Guidelines / Advice

Ordering and Administration of Blood

Preparation of the patient l Correct identification and verification of the patient and the blood unit l Correct aseptic technique l Monitoring of the patient during the transfusion l Special precautions


Monitoring The Patient

A critical part of transfusion therapy is monitoring of the patient, whether by a nurse or a medical practitioner. The accurate and quick interpretation of adverse effects could prevent a fatal reaction. The unit number, date of transfusion, and the starting and finishing time of each unit transfused should be recorded in the patient’s folder. Some services require additional signatures on accompanying forms. All this information should be permanently retained in the patient’s folder.

Baseline observations of vital signs should be recorded prior to commencing the transfusion. The patient is then observed closely for the first 30 minutes of the transfusion to detect any untoward reaction, and to ensure that the desired rate of transfusion is maintained. In cases of major blood loss, ideally the CVP, pulse, BP, respiratory rate and urinary output should be monitored every 15 minutes throughout the transfusion. In less severe cases the recipient’s vital signs should be checked every half hour after the initial 30-minute observation. Patients at risk for circulatory overload should be observed for 12-24 hours after transfusion.

If a transfusion reaction is suspected because the patient complains of symptoms or there are clinically significant changes in vital sign measurements, the transfusion must be stopped immediately, the drip set changed, and the vein kept open with a transfusion of normal saline.

The following actions must be undertaken:

• A member of the medical staff must be contacted immediately.
• The patient’s temperature, pulse, respirations and blood pressure must be recorded.
• All clerical and identity checks must be repeated.
• Further management depends on the type and severity of the reaction.

All empty blood units should be returned to the blood bank. In any event, they must be retained for 48 hours following transfusion, at a temperature of 1-6 °C.