Infusing Blood Products
Prior to ordering blood products ensure vascular access!

Acquire the Blood Products:

Call the Blood Center (6-2561) to insure availability of blood products.

On a 3x5 card imprint the transfusion recipient's addressograph and list the product to be obtained.  Take the card to the blood center.
Blood unit labeling is completely checked by a Blood Center staff member and a Nursing Staff member before the release of the product.  The unit bag label, transfusion "chart copy" and the addressograph imprinted 3x5 card are read aloud.  After verifying that all patient and labeling information is correct, the blood product is released to the Nursing staff member, who records receipt of the blood product in the Blood Center log book.

Pre-Transfusion Preparation:
Immediately before transfusion of each unit of blood or component, the RN who will be the transfusionist and another staff member must completely check all blood unit labeling and patient identification in the presence of the patient. The transfusionist reads aloud from the primary label and the blood center label on the unit. The witness compares the information to the Blood Center "chart copy".
Verify:  The Primary label on the unit
The Donor Center Label on the unit

The "Chart Copy" label

The Transfusionist and the Witness verify the patient identification and Typenex bands to the Blood Center label and "chart copy" label.

The patient ID and Typenex bands are verified.

The following is read aloud: 
-Typenex number
-Patient's name
-Patient's hospital number
-Blood unit number
-Blood ABO group and Rh factor
-Special testing/preparation if applicable
-Expiration date.

When the verification has been completed, both persons who performed the check sign the "chart copy"

Equipment Needed:
19 gauge or larger needle (23-gauge needle may be used for pediatric patients)
Y-type blood infusion set with 80-micron filter
0.9 percent normal saline. (saline is the only solution approved for direct mixing with blood.)
Prime the Tubing:
Prime the tubing with NS.
immediately before starting the transfusion, mix the blood unit by gentle inversion.
No medication should be added to the IV while blood is transfusing.  In multi-lumen catheters, medications may be added to the lumens not being used for the transfusion.

Blood received on the unit from the Blood Center must not be out of the Blood Center controlled refrigeration longer than 15-20 minutes before it is to be transfused.  If the transfusion cannot be started within this time, return blood units to the Blood Center for proper storage.

Simultaneous transfusion of more than one unit of blood or component should not be performed unless patient condition indicates a critical need.  If transfusion of more than one unit or component is necessary, each transfusion unit should be administered via separate IV access.


Infusion Rate:
Initial--at a rate not to exceed a total infused volume of greater than 50ml in the first 15 min.

Remainder of transfusion--PRN to maintain the desired rate
The transfusion should not exceed 4 hours.

An external pressure type blood pump may be used with a physician's order.  To prevent lysis of cells do not inflate the bag above 250 mm Hg.

Transfusion assessment/intervention must be documented on the "chart copy" issued by the Blood Center and either on the Nursing Notes/Flowsheet, Transfusion Flowsheet, or online via Blood Products Administration/NIC.
Transfusion Assessment/Intervention
Nursing Action
     Patient instruction/review: procedure and s/s reaction      Once: before transfusion
     Blood Label check/Blood Band and Patient ID in the presence of the patient     Once: Immediately before transfusion
     Filter selection      Once: As infusion is prepared.  Document type of filter used
     Vital signs      Baseline ( < 15 min. pre transfusion )
     15 min. after the start of the transfusion.
     At completion of transfusion
     plus PRN if s/s reaction occur
     Rate*      Initial:  at a rate not to exceed a total infused volume of greater than 50ml in the first 15 min.
     Remainder of transfusion:  PRN to maintain desired rate
     Assessment for s/s reaction
     s/s reaction include: (but no limited to)
     chills or fever (increase of > 1ºC from baseline
     sudden severe back pain or headache
     sudden abdominal pain or diarrhea
     Constant for the first 15 min.
     Every 30 min. throughout transfusion
     At completion of transfusion
     If s/s reaction are noted, stop the transfusion immediatly and follow steps outlined for transfusion reaction.
     * Delayed reactions may occur.  Follow steps as appropriate if transfusion completed.
     Tubing and filter change      After each unit recommended
     Every 4 hours required.

      * The volume to be transfused or the condition of the patient may preclude initial administration at a decreased rate.

When the Infusion is Complete
Complete the chart copy label and place it on form G9  Blood Transfusion Record, and insert it in the Chart