Question

Blood Administration

We have a 40-year-old patient who is anemic. related to a gastric bleed. They are stable but still needs a transfusion of Red packed blood cells because of hemoglobin of 6.9. The blood bank has called and notified you that the blood is ready to be picked up. Answer the following questions?

1) Before we administer a blood product what are the steps the nurse needs to do?

2) With another RN when the nurse is about to administer the blood, what needs to be verified before the infusion begins?

3) What is the rationale for flushing the line with NS before administration of the blood?

4) What is the rationale for infusing the blood slowly for the first 15 minutes?

5) The patient begins complaining of chills and headache after 10 minutes of the infusion and their temp is 101.2. What kind of reaction is this?

6) What does the nurse need to do because of the reaction?

7) What are the differences in Levoquin, Penicillin, Erythromycin, Doxycycline and their effects on different organisms and give examples?

Answer 1

1.Steps to do before administration

• Informed written consent; The nurse must check whether the patient is informed about the blood transfusion, indication, benefits and risk prior to transfusion in a clear and understandable language to the patient by the prescriber and the signature is obtained.
• Patient recent lab values to be obtained and verified for hemoglobin, red blood cells and other component to make sure the need of blood transfusion to avoid unnecessary blood transfusions.
• Obtain history of any kind of transfusion reactions in the past to avoid unintended complications like transfusion reactions
• Check and confirm the transfusion order by the prescriber for first and last names of the patient, patient identification number, type of blood product to be administered,volume or amount of blood to be transfused, rate of infusion or duration , date and time of transfusion, special transfusion requirements, Pre, intra or post medication if needed.
• Obtain intravenous access which is large enough for transfusion and confirm the patency.
• Assess vital signs and explain the procedure to the patient

2.Two registered nurses to be verified for the blood transfusion order, number of blood units to be transfused, patient identity, blood group and type with the label of blood bag, expiration date on the blood bag and observation of blood bag for unusual change in color or presence of precipitates.

3.the IV line to be flushed with saline to ensure that IV line is patent and identify chance of infiltration or  extravasation and to clear the line if any fluid or medication administered through the same line to prevent contact of blood with other substances.

4. The nurse should monitor the patient and remain bedside for the first 15 minutes, vital signs to be monitored and skin around the Iv site to be checked for any unusual signs. the rate of flow should be slow during this initial 15 minutes because the most serious blood transfusion reactions can start during this time.

5.The patient will be experiencing a febrile transfusion reaction which is most common during transfusion of packed red blood cells. The sudden rise in body temperature with chills are the major sign for febrile reactions.

6.The nurse should immediately stop the blood transfusion and disconnect the tubbings from the IV line. The IV line to be flushed with normal saline and saline infusion to be started to keep the line patent, the vital signs of the patient to be monitored. Notify the physician and the blood bank. Provide medications as directed and complete documentation of the event. A blood transfusion record to be filled according to facility policy.