approved from blood administration can be used with transfusions, since other pumps may cause hemolysis.
    • Pressure bags and warmers are used when patients require rapid transfusions and/or multiple units. Pressure bags (not blood pressure cuffs) are inflated to about 200 mmHg so the blood is infusing in a constant stream in the drip chamber. Pressures of about 300 mmHg will cause hemolysis and damage the blood bag. If a blood warmer is used, the blood must not be heated above 420 C. Only approved devices for warming blood can be used.

Administering RBCs

  • Obtain the blood from the blood bank (blood left out of an unmonitored refrigerator for more than 30 minutes cannot be returned to the blood bank).
  • Inspect the blood bag for leaks, abnormal cloudiness, clots, bubbles, or an abnormal dark purple-blue color.

    Blood Bag

  • Verify that the correct blood is being given to the correct patient (requires 2 qualified people, usually 2 RNs, according to agency policy). Nursing students are never allowed to verify blood.
Blood bag label

Check expiration date

Compare the following information on the unit label, the Unit Record attached to the unit of blood, and the Transfusion Report in the patient's chart:

  • Patient's name and hospital/ID number
  • Blood Unit Number
  • Blood type (ABO/Rh)
  • Component label (RBCs, platelets, etc.)
  • Special processing if ordered - CMV negative, irradiated, or leukocyte reduced
  • Autologous blood or directed donation

Then recheck the information, comparing the patient's ID band with the unit of blood and the Transfusion Report. If possible have the patient state their full name.

The two people verifying the information sign the Unit Record attached to the unit.

Document the time and date the transfusion was started.

Keep the Unit Record attached to the unit until the transfusion is complete.

Prime tubing with normal saline

Spiking the normal saline
Priming the tubing with normal saline
Spiking the blood bag Starting the blood

Vital signs should be taken before starting the infusion, after 15 minutes, as appropriate based on the patient's condition, and at the completion of the transfusion.

Transfusion should be complete within 4 hours of blood bags being removed from refrigeration (the risk of bacterial growth is too great after 4 hours). A unit of blood can usually be transfused over 1 1/2 hours. Infusion rates are based on the patient's blood volume, cardiac status, and hemodynamic condition. Patients with hypovolemia can tolerate blood being administered as fast as possible. Healthy adults with chronic anemia can receive RBCs safely at a rate of 3-4 ml/kg/hr. Patients with cardiovascular compromise may tolerate rates of no more than 1 ml/kg/hr.