Safe Blood Transfusion

General Precautions
A large volume of refrigerated blood infused rapidly through a
central venous catheter into the ventricle of the heart can cause cardiac dysrhythmias.
No solution other than normal saline should be added to blood
components.
Medications are never added to blood components or piggy-backed into a blood transfusion.
To avoid the risk of septicemia, infusions (1 unit) should not
exceed the prescribed time for administration (2 to 4 hours
for packed red blood cells); follow evidence-based practice Guidelines and agency procedure.

The blood administration set should be changed with each unit
of blood, or according to agency policy, to reduce the risk of
septicemia.
Check the blood bag for the date of expiration; components
expire at midnight on the day marked on the bag unless oth-
erwise specified.
Inspect the blood bag for leaks, abnormal color, clots, and
bubbles.
Blood must be administered as soon as possible (within 20 to
30 minutes) after being received from the blood bank, because
this is the maximal allowable time out of monitored storage.
Never refrigerate blood in refrigerators other than those used in
blood banks; if the blood is not administered within 20 to
30 minutes, return it to the blood bank.
The recommended rate of infusion varies with the blood com-
ponent being transfused and depends on the client’s condi-
tion; generally blood is infused as quickly as the client’s
condition allows.
Components containing few red blood cells (RBCs) and plate-
lets may be infused rapidly, but caution should be taken
to avoid circulatory overload.
The nurse should measure vital signs and assess lung sounds
before the transfusion and again after the first 15 minutes
and every 30 minutes to 1 hour (per agency policy) until
1 hour after the transfusion is completed.
Client Assessment
Assess for any cultural or religious beliefs regarding blood
transfusions.
A Jehovah’s Witness cannot receive blood or blood products;
this group believes that receiving a blood transfusion has
eternal consequences.
Ensure that an informed consent has been obtained.
Explain the procedure to the client and determine whether the
client has ever received a blood transfusion or experienced
any previous reactions to blood transfusions.
Check the client’s vital signs; assess renal, circulatory, and
respiratory status and the client’s ability to tolerate intrave-
nously administered fluids.
If the client’s temperature is elevated, notify the health care pro-
vider (HCP) before beginning the transfusion; a fever maybe
a cause for delaying the transfusion in addition to masking a
possible symptom of an acute transfusion reaction.
Blood Bank Precautions
Blood will be released from the blood bank only to personnel
specified by agency policy.
The name and identification number of the intended recipient
must be provided to the blood bank, and a documented
permanent record of this information must be maintained.
Blood should be transported from the blood bank to only1client
at a time to prevent blood delivery to the wrong client.
Only 1 unit of blood should be transported at a time, even if the
client is prescribed to have more than 1 unit transfused.
Client Identity and Compatibility
Check the HCP’s prescription for the administration of the
blood product.
The most critical phase of the transfusion is confirming product
compatibility and verifying client identity.
Universal barcode systems for blood transfusions should be
used to confirm product compatibility, client identity, and
expiration.
Two licensed nurses (follow agency policy) need to check the
HCP’s prescription, the client’s identity, and the client’s
identification band or bracelet and number, verifying that
the name and number are identical to those on the blood
component tag.
At the bedside, the nurse asks the client to state his or her name,
and the nurse compares the name with the name on the
identification band or bracelet.
The nurse checks the blood bag tag, label, and blood requi-
sition form to ensure that ABO and Rh types are compat-
ible. The nurse uses the barcode scanning system per
agency policy.
If the nurse notes any inconsistencies when verifying client
identity and compatibility, the nurse notifies the blood bank
immediately.