It is critical for nurses to know and understand the principles of blood transfusion to prevent life-threatening transfusion reactions from occurring. This pocket card reviews the different types of blood products as well as nursing tips for transfusions.
Y-type IV set with 10-micron filter (unless 20- to 40-micron filter ordered) Transfuse slowly but within 4 hours of initiation.
Symptomatic anemia Acute anemia caused by trauma, acute or surgical blood loss, or chemotherapy Chronic anemia associated with cardiovascular decompensation
Y-type IV set with 10-micron filter (unless a 20- to 40-micron filter is ordered) Transfuse slowly but within 4 hours of initiation.
Patients at risk for reactions caused by leukocyte antibodies with any of the following: Symptomatic anemia Immunocompromised Acute anemia caused by trauma, surgical blood loss, or chemotherapy Chronic anemia related to cardiovascular decompensation
Sepsis unresponsive to antibiotics, if patient has blood cultures positive for sepsis or a persistent fever greater than 101 F combined with granulocytopenia (granulocyte count less than 500/uL)
Control or prevent bleeding due to decreased or malfunctioning platelets Increase platelet count in patients who require an invasive procedure
Component drip set to infuse 100 mL over 15 minutes. Don t use a microaggregate filter. Transfuse as quickly as tolerated, within 4 hours of initiation.
Noncellular portion of blood that is separated and frozen after donation; contains coagulation factors and proteins 200 to 250 mL
Plasma exchange thrombotic thrombocytopenia Factor deficiency (if concentrate is unavailable) Treat abnormal coagulation prior to invasive procedures Liver disease with protein synthetic defect Dilutional coagulopathy Consumptive coagulopathy
Small plasma protein prepared by fractionating pooled plasma 5% (buffered saline) 12.5 g/250 mL 25% (salt-poor saline) 12.5 g/50 mL
Replace volume lost due to shock from burns, trauma, surgery or infection Prevent significant hemoconcentration Treat hypoproteinemia (with or without edema)
Treat hemophilia A (standard dose is 15 to 20 units/kg) Control bleeding associated with factor VIII deficiency Replace fibrinogen or deficient factor VIII
Lyophilized, commercially prepared solution drawn from pooled plasma Prothrombin complex
Congenital factor V deficiency Disorders associated with an acquired lack of factors II, VII, IX, and X
Hemophilia (lack factor VIII) Low levels of fibrinogen, von Willebrand factor, factor XIII, and fibronectin
Use a pyrogen-free transfusion set with appropriate filter. Infuse immediately after thawing over 15 to 30 minutes.
One of the most common blood products transfused are red blood cells. It is important that nurses have knowledge of transfusion thresholds for which transfusions are indicated. The most recent transfusion guidelines from the Association for the Advancement of Blood Biotherapies recommend a restrictive transfusion strategy considering transfusion when hemoglobin concentration is less that 7 g/dL with a less restrictive threshold of 7.5 g/dL for patients undergoing cardiac surgery and 8 g/dL for those undergoing orthopedic surgery or those with pre-existing cardiovascular disease (Carson et al., 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. Consult your facility s policy regarding blood transfusion. Most institutions require two nurses or practitioners to identify the patient using two criteria and to double-check blood product compatibility before transfusion to prevent errors and a possible fatal transfusion reaction.
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.
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.
Carson, J. L., Stanworth, S. J., Guyatt, G., Valentine, S., Dennis, J., Bakhtary, S., Cohn, C. S., Dubon, A., Grossman, B. J., Gupta, G. K., Hess, A. S., Jacobson, J. L., Kaplan, L. J., Lin, Y., Metcalf, R. A., Murphy, C. H., Pavenski, K., Prochaska, M. T., Raval, J. S., Salazar, E., Pagano, M. B. (2023). Red Blood Cell Transfusion: 2023 AABB International Guidelines. JAMA, 330(19), 1892 1902. https://doi.org/10.1001/jama.2023.12914
Lippincott Advisor (2023, July 10). Blood and blood product transfusion.
https://advisor.lww.com/lna/document.do?bid=3 did=1281588 searchTerm=blood%20transfusion hits=blood,transfusion,transfusions,transfused,transfuse,transfusing
Connect with us on Facebook, Twitter, Linkedin, YouTube, Pinterest, and Instagram.
Get access to this Pocket Card and UNLIMITED access to all our clinical content when you join NursingCenter.
Content created and reviewed by NursingCenter's team of clinical experts. Authoritative, evidence-based pocket cards, guideline summaries, and more so you can put research into practice sooner.
