Blood Transfusion & the Role of the Nurse

Infusion Devices

1. Electronic volumetric pump

Pump does not cause haemolysis or damage of blood component

Designed to deliver fluid including blood &blood component at specified flow rate

Component filter 170-260microne

Need to check pump prior to start procedure
Both pump setting and volume deliver shall be monitored hourly.

2. External pressure devices (rare )
Make it possible to administer a unit of blood within few minutes
Only used in emergency situation .


Blood Warmers



The routine warming of blood and blood component is not recommended , as it is of limited benefit and is potentially dangerous.
Keeping the patient warm is probably more important than warming the infusion blood.

Blood warmer is indicated in
Exchange transfusion in infant.
When transfusion patient with clinically significant cold agglutation.
Adult receiving blood at rate greater than 50ml/kg/hr
Children receiving blood at rate greater than 15ml/kg/hr.

Massive transfusion ( 50% or above of body blood volume ).
Trauma situation .
Cardiopulmonary bypass surgical procedure.

Blood and blood component should not be warmed using improvisation such as putting the pack into hot water, orin microwave.




Transfusion Process
Prescription of blood component
Informed consent
Pre-transfusion sample collection
Transfusion nursing priorities(nine steps)


1. Prescription of Blood Component
Prescription form is responsibility for a doctor
Should include: patient **************** & ID
date and time
patient diagnosis
Reason of transfusion
number of unit to be administered
rate of infusion
special procedure


2. Informed Consent
Patient should be informed that transfusion of blood or blood component is a possible element of the planned medical or surgical intervention.
Patient should be informed about the risks, benefits and available alternative.
Consent form is a doctor responsibility.


3. Pre-transfusion Sample Collection
Usually this procedure done by phlebotomy
Cross-matched blood can be keep it for specific patient only for 72 hrs
Recommendation
Never pre-label the tube
Re- check sample with wristband
These considered the major areas for error.


4. Transfusion Nursing Priorities
The most basic principles of patient care during transfusion is to insure the patient safety.
Safe blood transfusion starts with ME!
Nurses should adhere to the hospital transfusion policy & procedure.
Make sure the right patient gets the right blood
at the right time.
patient identify at all the steps.
Never put blood in ward refrigerators.
Never warm blood except with an approved blood-warming device.
Mix gently before transfusion.
If you have any doubts contact blood bank.

Transfusion Nursing Priorities (nine steps)

Step One :
If the patient doesn't have any I.V line in place perform insert an IV cannula.
Commence saline solution only 0.9%normal saline to keep vein open.
Recommendation:
Dextrose solution may cause haemolysis RBC’s and decrease RBC’s survival.
The calcium contained in lactate ringers solution may cause clotting

Step Two:
Only registered nurse can collect blood & blood component from blood bank.
Check with technologist in the blood bank.
Ensure that requested unit is properly labeled and identification details of patient and blood component are the same on the compatibility label attach to the blood component.
Assess the blood products for any abnormalities in color …etc.

Step Three:
Only registered nurses from staff nurse level and above , may administer blood product
(2)regestered nurses or (1) nurse and (1) doctor may identify patient and blood product
Bedside check is a vital step in preventing transfusion error
Explain the procedure to the patient , make sure there is a signed informed consent form before the therapy is started.
Patient most be advice to inform nurse if he/she feel unwell or have any of abnormal signs immediately.


Step Five:
Obtain the patients vital signs.
Vital signs should be monitored prior to transfusion , 15 to 20 minutes after starting transfusion and post transfusion for each unit .

Step Six
Use special blood transfusion set
Component filter 170-260 microns
Filters are not required for albumin or immunoglobulin.


Step Seven :
Blood should be returned to blood bank within 30 minutes if not used.
No blood or blood component can be store in ward refrigerator .


Step Eight
All observations should be recorded in the patient chart.
The investigation and reporting of transfusion reaction or other incident related to transfusion should be recorded on patient chart.


Step Nine
Discard the tubing and filter according to the hospital infection control protocol .
Return to the blood bank the duplicate copy of “cross mat


Blood Transfusion Reactions
Immediate
Hemolytic
Allergic
Febrile
Bacterial contamination
Circulatory overload
Transfusion related
acute lung injury (TRALI)

Delayed
Hemolytic reaction
Post transfusion purpura
Graft versus host disease
Alloimmunization
Transfusion transmitted infection
Iron overload


Transfusion Of Incompatible Blood
Transfusion of incompatible blood component is regarded as an error that should be avoided .
Some situation it is the only option available that can save patient life.
The patients physician will always be informed of decision by director of the blood bank.


Nursing Consideration

Start the transfusion slowly at rate 1ml/min for first 15 minutes.
Observe the patient constantly for any abnormal signs .
Take vital signs prior to transfusion after first 15 minutes , after 30 minutes and after completion of transfusion.

If there is any abnormal signs or symptoms :
follow transfusion reaction practice.
Being another new unit of blood per physician order, the new unit also is likely to test as incompatible , but may be tolerated better.
Summary
Nurses have a major role in blood transfusion practice.

They should follow all safety and general precautions throughout all of the steps for administering transfusions chart form”