Skills Presentation: Blood

Administration
Megumi Miyajima-Olguin RN
Bon Secours Memorial College of
Nursing
Nur 3209
JeanMarie Digges, MSN, RN, CPNP,
CNE
10/31/20
“I Pledge”
Reasons to Give Packed Red Blood Cells:
Generally, blood transfusions are given to those with hemoglobin of <7 to
8 g/dL or emergently with shock or hemmorhage. The choice to transfuse
is made up of many factors including the patient's symptoms, underlying
medical conditions, baseline labs, upcoming procedures that may cause
blood loss, as well as clinical judgement.   

Up-to-Date has made a list of recommendations:

●Hemoglobin <6 g/dL – Transfusion recommended except in exceptional

circumstances.
●Hemoglobin 6 to 7 g/dL – Transfusion generally likely to be indicated.
●Hemoglobin 7 to 8 g/dL – Transfusion may be appropriate in patients
undergoing orthopedic surgery or cardiac surgery, and in those with
stable cardiovascular disease, after evaluating the patient’s clinical
status.
●Hemoglobin 8 to 10 g/dL – Transfusion generally not indicated, but
should be considered for some populations (eg, those with symptomatic
anemia, ongoing bleeding, acute coronary syndrome with ischemia).
●Hemoglobin >10 g/dL – Transfusion generally not indicated except in
exceptional circumstances.

(UpToDate, 2020)
Information and Special
Considerations you'll
need before you Tranfuse:

• Order from Doctor 

• Informed consent from
Patient/guardian signed by MD,
patient, and witness (typically RN)
• Indications for transfusion
• Medical history (CHF?) and allergies
• Past reactions to transfusions?
• Patient Assessment
Equipment you'll need
before:

• IV access: 22g or larger, ideally

18-20g for adults, 22-24g for
peds
• Y-Type blood administration set
with in-line filter 
• Infusion pump with pole
• 0.9% Normal Saline 250 mL to
prime pump tubing
Patient Education on
Possible Transfusion
Reactions and Complications:
• Allergic reactions: Itching or rash from passing of allergens.
Mild symptoms can be relived with antihistamines ordered by
notified provider. 
• Sepsis: from bacteria contamination 
• Volume overload: (Does your patient have CHF? Is the
infusion rate appropriate?)
• Immune related hemolytic reactions: Flank pain, fever, dark
urine from hemolysis r/t incompatible blood products:
• Acute
• Delayed 24 hour-30 days post transfusion
• Nonhemolytic febrile reactions: Fever, chills, headache from
WBC releasing cytokines. 
• Transfusion-related acute lung injury (TRALI): hypotension
and dyspnea 1-6 hours during and post transfusion from lung
injury r/t antibody reactions. 
Let's Start! Per Richmond Bon Secours Mercy Policies and Procedures.
Check your facilities p&p's!

• Hand hygine before and after every proceedure!

• Start NS infusion at 20 ml/hr with y tubing and

make sure your IV is functional before you get the
blood.

• Check baseline vitals before you pick up blood.

This way, if vitals are abnormal, you don't have
blood waiting outside of the cooler. 

• Walk blood release form with patient information

to lab/blood bank (no putting blood in tube
system!)
*Blood must be started within
• With the blood bank technician check: 30 minutes of being released
• Patient's name, DOB, and MRN and the blood must be
• Donor number transfused over 4 hours from
• Blood type time of release!
• Expiration date
 Patient and Blood Verification with 2 Registered Nurses:

• Ask the patient's name and DOB (if patient is alert) • Compare and verify the blood bag slip (which
• Out loud, verify patient's name, DOB, and last 4 of stays on the bag until after transfusion) and the
MRN  labels on the blood component
• Compare to patient's arm band • Verify the order to transfuse with the blood
• Compare to blood order on MAR component(s). 
• Patient's full name 
• Patients DOB and/or medical record number
• Patient's type and RH 
• Donor's type and RH 
• Donor number 
• Expiration
• Scan patient's arm band and then scan the 4
labels on the blood components  

If everything matches, you're good to begin the

infusion...
• Disconnect the tubing from patient

• Clamp the saline side first!

• Spike the blood bag

• Manually prime the tubing with blood

• Start the infusion 50-75 ml/hr for the 1st 15

mins
• You can increase the infusion rate after
that denpending on patient's medical
history and tolerance. 
• Packed red blood cells can be
given between 2-4 hours
RN to stay 1:1 with the patient from the start time (the time
the blood enters the patient) to 15 minutes. 

Vital Signs:
Within 15 minutes prior to starting
blood, then 15 minutes after start
time

Repeat vital signs: 

• 30 minutes from start time 
• 60 minutes from start time
• 120 minutes from start time
• 180 minutes

Vital signs 1 hour post-transfusion

In the event of an adverse
reaction:

Stop the infusion!!!

• Using a new bag of 0.9% NS and new tubing,

keep line open @ 20 mL/hr
• Notify provider
• Recheck the bag, blood bag slip, and patient
information for errors. 
• Contact blood bank
• You may have to send the blood
bag, tubing, and a post-reaction pink tube of
patient blood to blood bank
Common Mistakes

• Hanging the blood before the

dual RN verification
• Even if it isn't running, don't
spike the bag until it checks
out! You may have to return
it.
• Not taking vitals or making sure IV
works before picking up blood.
• This could result in blood
sitting out and being wasted.
After the infusion:

• Flush the remainder of the blood

in tubing with NS
• Finished blood tubing goes in
red biohazard bag
• Pink blood bag slip goes back to
lab/blood bank.
• White blood bag slip is scanned
in patient's chart
• 1 hour Post-tranfusion vital.
Lastly...
Donate blood if you can...
https://www.redcrossblood.org/
 References

Carson, J. L. & Kleinman, S. (2020). Indications and hemoglobin thresholds for red blood cell transfusion in
the adult. UpToDate.com. Retrieved from 
https://www.uptodate.com/contents/indications-and-hemoglobin-thresholds-for-red-blood-cell-transfusion-
in-the-adult