Safe Blood Administration
By: Kim Maryniak, PhD, RNC-NIC, NEA-BC
There are estimates that 36,000 transfusions are needed every day in the United States (Miller-Hoover, 2018). Blood is given to correct blood loss, treat shock, and increase blood volume. Administering blood products is a common practice for nurses. However common, this practice is not without risks. Nurses need to understand and adhere to safe administration practice of blood products to reduce the risk of transfusion reactions. Knowledge should include types of blood products, potential complications, and steps to ensure safety throughout the process of blood administration. Blood products may include whole blood, packed red blood cells, platelets, plasma, granulocytes, and cryoprecipitate. Blood transfusion reactions can be non-hemolytic or hemolytic (American Association of Blood Banks [AABB], 2017; Bachowski et al., 2017).
When preparing to administer blood to a patient, nurses should always refer to policy and procedure specific to the facility where they work. There are common best practices that should be implemented. Unless in an emergency, a blood transfusion consent and blood typing and cross-matching is needed prior to blood administration. Checking blood products against the order and using two patient identifiers is critical. Once blood is removed from the blood bank, it should be initiated within 30 minutes or returned (AABB, 2017; AABB, 2018, Bachowski et al., 2017).
Immediately prior to administration, two licensed personnel must verify the correct blood product and patient. Blood products require a dedicated line for infusion, and filtered intravenous tubing. Only normal saline should be used to prime the intravenous line, with no other solutions or medications used. The patient and family also need explanations of the procedure before beginning, including what to expect. Baseline vital signs should be taken just prior to initiating the transfusion, and the nurse must stay with the patient during the first 15 minutes of transfusion, to monitor for any immediate reaction. Vital signs should be repeated at 15 minutes after the beginning of the transfusion, during the procedure per facility policy, at the conclusion and one hour after the transfusion (AABB, 2017; AABB, 2018, Bachowski et al., 2017).
There are a variety of signs and symptoms of blood transfusion reaction for both hemolytic and non-hemolytic reactions. Pain, anxiety, hematuria, fever, headache, pruritus, rash or hives, nausea, and respiratory difficulties are common for non-hemolytic reactions. The aforementioned symptoms, as well as bleeding, hypotension, and oliguria can be associated with hemolytic reactions. If a reaction is suspected, the transfusion should be immediately stopped, blood products and tubing removed, and the intravenous line kept open with normal saline. The provider should be notified immediately, and the patient monitored. Remaining blood products and tubing should be taken to the laboratory (AABB, 2017; Bachowski et al, 2017; Miller-Hoover, 2018). Refer to facility policy and procedure for documentation and other requirements.
Across the country, nurses administer thousands of blood transfusions every day. To safely administer blood products, it is important to follow your facility’s policy and procedure for blood administration. In some instances, in spite of all best efforts; transfusion reactions still occur. Understanding how to identify a transfusion reaction and your next steps is important in managing the reaction and should not be underestimated.
For more information about blood administration, see the RN.com course Blood Administration and Transfusion Reactions.
American Association of Blood Banks (AABB). (2017). Technical manual (19th ed.). Bethesda, MD: American Association of Blood Banks.
American Association of Blood Banks (AABB). (2018). Standards for blood banks and transfusion services (31st ed.). Bethesda, MD: American Association of Blood Banks.
Bachowski, G., Borge, D., Brunker, P., Eder, A., Fialkow, L.,... & Westphal, R. (2017) A compendium of transfusion practice guidelines (3rd ed.). Retrieved from http://success.redcross.org/success/file.php/1/TransfusionPractices-Compendium_3rdEdition.pdf
Miller-Hoover, S. (2018). Blood administration and transfusion reactions. Retrieved from https://www.rn.com/nursing-education/course-details/?course_id=2254
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