BLOOD ADMINSTRATION

INTRODUCTION : A blood transfusion is a safe, common procedure in which through an intravenous (IV)
line inserted into blood vessels. Blood transfusions are used to replace blood lost during surgery or a serious
injury. A transfusion also might be done because of an illness. During a blood transfusion, a small needle is used to
insert an IV line into one of your blood vessels. The procedure usually takes 1 to 4 hours, depending on how much blood
you need. Blood transfusions are very common. Mild complications can occur. Very rarely, serious problems develop.

DEFINITION:- Blood administration or transfusion therapy is the intravenous administrations of whole blood
or blood products.

 Blood transfusion consists of administration of compatible donors whole blood or any of its
components to correct any clinical condition.

PURPOSES:

 To restore blood volume after severe hemorrhage.

 To restore the oxygen carrying capacity of the blood.
 Maintain hemoglobin levels in severe anemia
 Replace specific blood component.
 Assessment focus Clinical signs of reaction (e.g. sudden chills, nausea, itching rash, dyspnea) status of
infusion, site, any unusual symptoms

BLOOD TYPES:-

Every person has one of the following blood types: A, B, AB, or O. Also, every person's blood is either Rh-
positive or Rh-negative. So, if you have type A blood, it's either A positive or A negative.

The blood used in a transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your
blood attack the new blood and make you sick.

Type O blood is safe for almost everyone. About 40 percent of the population has type O blood. People who
have this blood type are called universal donors. Type O blood is used for emergencies when there's no time to
test a person's blood type.

People who have type AB blood are called universal recipients. This means they can get any type of blood.

If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you have Rh-negative
blood, you should only get Rh-negative blood. Rh-negative blood is used for emergencies when there's no time
to test a person's Rh type.

Blood Types RBC antigens Plasma antibodies

A A B
B B A
AB -- A and B
O A and B --
RHESUS (Rh) FACTOR:-

Rhesus (Rh) factor antigen is present on RBCs of approximately 85% of the people. Blood that contain the Rh
factor is known as Rh positive, when it is not present the blood is said to be Rh negative.
BLOOD BANKS:-

Blood banks collect, test, and store blood. They carefully screen all donated blood for infectious agents (such as
viruses) or other factors that could make you sick. Blood banks also screen each blood donation to find out
whether it's type A, B, AB, or O and whether it's Rh-positive or Rh-negative. Thus, blood banks carefully test
donated blood.

To prepare blood for a transfusion, some blood banks remove white blood cells. This process is called white cell
or leukocyte reduction. Although rare, some people are allergic to white blood cells in donated blood.
Removing these cells makes allergic reactions less likely.

Not all transfusions use blood donated from a stranger. If you're going to have surgery, you may need a blood
transfusion because of blood loss during the operation. If it's surgery that you're able to schedule months in
advance, your doctor may ask whether you would like to use your own blood, rather than donated blood.

BLOOD TYPING AND CROSS MATCHING:-

To avoid transfusion incompatible red blood cells, both blood donor and recipient are typed and cross matched.
Blood typing is done to determine the ABO blood group and Rh status. This test is performed to on pregnant
women and neonate to assess for possible intrauterine exposure of incompatible blood type. Because blood
typing is only determine the presence of major ABO and Rh antigen, cross matching also is necessary prior to
transfusion.

SELECTION OF BLOOD DONORS:-

1. Age > 18
2. Smoking:
Candidates will not be considered for donation unless they have been tobacco free (including chewing tobacco)
for at least 8 weeks prior to donation
3. Drug Use: Potential donors must not use any illicit drugs. This includes periodic use of any drug such as
marijuana
4. Health Problems: Donors must be healthy individuals. If a donor has a past history of suffering from the
following problems, or if these are discovered during the medical evaluation, a donor may be declined.
 High blood pressure treated with medication
 Diabetes
 Gestational diabetes
 Systemic lupus erythematosus
 Polycystic kidney disease
 Substance abuse
 Psychiatric illness.
 Recent cancer or a history of cancer that typically takes a long time to recur
 Low kidney function (usually creatinine clearance of <80ml/min (a test of kidney function).
 Active hepatitis B or C infection or HIV infection.
 History of blood clots or risk factors for the development of blood clots
5. Obesity: Obesity is an independent risk factor for kidney disease. Candidates with a body mass index of
over 35 will generally not be considered for donation .
6. Psychosocial Issues: Donors may be declined if they have inadequate support for recovery, a history of poor
coping or psychiatric illness, a history of not taking good care of their health.

BLOOD PRODUCT FOR TRANSFUSION:-

PRODUCTS USES
Whole blood Use in case of hemorrhage.
Replace blood volume and all blood products: plasma,
fresh platelets, RBCs, plasma protein and clotting
factors.
Packed red blood cells Used to increase the oxygen carrying capacity of blood
anemia’s, surgery and disorder with slow bleeding.
Platelets Replace in platelet disorder.
Fresh frozen plasma Expand blood volume and provides clotting factors.
Albumin and plasma protein fraction Blood volume expender
Provide plasma protein.
Clotting factors and cryoprecipitate Used for patient with clotting factors deficiencies.
PATIENT INSTRUCTIONS AND PREPARATION
Informed Consent

o Informed consent may be obtained by a physician, a nurse, or a physician extender who is

knowledgeable about blood transfusion and the patient’s condition so as to be able to explain the
elements of informed consent above.
o The risks of transfusion, including adverse symptoms , must be discussed with the patient well before
the transfusion.
o The patient is then given a choice to accept or decline transfusion
o Consent should be documented in the medical chart using the form.

Refusal of Blood Transfusion

o The form "Patient’s Release Form for Refusal of Blood or Treatment" should be used to document the
patient’s refusal of transfusion.

Receipt of Blood Components

Step Action
1 Verify

 Name and admission number recorded on the Transfusion Record Form attached to the unit
correspond with that of the intended recipient
2 The person receiving the blood component should:

 Record the date and time that the blood was received/removed from the pneumatic tube on the
Blood Delivery form
 Sign the Blood Delivery form

3. Verify that red blood cells and plasma components were received within 30 minutes of the dispensed
time stamp on the form. If Then
4. If more than 30
minutes have elapsed Do not store Red Blood Cells and plasma that has been out of refrigeration
since the time stamp for more than 30 minutes in patient care unit Blood Refrigerators.
on the Blood Delivery If the blood component is not needed for immediate transfusion, return the
Form Red Blood Cells or plasma to the blood bank for proper disposal.

IMMEDIATELY PRIOR TO BLOOD TRANSFUSION

Pre transfusion Vital Sign Documentation

o To provide a baseline, record the patient's blood pressure, pulse, respirations and temperature in the chart or
on the transfusion record form

If a patient is febrile, consideration should be given to postponed of blood transfusion, since the fever may
incerase the development of a febrile reaction to the blood component itself.

 Verify physician's orders for transfusion and any pretransfusion medications have been administered
 Perform bedside verification of patient and component Using the:
 labels on the bag,
 the Transfusion Record Form and
 the patients attached positive patient identifier.

These steps must never be bypassed.

1 Ask the patient to state his or her name. Verify patient and component identification information.
2 Verify the blood type, donor number, component name
3 Verify compatibility: a compatibility chart is on the back inside cover of this booklet.
4. Sign the Transfusion Record Form before blood transfusion is initiated.
5. The person who hangs the blood must record the date and time the transfusion was started
6. Record the date, time, component and unit number on the appropriate sheet on the patient's chart.
Refer to unit policy and procedures.
DO NOT START the transfusion if there is any discrepancy. Contact the Blood Bank.
Flow Rates
Initial Flow Rate Slowly at no more 1 mL/minute to allow for recognition of
an acute adverse reaction. Proportionately smaller volume for
pediatric patients.
Standard Flow Rate – Adults If no reaction occurs in the first 15 minutes, the rate may be
increased to 4 mL/minute
Pediatrics 10-20 mL/kg over 30-60 minutes
Maximum Infusion Time Infusion time should not exceed 4 hours for any component.
If rate slows appreciably investigate immediately

Consider measures that may enhance blood flow

 repositioning the patient's arm,

 changing to a larger gauge needle,
 changing the filter and tubing,
 and elevating the IV pole, if gravity rather than a
pump is being used.

During the Transfusion Document

What  temperature, blood pressure, respirations and pulse,

and examine the skin for urticaria.
 Assess flow rate

When  before initiating the transfusion

 after the first 15 minutes
 after 30 minutes
 hourly until one hour after completion of the
transfusion

Outpatient Post Transfusion Vital Signs For outpatient transfusions, the vital signs may be taken at 30
minutes post transfusion.
If the patient has a preexisting fever
The need for transfusion must be balanced with the risk of transfusion. Contact the patient’s physician to
determine if pre transfusion medications should be administered.

Medications

o Medications that can be administered "IV Push" may be administered by stopping the transfusion, clearing
the line at the medication injection site with 5-10 mL of normal saline, administering the medication,
reflushing the line with saline and restarting the transfusion.

At the Termination of Transfusion

 date and time transfusion was stopped

 volume of blood infused
 Check the box documenting the presence/absence of a transfusion reaction.

Document the patient's response to the transfusion in the patient's medical record.

If a Transfusion Reaction is Suspected

o Stop the transfusion

o Maintain the IV.
o Save the bag and attached tubing

ARTICLES

 Blood administration set

  250 ml 0.9% NaCl IV solution
 Alcohol swabs
 Disposable clean gloves
 Tapes
 Blood pressure cuff and stethoscope
 Thermometer
 Signed transfusion consent form
STEPS
1. Complete pre procedure.
2. Verify that IV cannula . In emergency situations  It ensures that transfusion will be infiltrated
that require rapid transfusions, 16 or 18 gauge
cannula is preferred; transfusion for therapeutic
indications may be infused with cannulas ranging
from 20 to 24 gague.
3. Obtain client’s transfusion history.
4. Review physician’s order for blood component  Identifies client’s prior response to transfusion of
transfusion. Check that consent has been properly
completed and signed by client.
5. Obtain and record vital signs before administration
of transfusion.
6. Pre administration:-
a. Obtain blood component from blood bank.
b. Correctly verify product and identify client with  To ensure that product is safe to administer.
person considered qualified by your agency:-
i. Check client’s first and last names by having
client state name, if able.
ii. Verify that component received from blood bank
is component ordered by physician.
iii. Check that client’s blood types and Rh type are
compatible with donor blood type and Rh type.
iv. Check that unit number on unit of blood and on
from blood bank match.
v. Check expiration date and time on unit of blood.
vi. Record verification process as directed by
agency policy.
7. Administration:-
a. Autologous transfusion only:-
i. Connect drainage tubes to collection container
or cell processing system.
ii. Minimize air bubbles by establishing secure
connections.
RATIONALE
infused with in time. Gauge of IV cannula should
be appropriate. Large cannula promotes optimal
flow of blood components. Uses of smaller
cannula such as 22 to 24 gauges may require to
blood bank to divide unit so that each half can be
infused within allotted time.
blood components.
 For checking Physician’s order must be present
before transfusing blood products and to provide
complete information to patient about procedure.
 To check the baseline data .
 Strict adherence to verification procedure before
administration of blood or blood components
reduces risk of administering wrong blood to
client.
 Notify blood bank and appropriate personnel as
indicated by agency policy.
 Ensures that client receive correct therapy.
 Verifies accurate donor blood type. Air bubbles,
clots or discoloration may be indicating bacterial
contamination or inadequate coagulation of
stored component.
 Expired blood should never be used, because cell
components deteriorate and may contain excess
citrate ions.
 Documentation on legal medical record.
 Allow collection of client’s blood for
reinfusion, storage no longer than 6 hours or
washing and spinning.
 b. Open Y tubing blood administration set.
 Y Tubing is used to facilitate maintenance of Iv
access in case client needs more than 1 unit of
blood. Both a unit of blood and container of
c. Set roller clamp to “off” position. 0.9% NaCl are connected to system.
 Moving roller clamps to “off” position prevents
d. Spike 0.9% NaCl IV bag with one of Y tubing accidental spilling and wasting of product.
spikes invert filter, open roller clamps of IV  Primes tubing with fluid to eliminate air on both
bag and component side of Y, keeping sides of Y tubing. Inverting filter to fill from top
common tubing clamp below filter closed. set to bottom reduces formation of air pockets.
IV bag on table and gently press down to closing roller clamp prevents spillage and waste
squeeze IV bag to fill both sides of Y tubing. of fluid.
Close tubing clamp of component side of Y,
and open common tubing clamp below filter.
Continue to press down on IV saline bag to
completely fill filter and half of drip chamber.
Close both tubing clamps. All Three tubing
clamps should be closed.
e. Hang on IV pole. Open common tubing clamp
to finish priming Tubing to distal end of tubing  This will completely prime tubing with saline
connector. Close tubing clamp when tubing is and IV line is ready to be connected to client’s
filled with saline. Maintain protective sterile vascular access device.
cap on tubing connector.
f. Prepare blood component for administration.
Remove protective covering from access port.  Protective barrier drape may be used to catch
Spike blood component unit with other Y any potential blood spillage. Tubing is primed
connection. Hang on IV pole. Open clamp of Y with blood unit and ready for transfusion into
connected to blood unit and open common client.
tubing clamp to prime tubing with blood.
Allow saline in tubing to flow into receptacle,
being careful to ensure that any blood spillage
is contained in blood precaution container.
NURSE ALERT:- Normal saline is compatible with
blood products, unlike solutions that contain
dextrose, which cause coagulation of donor blood.
g. Maintaining asepsis, attach primed tubing to
client’s VAD. Open common tubing clamp.
h. Remain with client during first 5 to 15 min of  This initiates infusion of blood product into
transfusion. Initial flow rate during this time client’s vein.
should be 2ml/ min.  Most transfusion reactions occur within first 5
NURSE ALERT:- If signs of a transfusion reaction to 15 min. of transfusion.
occur, stop infusion, start normal saline with new
primed tubing directly into VAD at KVO (5-10 ml/
hr) and notify the physician immediately.
i. Monitor client’s vital signs 5 min. after blood
product has begun infusing and per agency
policy after that.  Frequent monitoring of vital sign will help
j. Regulate rate of transfusion according to quickly alert nurse to transfusion reactions.
physician’s orders. (Drop factor for blood
tubing is 10 gtt/ ml)  Maintaining prescribed rate of flow decrease
NURSE ALERT:- A unit of whole blood should not risk of fluid volume excess while restoring
hang for more than 4 hrs because of the danger of vascular volume.
bacterial growth.
k. After Blood has infused, clear IV line with
normal saline and discard blood bag according
to agency policy.
l. Appropriately dispose of all supplies. Remove
gloves and perform hand hygiene.
8. Monitor IV site and status of infusion each time
vital signs are taken.
9. Observe for any change in vital signs and for
chills, flushing, itching, dyspnea, rashes or other
signs of transfusion reaction.
10. Complete post procedure protocol.
 Infusing IV saline solution infuses remainder of
blood in IV tubing and keep IV line patent for
supportive measures in case of transfusion
reaction.
 Standard precautions during transfusions reduce
transmission of micro organisms.
 Detects presences of infiltration or phlebitis and
verifies continuous and safe infusion of blood
products.
 These may be early signs of transfusion
reaction.

AFTER CARE:- Recording and reporting:-

 Record type of blood component and amount administered

 Record starting and finishing time of blood administration.
 Report signs and symptoms of transfusion reaction immediately.

NURSING MANAGEMENT:-

Unexpected outcomes Nursing interventions

Hemolytic reaction:- Client displays  Stop transfusion.
signs and symptoms of transfusion  Normal saline should be connected at vascular access hub to
reaction which include:- prevent subsequently blood from infusing from tubing.
 Fever with or without chills  Disconnect blood tubing at VAD hub, and cap distal end
 Tachycardia with sterile connector to maintain sterile system
 Tachyponea  Keep vein open with slow infusion of normal saline at 10 to
 Wheezing 12 gtt/ min. to ensure venous patency.
 Dysponea  It is impotant to regulate flow rate to minimize
 Headache administration of excess IV fluid, especially in client who
 Flushing of skin are prone to fluid overload.
 Hives or itching
 Hypotension
 Gastrointestinal system
Client develops infiltration or phlebitis at  Remove IV and insert new VAD in different site.
veni puncture site.  Product may be restarted if reminder can be transfused
within 4 hours of initiation of transfusion.
 Nursing measures to reduce discomfort at infiltration site.
Fluid overload:- occurs and client  Slow and stop Transfusion.
exhibit difficulty in breathing and  Elevate head end side of bed
crackles upon auscultation  Inform physician about physical findings
 Administered diuretics, morphine and oxygen as doctors
order

Sepsis:- High grade fever, chills,
vomiting, diarrhea, hypotension
Febrile reactions:- High grade fever,
chills, Headache, Flushing of skin,
anxiety, muscle pain
Allergic reactions:- Flushing, itching,
urticaria, bronchial wheezing, chest pain,
cardiac arrest
BIBLIOGRAPHY:-
1. Potter Perry. Basic Nursing 6th edn..Mosbi, Missouri, 2006.
2. Carel Tyler Carel Lilli, Pricilla Lemone. Fundamentals of Nursing. Lippincott’s Williams Philadelphia,
2006
 Continue frequent assessment
 Check vital signs at regular interval time.
 Stop transfusion
 Keep the vein open with normal saline
 Notify the primary care provider.
 Administer IV fluids, antibiotics
 Obtain a blood specimen from the client for culture.
 Send remaining blood and tubing to the laboratory.
 Stop transfusion
 Keep the vein open with normal saline
 Notify the primary care provider.
 Give antipyretics to the patient.
 Stop transfusion
 Keep the vein open with normal saline
 Notify the primary care provider.
 Give antihistamine to the patient.