Transfusion Tips (Lippincott Advisor, 2023)

• Informed consent should be obtained unless the transfusion is an emergency.
• Verify that the patient’s religious beliefs don’t conflict with blood transfusion therapy.
• Ensure patient has adequate intravenous (IV) access with 20 gauge (G) to 24G catheter. For rapid transfusion, a larger catheter (18G or 20G) should be inserted.
• Obtain baseline vital signs. If the patient’s temperature is 99.5° or greater, notify the practitioner and ask if the transfusion should be postponed until the temperature is within normal limits.
• Perform physical assessment; note abnormal or adventitious lung sounds.
• Administer blood products within 30 minutes of its arrival from the blood bank. Don’t store blood in a non-blood bank refrigerator. If there is a delay longer than 30 minutes, send the blood back to the blood bank for storage.
• Check the expiration date and assess for abnormal color, consistency, bubbles, or other materials. Return any expired or suspicious products to the blood bank.

• Check the following:
  • Compare name and medical record number on the patient’s identification band with the blood product container label.
  • Verify blood product label identification number, ABO blood group, and Rh compatibility.
  • Compare the patient’s blood bank identification number with the number on the blood bag.
• Documentation may include name and volume of blood product, blood product ID number, date, and time of transfusion.
• Prior to WBC administration, premedicate the patient with diphenhydramine, as ordered.
• Prior to administration of factors II, VII, IX, and X complex, draw blood for a coagulation assay, as ordered.

• Administration sets should be sterile and pyrogen-free.
• Remember to prime the line with normal saline before and flush with normal saline after the transfusion. Only normal saline is compatible with blood products.
  • Infusions containing calcium can cause clotting in the tubing.
  • Excess glucose causes hemolysis and shortens RBC life.
• Begin administration flow rate slowly, no more than 2 mL/minute for the first 15 minutes of the transfusion and observe closely for transfusion reaction (e.g., change in vital signs, facial color, and any patient complaints).
• If the patient develops a reaction to the blood product:
  • Immediately stop the transfusion.
  • Record the patient’s vital signs.
  • Infuse normal saline through a new or different IV line at a keep-vein-open rate.
  • Notify the practitioner.
  • Save the blood product bag and return to the blood bank.
  • Send patient urine and blood samples to the laboratory.

• If no sign of transfusion reaction within 15 minutes, increase flow rate as ordered (or per your facility’s policy).
• Continue to monitor the patient every 30 minutes during the transfusion and check the IV insertion site for infiltration.
• Once the transfusion is complete, flush the administration set and IV with normal saline.
• Monitor the patient for signs of a delayed transfusion reaction for 4 to 6 hours after completion of the transfusion.

• Repeat lab tests as ordered:
  • Citric acid in FFP products bind to calcium. Large-volume FFP transfusion may cause hypocalcemia requiring calcium supplementation.
  • Factor VII has a half-life of 8 to 10 hours. Repeat transfusion may be needed at specific intervals to maintain levels.