Formal Reflection

Hunter Garry

College of Nursing, University of South Florida

 Formal Reflection

In the ICU there can be many different complex and challenging clinical situations that

can make for great learning opportunities. One situation that I learned a lot from occurred when a

patient was having a blood transfusion reaction. In this reflection I will be describing a case

involving a blood transfusion reaction that served as a significant learning experience, prompting

reflection on practice and decision-making processes.

Noticing

The patient was a 65-year-old male who had small cell lung cancer that metastasized to

the brain. He was admitted to the ICU due to respiratory distress. The patient’s hemoglobin was

critically low and the physicians put in orders for a blood transfusion. When we started the

transfusion, everything seemed to be going fine and we took our 5 min vitals and noticed he was

starting to fever a little. Just as we realized he was fevering his blood pressure began to drop and

he started getting hives on his skin. After seeing these symptoms and applying what I learned in

lecture, my nurse and I decided he was having a blood transfusion reaction.

Interpreting

To interpret what was going on in this situation, I had to know some additional

information such as what the patients baseline vital signs were, laboratory results that are related

to the patients’ blood counts, and the patient's medical history to have an accurate assessment

and make a proper decisions. Some of the people I needed to notify of the suspected transfusion

reaction were the attending physician, the critical care team, and the respiratory therapist in case

the airway became compromised. We had to ensure that all these members of the
interdisciplinary team were promptly informed to ensure a coordinated response and appropriate

management of the transfusion reaction. This situation is a critical situation that needs immediate

attention as it could quickly take a turn and cause serious harm to the patient.

Responding

When responding to a blood transfusion, immediate intervention is required. The first and

most crucial step was immediately stopping the infusion and increasing oxygen for the patient.

The critical care physicians ordered for normal saline to be put in the line as well as an order for

Benadryl to help combat the reaction. The BCSH Blood Transfusion Task Force (2018)

described these symptoms as a mild transfusion reaction and that the infusion can continue after

a short pause. The team did not decide to continue the transfusion at the time and instead wanted

to run a few tests to try and figure out what had caused the reaction. In order to know the right

decision was made I continuously took the patients vital signs, monitored the patient to see if the

symptoms of the reaction had gone away, and the last thing was taking labs to see if there had

been any changes. I then delegated tasks such as getting vitals hourly after the reaction to the

technician. I then asked another nurse to prep meds during the reaction that way I can continue to

be by my patients side.

Reflecting

After going back and reflecting on the situation, I believe that I made the right decision

and went through all the proper steps to ensure the safety of my patient. The decision was made

in a timely manner and was efficiently communicated to the people that were part of the patients

care team. The patient ended up making a full recovery from this reaction which means that all
of the interventions we used were successful. This experience was an ah-ha moment for me

because it showed me how quickly a patient can take a turn and also showed me how important

is to be knowledgeable in symptoms and interventions for many different areas. In a study done

by Agnes Bediako (2021) showed that 58% of nurses had insufficient knowledge on

complications of a blood transfusion. Knowing this statistic helps solidify my belief that nursing

is a field where constant learning is an essential aspect to save patients’ lives. Having this

experience will always stick with me as the first time my eyes were opened in an emergent

scenario of how critical is to be well educated in the nursing profession.

References

Bediako, A. A., Ofosu-Poku, R., & Druye, A. A. (2021). Safe blood transfusion practices among

nurses in a major referral center in Ghana. Advances in Hematology, 2021

Tinegate, H., Birchall, J., Gray, A., Haggas, R., Massey, E., Norfolk, D., ... & Allard, S. (2012).

Guideline on the investigation and management of acute transfusion reactions Prepared

by the BCSH Blood Transfusion Task Force. British journal of haematology, 159(2), 143-

153.