Donor blood must be compatible to the recipient of the transfusion. Compatibility blood testing (type and cross match) must be performed before administering homologous blood to avoid serious transfusion reactions. This blood test assures that the donor blood matches and is compatible with the recipient blood (including the blood type and the Rh factor). In an emergency when there is no time for matching blood, type O, Rh-negative blood (universal donor) is used until compatibility testing can be performed.
To minimize the chance of giving a patient the wrong product and causing a severe transfusion reaction, blood and blood products are labeled with patient name, number, type, and Rh factor by the blood bank. The clinician should check and record the blood bag name, number, type, and Rh factor against the patient's identification armband and the lab slip numbers twice with another nurse before administering blood products. The nurse should recheck the physician's order and the expiration date on the blood product before giving the blood product.
Patients must understand and sign an informed consent form before receiving a blood transfusion. Blood is never given without the patient's consent. When a patient is unable to give consent, the closest family member should sign the form. The consent assures that the patient or family member is aware of the risks involved in blood transfusions including the potential for an allergic reaction, transfusion reaction, and/or the possibility of contracting an infection from the transfusion.
Special equipment is used for blood transfusions to assure proper flow of the blood product and to filter out impurities or small clots. Use appropriate blood tubing, filter tubing, and/or needle filters as directed in the policy of the medical setting. The tubing may vary according to the blood product being administered. Blood and blood products require a separate IV line, separate IV lumen in a multi-lumen central line, or an IV line that has been thoroughly flushed with normal saline. Blood and blood products are not compatible with IV solutions other than normal saline. Drugs should not be administered through the IV line while blood or blood products are running. Drugs may be given in some medical settings through a separate lumen of a multi-lumen central IV line if the lumen is flushed with normal saline before and after drug administration.
Blood should be given to the patient within 30 minutes of receiving it from the blood bank. If there is a delay because of IV line issues or other patient needs, the blood should be returned to the blood bank until the staff is ready to administer the blood. This decreases the chance of bacteria growing in the blood bag and helps prevent confusion and errors. Never transfuse blood for longer than four hours to minimize risks of infection.
Nurses monitor patients receiving blood or blood products closely by checking their vital signs every 15 minutes during the first hour of the transfusion and hourly thereafter or as dictated by the policy of the medical setting. Transfusion reactions most often occur within the first 15 minutes of the blood administration. If signs such as high fever, rapid pulse, wheezing, shortness of breath, flushed face, chest pain, flank pain, hematuria or restlessness occur, the nurse should stop the
Mary Elizabeth Martelli R.N., B.S., The Gale Group Inc., Gale, Detroit,