Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Blood Transfusion
 Objectives
At the end of the discussion the student will be able to:
▪ Define what is blood transfusion
▪ Mention the purposes of blood transfusion
▪ Understand the Indications
▪ Perform assessment prior to blood transfusion
▪ Enumerate the different blood products
▪ Understand the general considerations in administering
blood transfusion
▪ State the Nursing responsibilities
▪ Administering blood transfusion (skill)
 Introduction
 Transfusion of blood and its products is very common
medical procedure in the practice of modern medicine.
Nursing staff plays a very important role and crucial role
in the blood transfusion procedure.
 Definition
 Blood transfusion is the transfusion of the whole blood or
its component such as blood cells or plasma from one
person to another person.

▪ Reaches patient’s blood vessels and enters the circulatory

system.
 Purpose
 Restore blood volume
 Replace clotting factors
 Improve oxygen carrying capacity
 Restore blood elements that are depleted
 Prevent complications
 To raise the hemoglobin level
 To provide antibodies
 Assessment
1. Assess the client for the indication of the blood product
to be given, that is low hematocrit or platelet count. This
will enable more specific evaluation of response to the
transfusion.
2. Verify the physician’s or qualified practitioner’s order for
the type of blood product to be given. Only he or she
may order blood products due to legal regulations.
3. Review the client’s transfusion history, especially any
reactions or pretransfusion medications to be given. If
prior reaction has occurred, premedication can be given
to prevent a subsequent reaction.
4. Review the baseline vital signs in the client’s medical
record in order to compare with vital signs during
transfusion. Changes in baseline may indicate transfusion
reaction.
5. Assess the type, integrity and patency of the venous
access in place so that the transfusion will be completed
without infiltration of the IV.
6.Verify that a large-bore catheter (18-or-19-gauge) is to be
used. This prevents hemolysis since red blood cells are
large and will not flow through a small-bore needle.
7. Review hospital policy and procedure for the
administration of blood productions. Each hospital has its
own policies to ensure safe administration of blood
products.
 Components of the blood
 Plasma- in which the blood cells are suspended, including:
 Red blood cells (erythrocytes)- carrying oxygen from the
lungs to the rest of the body
 White blood cells (leukocytes)- helps fight infections and
aid in the immune system process.
Types of white blood cells:
 Lymphocytes

 Monocytes
 Eosinophils -fight substances r/t parasitic infection
 Basophils- to defend your body from allergens, pathogens and parasites

 Neutrophils (granulocytes) – 1ST IMMNUNE CELLS

RESPOND WHEN MICROORGANISMS SUCH AS BACTERIA OR VIRUSES, ENTER THE BODY
 Platelets (thrombocytes)- help in blood clotting.
 Fat globules
 Chemical substances, including:
➢ Carbohydrates
➢ Proteins
➢ Hormones
 Gases, including:
➢ Oxygen
➢ Carbon dioxide
➢ Nitrogen
 Blood transfusion products
1. Whole blood- provides both O2 carrying capacity and
volume expansion
2. Red blood cells- contains the oxygen carrying capacity
(hemoglobin); for the treatment of anemia in
normovolemic patients who require an increase in the
oxygen capacity.
3. Platelets – for the treatment of bleeding cause by
thrombocytopenia
 Functions of blood
 Blood carries the following to the body tissues:
o Nourishment
o Electrolytes
o Hormones
o Vitamins
o Antibodies
o Heat
o Oxygen
 Blood carries the following away from the body tissues:
o Waste matter
o Carbon dioxide
 Blood Component Infusion Rates

o Red blood cells – 1 unit over 2-3 hours (less than 4 hours)
o Platelets - 30-60 minute or more slowly (less than 4
hours)
o Fresh Frozen plasma – 200 ml/ or more slowly
o Cryoprecipitate – 1-2 ml/min.
General considerations in giving blood
transfusion
 Donor shall be free of disease
 No history of any disease
 They have not donated blood within the previous 90 days (3
months).
 They should be physically healthy, and should be between 18
and 65 years old.
 Donor must have a normal temperature, pulse rate and blood
pressure.
 They must not have been pregnant within the last 6 months
 Their hemoglobin level must be above 12 grams
per 100ml for female and 13 grams for male per
100ml.
 The donors are disqualified who have a history of recent
dental surgery or major surgery, receipt of blood or blood
components, immunizations or vaccinations, use of
narcotic drugs.
 Before the blood transfusion, the ABO grouping and Rh
typing with the recipient’s blood should be done.
 Before the blood is transfused, the donor’s blood must be
cross matched with the recipient’s serum (plasma)and the
recipient’s red blood cells.
 Explain the procedure to the donor and reassure him/her
to with confidence and cooperation.
 Blood should not be collected to the empty stomach
 A second withdrawal of blood should not be made until
the blood volume and constitutes have returned to
normal, that is usually after 3 months.
 Each donor unit must be labeled in clear, readable letters,
bearing the following information to be verified at the
time of administration :
o Name of donor
o Donor number
o ABO grouping
o Rh typing
o Date of drawing
o Date of expiry
o Results of tests for hepatitis and syphilis.
 Whole blood and packed cells administered cold. No
attempt is made to heat the blood. However, blood may
be allowed to stand at the room temperature for 30 to 45
minutes before it is administered to the patient.
 Once the blood is exposed to the atmosphere ( the unit is
opened), it should be discarded.
 The following observation are made throughout the
procedure:
➢ Rate of flow
➢ Signs of circulatory overload
➢ Urinary output
➢ The needle site for signs of infiltration, hematoma and
dislodgement of needle.
➢ Blood level in the container. Never allow the blood bottle
to be completely empty to prevent the entry of air
➢ Reaction to the blood transfusion
➢ Patency of the infusion set.
➢ Keep the patient warm and comfortable with blankets if
necessary.
➢ Offer bedpan before starting the procedure and as
necessary.
 Blood types
 Each person has one of the following blood types: A, B,
AB, or O.
 ‘O’ can be given to anyone but can only receive ‘O’
 ‘AB’ can receive any type but can only be given to ‘AB’
 Also, every person’s blood is either Rh-positive or Rh-
negative.
 Blood types
 The blood used in a transfusion must be compatible with
the patient’s blood type.
 Type ‘O’ blood is called the universal donor
 People with type ‘AB’ blood are called universal
recipients
 People with Rh-positive blood can get Rh-positive or Rh-
negative blood. But people with Rh-negative blood should
get only Rh-negative blood.
 The Rhesus (Rh) System
 The antigen to be considered always- the Rh antigen.
 Some of us have it, some of us don’t have.
 If it is present, then the blood is RhD positive, if not it’s RhD negative.
 For example, some people in group A will have it, and will therefore be
classed as A+ (or A positive).
 While the ones that don’t, are A- (or negative).
 And it goes for groups B, AB and O
 According to above blood grouping systems, you
can belong to either of the following 8 blood
groups:

- A Rh+ A Rh-
- B Rh+ B Rh-
- AB Rh+ AB Rh-
- O Rh+ O Rh-
 Equipment
 Blood products
 Blood administration set (with in-line filter) (Y- tube)
 0.9% normal saline solution for IV infusion
 IV pole
 Venous access with 20 gauge catheter or larger
 Clean gloves
 Tape
 Second nurse for verification of blood products and patient
information
 Nursing Responsiblities
 Confirm that there is a Physician’s order and a signed
consent from the client
 Have two nurses confirm that the client name and ID
number, blood type, Rh type and product unit numbers
are correct. Check also the expiration date.
 Make sure the transfusion is started within 30 minutes of
arrival at bedside
 Maintain asepsis. If possible wear gloves before
performing venipuncture, transfusing blood, and when
terminating blood and disposing of equipment.
 Use appropriate blood administration set
 Mix the blood cells with plasma gently to maintain their
integrity
 Assess the client closely for transfusion reactions
 If any reaction occurs
a. Stop infusion immediately
b. Notify Physician
c. Maintain patency of the IV with normal saline
d. Send the blood to the laboratory
e. Monitor vital signs frequently
f. Send urine specimen to the laboratory if hemolytic
reaction is suspected.
 No medicine such as; antibiotics, vitamins, calcium should
be added to the unit of blood or administered through the
same intravenous system as they may cause damage to
the red cells. If the client is receiving multiple IV
medications on strict schedule consider starting a second
IV line for a lengthy blood transfusion .
 Blood products should not be transfuses simultaneously or
immediately preceding or following medications also
capable of causing allergic-type reaction. Distinguishing
the etiology of the reaction could be difficult.
 Procedure
1. Verify Doctor’s order for blood transfusion
▪ Verify completion of informed consent in the in the
patient’s medical record
▪ Verify any order for pre-transfusion medications. If
ordered, administer ordered at least before 30 minutes
2. Gather all equipment and bring it to the bedside
3. Perform hand hygiene and put on the PPE if indicated
4. Identify the patient
5. Provide privacy and explain the procedure to the patient.
Advise patient to report any untoward signs and symptoms
such as:
➢ Chills
➢ Itching
➢ Rash
➢ Difficulty of breathing
➢ chest pain
➢ or any unusual symptoms
 6. Verify and record the blood products and identify the
client with another nurse
o Client’s name, blood group, Rh type
o Cross-match compatibility
o Donor blood group and Rh type
o Unit and hospital number
o Expiration date and time on blood bag
o Type of blood product compared with Physiscian’s or
qualified
practitioner’s order
o Presence of clots in blood
7. Instruct client to empty bladder.
8. Wash hands and put on gloves
9. Open blood administration kit and move roller clamps to
“off” position.
10. For Y-tubing set:
o Spike the normal saline bag and open the roller clamp on
the Y-tubing connected to the bag and the roller clamp on
the unused
inlet tube until tubing from the normal saline bag is filled.
Close clamp on unused tubing.
o Squeeze sides of drip chamber and allow filter to partially
fill
o Open lower roller clamp and allow tubing to fill with
normal saline to the hub.
o Close lower clamp.
o Invert blood bag once or twice. Spike blood bag, open
clamps on inlet tube to allow blood to cover the filter
completely.
o Close lower clamp.
11.For single-tubing set:
o Spike blood unit.
o Squeeze drip chamber and allow the filter to fill with
blood
o Open roller clamp and allow tubing to fill with blood to
the hub.
o Prime another IV tubing with normal saline and piggyback
it to the blood administration set with a needle and
secure all connections with tape.
12. Attach tubing to venous catheter using sterile
precautions and open lower clamp.
13. Infuse the blood at a rate of 2-5ml/min. according to the
physician’s or qualified practitioner’s order.
14. Remain with client for first 15-30 minutes, monitoring
vital signs every 5 minutes for 15 minutes, then every 15
minutes for 1 hour, then hourly until 1 hour after the
infusion is completed.
15. After blood has infused, allow the tubing to clear with
normal saline.
16. During transfusion, assess frequently for transfusion
reaction. Stop blood transfusion if you suspect a reaction.
Quickly replace the blood tubing with a new administration
set primed with normal saline for IV infusion at the rate of
40ml per hour.
Obtain vital signs and notify physician and blood bank.
17. When transfusion is complete close roller clamp on blood
side of administration set and open on normal saline.
18. When all of blood has infused into the patient,clamp
administration set.
19. Obtain vital signs.
20. Put on gloves
21. Dispose of the blood transfusion equipment or return to
the blood bank as per policy.
22. Remove equipment. Ensure patient’s comfort. Remove
gloves and additional PPE.
23. Perform hand washing
24. Document the procedure.
 Nursing responsibilities after the
procedure
EVALUATION:
o Observe for signs of transfusion reaction.
o Observe client and laboratory values to determine response to
transfusion.
DOCUMENTATION:
o Record patient name, ID number, blood component and component
number, names of individual verifying blood component, name of
individual starting and ending transfusion, start and end times,
volume transfused and reaction if any.