Blood Transfusion Protocol Quiz

Blood Product Transfusion

• The infusion of any blood products must be started within 30 minutes of acquiring them from the blood bank, highlighting the importance of preparatory tasks in advance.
• In emergency situations where no one is available to provide consent, the physician will document this in the medical record and the transfusion will proceed.

Informed Consent

• Ensure informed consent has been obtained, explaining the risks, benefits, and alternatives to the patient.
• The patient has the right to refuse treatment and ask questions.
• The patient must understand why they need the transfusion, how it will be performed, how long it will take, the type of blood product they will receive, and how to monitor for adverse reactions.

Pre-Transfusion Assessment

• Confirm the type and screen has been completed, a lab test that confirms the patient's blood type and screens for any known antigens.
• Ensure the patient has a patent IV no smaller than 22G, with 18-20G preferred for optimal flow rates.
• Administer PO pre-medications 30 minutes prior to the transfusion and IV medications just prior to the transfusion.
• Common pre-medications are acetaminophen and diphenhydramine.
• Perform a baseline assessment of the patient, including skin color, lung sounds, and presence of a rash.

Gathering and Preparing Equipment

• Choose the appropriate IV tubing, which is a specific type of IV tubing with two types: one for gravity flow with an option to squeeze a bulb, and one for use with an IV infusion pump.
• Blood tubing has two spikes that Y-site together above the filter, one for the blood product and one for the flush solution (0.9% sodium chloride).
• Blood tubing contains a built-in filter that eliminates clots and other debris before the blood product enters the patient.
• Prime the tubing with 0.9% sodium chloride, and set up the IV pump in advance if necessary.
• Other general equipment used for any IV access includes gloves, saline flushes, and alcohol pads.

Preparing to Administer the Blood Product

• Inspect the bag to ensure it is suitable for transfusion, checking for tears, leaking, discoloration, clumps, or gas bubbles.
• Verify the patient's identity, provider's order, and informed consent.
• Verify the blood product identification number, patient's blood type, and Rh factor, as well as the expiration date on the blood product.
• Verify the transfusion ID number against the patient's blood transfusion wristband to confirm the numbers match.

Administering the Blood Product

• Just prior to starting the infusion, take the patient's baseline vital signs.
• Perform hand hygiene, put on gloves, scrub the hub of the patient's IV, and connect the blood tubing.
• Initiate the blood transfusion at a slow rate for the first 15 minutes, typically between 50 ml/hr and 120 ml/hr, depending on the patient's condition and facility protocol.
• Stay with the patient for the first 15 minutes to observe for any signs of a transfusion reaction.

Monitoring and Post-Transfusion Care

• Monitor the patient for signs of circulatory overload, especially for rapid transfusions.
• Check in on the patient periodically, at least every 30 minutes, to monitor for any unexpected effects.
• Once the transfusion is complete, flush the IV with normal saline and take another set of vital signs to compare against the patient's baseline measurements.
• Continue to monitor the patient for signs of reaction, which can occur up to 24 hours after the transfusion, and delayed reactions, which can occur up to four weeks later.

Blood Transfusion Reactions

• Signs of a reaction include fever, chills, skin symptoms, respiratory distress, cardiac symptoms, neurological symptoms, abdominal symptoms, pain, and genitourinary symptoms.
• Types of reactions include febrile non-hemolytic, allergic, acute hemolytic, delayed hemolytic, septic, and transfusion-related acute lung injury (TRALI).
• Treatment for reactions varies depending on the type and severity of the reaction, and may include stopping the transfusion, administering medications, and providing supportive care.### Pre-Transfusion Preparation
• Each patient has a unique identifier for their most recent type and screen, which changes when a new one is drawn.
• Client blood samples are drawn and labeled at the bedside, and the client is asked to state their name, which is compared with the name on their identification band or bracelet.
• The recipient's ABO and Rh types are identified, and an antibody screen is performed to determine if there are any antibodies other than anti-A and anti-B.
• Crossmatching is performed by combining donor red blood cells (RBCs) with the recipient's serum and Coombs' serum.
• The crossmatch is compatible if there is no RBC agglutination.

Blood Warmers and Universal Donors

• Blood warmers are used to prevent hypothermia from large or rapid transfusions of cold blood, often in trauma units and emergency departments.
• The warmer must not heat the blood above 40-degrees C to avoid hemolysis.
• The universal RBC donor is O-negative, and the universal recipient is AB-positive.

Transfusion Process

• Baseline vital signs are taken before starting the infusion.
• Hand hygiene is performed, gloves are put on, and the hub of the patient's IV is scrubbed before connecting the blood tubing.
• The blood transfusion is initiated at a slow rate for the first 15 minutes (50 ml/hr to 120 ml/hr).
• The patient is monitored for signs of a transfusion reaction during the first 15 minutes.
• Vital signs are taken again at the 15-minute mark.
• If the patient is tolerating the transfusion, the flow rate may be increased according to facility protocol.

Post-Transfusion Care

• Monitor the patient for signs of circulatory overload, such as dyspnea, increased work of breathing, coarse lung sounds, and tachycardia.
• Flush the IV with normal saline and take another set of vital signs after the transfusion is complete.
• Monitor the patient for signs of a reaction, which can occur within 24 hours or up to four weeks after the transfusion.

Transfusion Reactions

• Signs of a reaction include fever, chills, skin reactions, respiratory distress, cardiac changes, neurological symptoms, abdominal symptoms, pain, and genitourinary symptoms.
• Types of reactions include febrile non-hemolytic, allergic, acute hemolytic, delayed hemolytic, septic, transfusion-related acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO).

Managing Reactions

• If an acute transfusion reaction occurs, stop the transfusion immediately and notify the provider and the blood bank.
• In mild reactions, the MD may prescribe diphenhydramine and/or acetaminophen, and the infusion may be resumed slowly with close observation.
• In severe reactions, disconnect the blood tubing, return the blood product to the blood bank, and do not flush the IV line; instead, acquire alternate IV access.

Test your knowledge on the procedures involved in blood transfusions, including patient identification, blood typing, and antibody screening. Learn about the importance of accurate labeling and verification in ensuring safe transfusion practices.