Only appropriately trained registered nurses may undertake the commencement of a
blood transfusion.

  • Has the unit been prescribed ?

  • Confirm the unit is safe to use by checking that the pack is in date and shows no sign of leakage, unusual colour or haemolysis.

If in doubt do not transfuse it !




Identity check of patient and blood

1. Two members of staff must carry out a bedside check.

2. The patient identification details must be identical on :

  • The patient’s identity band
  • The compatibility label on the pack
  • The form sent with the blood from the blood bank

3.. Ask the patient to state their first name, surname and date of birth. Check that it is the same on the
     wristband, compatibility label on the pack, and on the form sent from the blood bank.


4. The ABO  and Rh D group and donation number must be identical on:

  • The blood pack
  • The form sent from the blood bank

5. The pack and form must be checked for any special blood requirements.


6. Transfusion must commence within 30 minutes of removing from the refrigerator in order to minimise  
    the risk of bacterial proliferation.




Record keeping and observations

Before starting transfusion, record the time the transfusion was started, blood pressure, pulse and temperature.

Check pulse and temperature 15 minutes after starting each pack.

Observe the patient periodically during  the transfusion.

If the patient is conscious further recordings are only needed if the patient becomes unwell or has signs or symptoms of a reaction.

An unconscious patient should have pulse and temperature checked at 15 minute intervals during the transfusion.

Further observations should be taken if the patient becomes unwell or shows signs of a transfusion reaction.

Repeat blood pressure, pulse and temperature when the transfusion is complete.

Record time transfusion is completed.

Complete fluid balance chart to enable accurate fluid intake and output recording.


Management of Transfusion reactions

Throughout the transfusion, observe the patient for any signs or symptoms of incompatibility or adverse reaction.   e.g. flushing, fever, urticaria, itching, hypotension, rigor, pain, haemoglobinuria, collapse or circulatory failure.
Should any of these be observed, the transfusion must be stopped immediately and the doctor informed.
Further management depends on the severity of the reaction.


Time limits for infusion of blood components

Red cells Infusion must start within 30 minutes.
Infusion should take a maximum of four hours - most patients should be transfused at 2 hours per unit.
Red cells must be administered through a blood giving set.
Blood can be returned to the Blood Bank refrigerator within 30 minutes.
Platelets Never put platelets in any refrigerator.
Start infusion as soon as the pack is received from the blood bank.
 Platelets must be administered through a blood giving set - use a fresh set, not one that has been used for blood.
Infuse over not more than 30 minutes (or as instructed).
Plasma Once thawed, infusion should be completed within 4 hours.
Start transfusion as soon as thawed pack is received from
blood bank.
Plasma must be administered through a plasma giving set or a blood giving set.




Blood Products and Pharmaceuticals

No other infusion solutions or drugs should be added to any blood component. They may contain additives, such as calcium, which can cause citrated blood to clot. Dextrose solution (5%) can cause destruction of red cells.

Drugs should never be added to any blood product. If there is an adverse reaction it may be impossible to determine if this is due to the blood, the medication that has been added or to an interaction of the two.


References:
1.  Handbook of Transfusion Medicine (3rd edition) 2001.
2.  Standards for records and record keeping (2002) NMC.
3.  Good Hope NHS Trust Transfusion Guidelines.