Transfusion Therapy Health Article

Description

The blood or blood product is checked by two nurses, two times to be sure the label on the bag matches the patient and the lab slip. The patient should state his name, and the armband should be checked to avoid errors. The nurse should check the expiration date on the unit, to make sure to not give blood products past their expiration dates. He or she should gently rotate the bag in the hands to mix the blood or blood components and then connect the blood or blood product to the IV line in place of the normal saline. If a Y-tubing is in use, the saline line is shut off and the blood product line is opened. Blood products are usually started slowly at 5-10 ml per minute for the first 15 minutes. The line and the patient should be checked frequently during the first 15 minutes of the transfusion to assure that the line is intact, the rate is correct, and the patient is not displaying signs of a reaction. After 15 minutes, vital signs should be obtained and compared to pre-transfusion vital signs to detect any changes. The blood flow rate can then be increased to the correct flow rate for the product being delivered. The patient's vital signs, affect, IV site, and transfusion flow rate should be checked and recorded every 15 minutes for the first hour of the transfusion and then hourly until the completion of the transfusion or according to the medical setting policy.

Preparation

A blood specimen is drawn from the patient, so that the blood bank can type, match, and prepare the appropriate blood product. In most settings an armband is placed on the patient's wrist at the time of the blood draw with a number and name that will later match the blood product label. A physician or nurse will explain the procedure to the patient and obtain a signed informed consent for the transfusion. A physician or nurse will insert either a peripheral or central IV line and connect it to a normal saline drip with appropriate blood tubing and filters in place. If the patient has a peripherally inserted central catheter (PICC), it is better to start another peripheral IV to deliver blood because a PICC line has such a long narrow tubing that blood flows slowly through it and has a tendency to clog the line. Blood will flow most easily through a large bore (#18 or #19) needle or catheter. A blood pump, pressure bag, or blood warmer should be obtained if necessary. Blood warmers are most often used in the surgical or neonatal setting. Most IV pumps will pump blood without damaging the cells, but the medical center's policy should be checked for using blood pumps. The nurse should take and record a set of base-line vital signs, including the patient's blood pressure, temperature, pulse, and respirations prior to transfusion. The patient should be placed in a comfortable position in bed during a transfusion to enhance relaxation and decrease resistance to the blood flow.

Aftercare

When the transfusion is complete, the IV line is flushed with normal saline and discontinued or changed to other IV solutions with new IV tubing for ongoing IV therapy. The patient should be observed for 30 minutes after a transfusion for delayed reactions. A final set of vital signs is taken and recorded 30 minutes after the transfusion is finished. Blood slips are returned to the lab. Fresh IV tubing should be used for subsequent units of blood or blood products. Gloves should be worn when handling used blood supplies. Blood bags, tubing, and catheters are placed in a contaminated trash bag that can be sealed and discarded. Needles are placed (without recapping) in a puncture-proof contaminated needle box.

Complications

Complications of transfusion therapy are not frequent but can include:

• allergic reactions
• hemolytic reactions
• non-hemolytic febrile reactions
• circulatory overload
• hypothermia
• hypocalcemia
• hyperkalemia
• microbial contamination
• disease transmission (AIDS, hepatitis C or bacterial infection)

Results

The results of transfusion therapy are usually rapid and positive. Blood volume is expanded, missing factors are replaced, clotting problems are corrected, or immunity is improved. In some cases, a patient may need multiple transfusions to reach desired effect. Most transfusions are safe; however, mild febrile and allergic reactions occur in about 1-2% of all transfusions. Severe or fatal transfusion reactions are rare. Autologous transfusions are the safest type of transfusion and pose the least risk for infection or reaction. Autologous blood, however, is not always available when needed.