BLOOD ADMINSTRATION

INTRODUCTION:- The physician determines which blood component is needed to treat a client’s medical condition.
Blood products are ordered to restore circulating blood volume, to improve hemoglobin levels or to correct serum protein
deficiencies. Clinical indicators differ among blood products and the nurse is responsible for understanding which
components are appropriate in various situations.

A blood transfusion is a safe, common procedure in which you receive blood through an intravenous (IV) line inserted
into one of your blood vessels. Blood transfusions are used to replace blood lost during surgery or a serious injury. A
transfusion also might be done if your body can't make blood properly because of an illness. During a blood transfusion, a
small needle is used to insert an IV line into one of your blood vessels. Through this line, you receive healthy blood. The
procedure usually takes 1 to 4 hours, depending on how much blood you need. Blood transfusions are very common. Each
year, almost 5 million Americans need a blood transfusion. Most blood transfusions go well. Mild complications can
occur. Very rarely, serious problems develop.

DEFINITION:-Blood administration or transfusion therapy is the intravenous administrations of whole blood or blood
products.

PURPOSES:-

 To restore blood volume after severe hemorrhage.

 To restore the oxygen carrying capacity of the blood.
 Maintain hemoglobin levels in severe anemia
 Replace specific blood component. 
 Assessment focus Clinical signs of reaction (e.g. sudden chills, nausea, itching rash, dyspnea) status of infusion,
site, any unusual symptoms

BLOOD TYPES:-

Every person has one of the following blood types: A, B, AB, or O. Also, every person's blood is either Rh-positive or
Rh-negative. So, if you have type A blood, it's either A positive or A negative.

The blood used in a transfusion must work with your blood type. If it doesn't, antibodies (proteins) in your blood attack
the new blood and make you sick.

Type O blood is safe for almost everyone. About 40 percent of the population has type O blood. People who have this
blood type are called universal donors. Type O blood is used for emergencies when there's no time to test a person's blood
type.

People who have type AB blood are called universal recipients. This means they can get any type of blood.

If you have Rh-positive blood, you can get Rh-positive or Rh-negative blood. But if you have Rh-negative blood, you
should only get Rh-negative blood. Rh-negative blood is used for emergencies when there's no time to test a person's Rh
type.

Blood Types RBC antigens Plasma antibodies

A A B
B B A
AB -- A and B
O A and B --
RHESUS (Rh) FACTOR:-

Rhesus (Rh) factor antigen is present on RBCs of approximately 85% of the people. Blood that contain the Rh factor is
known as Rh positive, when it is not present the blood is said to be Rh negative.

BLOOD TYPING AND CROSS MATCHING:-

To avoid transfusion incompatible red blood cells, both blood donor and recipient are typed and cross matched. Blood
typing is done to determine the ABO blood group and Rh status. This test is performed to on pregnant women and neonate
to assess for possible intrauterine exposure of incompatible blood type. Because blood typing is only determine the
presence of major ABO and Rh antigen, cross matching also is necessary prior to transfusion.

SELECTION OF BLOOD DONORS:-

1. Age > 18: Our program will not consider donation from individuals under the age of 18.
2. Smoking: T. Candidates will not be considered for donation unless they have been tobacco free (including chewing
tobacco) for at least 8 weeks prior to donation and smoking is strongly discouraged after donation to protect long term
health.
3. Drug Use: Potential donors must not use any illicit drugs. This includes periodic use of any drug such as marijuana in
any form (including orally). Potential donors who use chronic pain medication experience a higher incidence of post-
operative pain after donation.  These individuals may be requested to see a surgeon and/or psychiatrist prior to being
considered for donation.  The transplant team may request random drug screening if there is concern regarding drug use.
Failure to comply with requests for drug screening would be considered cause for declining donation.
4. Health Problems: Donors must be healthy individuals. If a donor has a past history of suffering from the following
problems, or if these are discovered during the medical evaluation, a donor may be declined.
 High blood pressure treated with medication
 Diabetes
 Gestational diabetes
 Polycystic kidney disease
 Substance abuse
 Heart / heart valve disease or peripheral vascular disease
 Lung disease with impaired oxygenation or ventilation.
 Recent cancer or a history of cancer that typically takes a long time to recur
 Protein in the urine > 300 mg per 24 hours (a test of kidney function).
 Active hepatitis B or C infection or HIV infection.
 Use of medicines that are known to cause kidney damage.
 History of blood clots or risk factors for the development of blood clots
5. Obesity:  Obesity is an independent risk factor for kidney disease. Candidates with a body mass index of over 35 will
generally not be considered for donation unless an individual is very muscular. Individuals with a BMI of >25 will meet
with a dietitian to discuss strategies to remain at a healthy weight for life.
6. Psychosocial Issues: The social worker will evaluate many psychosocial aspects of living donation with the potential
donor. Donors may be declined if they have inadequate support for recovery, questionable donor-recipient relationship or
motivation for donation, a history of poor coping or psychiatric illness, a history of not taking good care of their health, or
other similar concerns.

BLOOD PRODUCT FOR TRANSFUSION:-

PRODUCTS USES
Whole blood Use in case of hemorrhage.
Replace blood volume and all blood products: plasma, fresh
platelets, RBCs, plasma protein and clotting factors.
Packed red blood cells Used to increase the oxygen carrying capacity of blood
anemia’s, surgery and disorder with slow bleeding.
Autologus red blood cells Use for blood replacement following planned elective
surgery.
Client denotes blood for autologus transfusion 4-5 weeks
prior to surgery.
Platelets Replace in platelet disorder.
Fresh frozen plasma Expand blood volume and provides clotting factors.
Albumin and plasma protein fraction Blood volume expender
Provide plasma protein.
Clotting factors and cryoprecipitate Used for patient with clotting factors deficiencies.
PATIENT INSTRUCTIONS AND PREPARATION
Informed Consent

o Informed consent may be obtained by a physician, a nurse, or a physician extender who is knowledgeable
about blood transfusion and the patient’s condition so as to be able to explain the elements of informed
consent above.
o The risks of transfusion, including adverse symptoms and alternatives to homologous (allogeneic)
transfusion, must be discussed with the patient well before the transfusion.
o The patient is then given a choice to accept or decline transfusion
o Consent should be documented in the medical chart using the form.

Refusal of Blood Transfusion

o The form "Patient’s Release Form for Refusal of Blood or Treatment" should be used to document the
patient’s refusal of transfusion. The form is available on the Blood Bank web site.

Receipt of Blood Components

The person receiving the blood being transported or opening the tube at the receiving location must immediately upon
receipt

Step Action
1 Verify

 Product is designated for a patient at the receiving location

 Name and admission number recorded on the Transfusion Record Form attached to the unit correspond
with that of the intended recipient
 Unit has a normal appearance.

2 The person receiving the blood component should:

 Record the date and time that the blood was received/removed from the pneumatic tube on the Blood
Delivery form
 Sign the Blood Delivery form

3 Return the signed and dated Blood Delivery Form to the Blood Bank using hospital mail
4 Verify that red blood cells and plasma components were received within 30 minutes of the dispensed time
stamp on the form. If Then
If more than 30 minutes the Red Blood Cells or plasma may be used for immediate transfusion that will be
have elapsed since the completed within 4 hours of the time stamp, transfuse the component.
time stamp on the Blood
Delivery Form Do not store Red Blood Cells and plasma that has been out of refrigeration for
more than 30 minutes in patient care unit Blood Refrigerators.
If the blood component is not needed for immediate transfusion, return the Red
Blood Cells or plasma to the blood bank for proper disposal.
Special Labels

o When blood is released for transfusion under unusual circumstances a special notation will be indicated on the
Transfusion Record Form.
o This information will often suggest to physicians and nurses that particular caution must be exercised during
transfusion, and that the blood transfusion should be terminated at the first sign of an untoward reaction.
o Personnel initiating the transfusion who have questions concerning the significance of this information should contact
the Blood Bank.

IMMEDIATELY PRIOR TO BLOOD TRANSFUSION

Pre transfusion Vital Sign Documentation

o To provide a baseline, record the patient's blood pressure, pulse, respirations and temperature in the chart or on the
transfusion record form

If a patient is febrile, consideration should be given to postponement of blood transfusion, since the fever may mask the
development of a febrile reaction to the blood component itself.

 Verify physician's orders for transfusion and any that any pretransfusion medications have been administered
 Perform bedside verification of patient and component Using the
 labels on the bag,
 the Transfusion Record Form and
 the patients attached positive patient identifier.

These steps must never be bypassed.

1 Ask the patient to state his or her name. Verify patient and component identification information.
2 Verify the blood type, donor number, component name
3 Verify compatibility: a compatibility chart is on the back inside cover of this booklet.
4. Verify the product is not outdated
5. Sign the Transfusion Record Form before blood transfusion is initiated.
6. The person who hangs the blood must record the date and time the transfusion was started
7. Record the date, time, component and unit number on the appropriate sheet on the patient's chart. Refer to
unit policy and procedures.
DO NOT START the transfusion if there is any discrepancy. Contact the Blood Bank.

Initiating the Transfusion

o Immediately before transfusion, mix the unit of blood thoroughly by gentle inversion.
o Follow the manufacturer's instruction for the use of special filters and ancillary devices. Additional administration
instructions for selected components are printed at the end of this chapter and are available upon request from the
Blood Bank.
o If any part of the unit is transfused, the unit is considered transfused.

Flow Rates
Initial Flow Rate Slowly at no more 1 mL/minute to allow for recognition of an
acute adverse reaction. Proportionately smaller volume for
pediatric patients.
Standard Flow Rate – Adults If no reaction occurs in the first 15 minutes, the rate may be
increased to 4 mL/minute
Pediatrics 10-20 mL/kg over 30-60 minutes
Usual Infusion time Red Blood Cells: two hours unless the patient can tolerate only
gradual expansion of the intravascular volume

Platelets, plasma and cryoprecipitate: 10 mL per minute. The

transfusion may be administered as rapidly as the patient can
tolerate, usually 30 minutes.
Maximum Infusion Time Infusion time should not exceed 4 hours for any component.
If rate slows appreciably investigate immediately

Consider measures that may enhance blood flow

 repositioning the patient's arm,

 changing to a larger gauge needle,
  changing the filter and tubing,
 and elevating the IV pole, if gravity rather than a pump is
being used.

During the Transfusion Document

What  temperature, blood pressure, respirations and pulse, and

examine the skin for urticaria.
 Assess flow rate

When  before initiating the transfusion

 after the first 15 minutes
 after 30 minutes
 hourly until one hour after completion of the transfusion

Outpatient Post Transfusion Vital Signs For outpatient transfusions, the vital signs may be taken at 30
minutes post transfusion.
If the patient has a preexisting fever

The need for transfusion must be balanced with the risk of transfusion. Contact the patient’s physician to determine if pre
transfusion medications should be administered.

If a patient is being transported with blood hanging

Patients should not be transported with blood components infusing unless accompanied by a clinician who can monitor
and respond to a potential reaction.

Medications

o Do not add medications directly to a unit of blood during transfusion.

o Medications that can be administered "IV Push" may be administered by stopping the transfusion, clearing the line at
the medication injection site with 5-10 mL of normal saline, administering the medication, reflushing the line with
saline and restarting the transfusion.

At the Termination of Transfusion

 date and time transfusion was stopped

 volume of blood infused
 Check the box documenting the presence/absence of a transfusion reaction.

Discontinue the isotonic saline solution used to initiate the transfusion after the completion of the transfusion unless
specifically ordered.
Document the patient's response to the transfusion in the patient's medical record.

If a Transfusion Reaction is Suspected

o Stop the transfusion

o Maintain the IV.
o Save the bag and attached tubing

ARTICLES

 Blood administration set

 250 ml 0.9% NaCl IV solution
 Alcohol swabs
 Disposable clean gloves
  Tapes
 Blood pressure cuff and stethoscope
 Thermometer
 Signed transfusion consent form

STEPS RATIONALE
1. Complete pre procedure.
2. Verify that IV cannula is patent and without  It ensures that transfusion will be infiltrated infused
complication such as infiltration or phlebitis. In with in time. Gauge of IV cannula should be
emergency situations that require rapid transfusions, 16 appropriate. Large cannula promotes optimal flow of
or 18 gauge cannula is preferred; transfusion for blood components. Uses of smaller cannula such as
therapeutic indications may be infused with cannulas 22 to 24 gauges may require to blood bank to divide
ranging from 20 to 24 gague. unit so that each half can be infused within allotted
3. Obtain client’s transfusion history. time.
 Identifies client’s prior response to transfusion of
4. Review physician’s order for blood component blood components.
transfusion. Check that consent has been properly  For checking Physician’s order must be present before
completed and signed by client. transfusing blood products and to provide complete
information to patient about procedure.
5. Obtain and record vital signs before administration of
transfusion.  To check the baseline data and to alert the patient
about warning signs.
6. Pre administration:-
a. Obtain blood component from blood bank.
b. Correctly verify product and identify client with person  To ensure that product is safe to administer.
considered qualified by your agency:-  Strict adherence to verification procedure before
administration of blood or blood components reduces
risk of administering wrong blood to client.
i. Check client’s first and last names by having client  Notify blood bank and appropriate personnel as
state name, if able. indicated by agency policy.
ii. Verify that component received from blood bank is  Ensures that client receive correct therapy.
component ordered by physician.
iii. Check that client’s blood types and Rh type are  Verifies accurate donor blood type. Air bubbles, clots
compatible with donor blood type and Rh type. or discoloration may be indicating bacterial
iv. Check that unit number on unit of blood and on from contamination or inadequate coagulation of stored
blood bank match. component.
v. Check expiration date and time on unit of blood.  Expired blood should never be used, because cell
components deteriorate and may contain excess
citrate ions.
vi. Record verification process as directed by agency  Documentation on legal medical record.
policy.

7. Administration:-
a. Autologous transfusion only:-  Allow collection of client’s blood for reinfusion,
i. Connect drainage tubes to collection container or storage no longer than 6 hours or washing and
cell processing system. spinning.
ii. Minimize air bubbles by establishing secure
connections.
b. Open Y tubing blood administration set.  Y Tubing is used to facilitate maintenance of Iv
access in case client needs more than 1 unit of
blood. Both a unit of blood and container of 0.9%
NaCl are connected to system.
c. Set roller clamp to “off” position.  Moving roller clamps to “off” position prevents
accidental spilling and wasting of product.
d. Spike 0.9% NaCl IV bag with one of Y tubing  Primes tubing with fluid to eliminate air on both
spikes invert filter, open roller clamps of IV bag sides of Y tubing. Inverting filter to fill from top to
 and component side of Y, keeping common tubing bottom reduces formation of air pockets. closing
clamp below filter closed. set IV bag on table and roller clamp prevents spillage and waste of fluid.
gently press down to squeeze IV bag to fill both
sides of Y tubing. Close tubing clamp of
component side of Y, and open common tubing
clamp below filter. Continue to press down on IV
saline bag to completely fill filter and half of drip
chamber. Close both tubing clamps. All Three
tubing clamps should be closed.
e. Hang on IV pole. Open common tubing clamp to  This will completely prime tubing with saline and
finish priming Tubing to distal end of tubing IV line is ready to be connected to client’s vascular
connector. Close tubing clamp when tubing is filled access device.
with saline. Maintain protective sterile cap on
tubing connector.
f. Prepare blood component for administration.  Protective barrier drape may be used to catch any
Remove protective covering from access port. potential blood spillage. Tubing is primed with
Spike blood component unit with other Y blood unit and ready for transfusion into client.
connection. Hang on IV pole. Open clamp of Y
connected to blood unit and open common tubing
clamp to prime tubing with blood. Allow saline in
tubing to flow into receptacle, being careful to
ensure that any blood spillage is contained in blood
precaution container.
NURSE ALERT:- Normal saline is compatible with
blood products, unlike solutions that contain dextrose,
which cause coagulation of donor blood.
g. Maintaining asepsis, attach primed tubing to  This initiates infusion of blood product into client’s
client’s VAD. Open common tubing clamp. vein.
h. Remain with client during first 5 to 15 min of  Most transfusion reactions occur within first 5 to 15
transfusion. Initial flow rate during this time should min. of transfusion.
be 2ml/ min.
NURSE ALERT:- If signs of a transfusion reaction
occur, stop infusion, start normal saline with new
primed tubing directly into VAD at KVO (5-10 ml/ hr)
and notify the physician immediately.
i. Monitor client’s vital signs 5 min. after blood  Frequent monitoring of vital sign will help quickly
product has begun infusing and per agency policy alert nurse to transfusion reactions.
after that.
j. Regulate rate of transfusion according to  Maintaining prescribed rate of flow decrease risk of
physician’s orders. (Drop factor for blood tubing is fluid volume excess while restoring vascular
10 gtt/ ml) volume.
NURSE ALERT:- A unit of whole blood should not
hang for more than 4 hrs because of the danger of
bacterial growth.
k. After Blood has infused, clear IV line with normal  Infusing IV saline solution infuses remainder of
saline and discard blood bag according to agency blood in IV tubing and keep IV line patent for
policy. supportive measures in case of transfusion reaction.
 Standard precautions during transfusions reduce
l. Appropriately dispose of all supplies. Remove transmission of micro organisms.
gloves and perform hand hygiene.  Detects presences of infiltration or phlebitis and
8. Monitor IV site and status of infusion each time vital verifies continuous and safe infusion of blood
signs are taken. products.
 These may be early signs of transfusion reaction.
9. Observe for any change in vital signs and for chills,
flushing, itching, dyspnea, rashes or other signs of
transfusion reaction.
10. Complete post procedure protocol.

AFTER CARE:- Recording and reporting:-

 Record type of blood component and amount administered

 Record starting and finishing time of blood administration.
 Report signs and symptoms of transfusion reaction immediately.

NURSING MANAGEMENT:-

Unexpected outcomes Nursing interventions

Hemolytic reaction:- Client displays signs  Stop transfusion.
and symptoms of transfusion reaction which  Normal saline should be connected at vascular access hub to
include:- prevent subsequently blood from infusing from tubing.
 Fever with or without chills  Disconnect blood tubing at VAD hub, and cap distal end with
 Tachycardia sterile connector to maintain sterile system
 Tachyponea  Keep vein open with slow infusion of normal saline at 10 to 12
 Wheezing gtt/ min. to ensure venous patency.
 Dysponea  It is impotant to regulate flow rate to minimize administration of
 Headache excess IV fluid, especially in client who are prone to fluid
 Flushing of skin overload.
 Hives or itching
 Hypotension
 Gastrointestinal system

Client develops infiltration or phlebitis at  Remove IV and insert new VAD in different site.
veni puncture site.  Product may be restarted if reminder can be transfused within 4
hours of initiation of transfusion.
 Nursing measures to reduce discomfort at infiltration site.
Fluid overload:- occurs and client exhibit  Slow and stop Transfusion.
difficulty in breathing and crackles upon  Elevate head end side of bed
auscultation  Inform physician about physical findings
 Administered diuretics, morphine and oxygen as doctors order
 Continue frequent assessment
 Check vital signs at regular interval time.
Sepsis:- High grade fever, chills, vomiting,  Stop transfusion
diarrhea, hypotension  Keep the vein open with normal saline
 Notify the primary care provider.
 Administer IV fluids, antibiotics
 Obtain a blood specimen from the client for culture.
 Send remaining blood and tubing to the laboratory.
Febrile reactions:- High grade fever, chills,  Stop transfusion
Headache, Flushing of skin, anxiety, muscle  Keep the vein open with normal saline
pain  Notify the primary care provider.
 Give antipyretics to the patient.
Allergic reactions:- Flushing, itching,  Stop transfusion
urticaria, bronchial wheezing, chest pain,  Keep the vein open with normal saline
cardiac arrest  Notify the primary care provider.
 Give antihistamine to the patient.

BIBLIOGRAPHY:-
1. Potter Perry. Basic Nursing 6th edn..Mosbi, Missouri, 2006.
2. Carel Tyler Carel Lilli, Pricilla Lemone. Fundamentals of Nursing. Lippincott’s Williams Philadelphia, 2006