BLOOD TRANSFUSION

NURSES ROLE

1. ROLE OF A NURSE IN SAFE BLOOD TRANSFUSION R. RUPPAMERCY M.Sc Nursing 1 st year. INTRODUCTION: Blood transfusion is defined as the transfusion of the whole blood or its component such as blood cells or plasma from one person to another person. Blood transfusion involves two procedures such as collection of blood and administration of blood . The role of a nurse in safe blood transfusion involves both nurse’s safety and patient’s safety. Basically there are two different types of risks – procedural error and transfusion reaction . Hence the nurse can have a checklist of things to do step – by – step and other responsibilities to ensure proper blood transfusion.

2. 4 P’S BEFORE TRANSMISSION PRE TRANFUSION ASSESSMENT: History: Previous transfusions Reactions to transfusions No. of transfusions Health problems Cardiac diseases Pulmonary & vascular diseases PHYSICAL ASSESSMENT: Baseline vital signs Auscultation of lungs & patients use of accessory muscles. Assess for Edema, skin rashes, echymosis , icterus etc. Blood tests includes CBC, BT/CT, BLOOD GROUP,RH TYPE, crossmatching and screening tests(VDRL, HBsAg , HIV, Malarial smear) PATIENT PREPARATION: Verify Doctor’s order. Verify patient’s details. Explain the procedure clearly. Psychological support. Consent should be obtained from patient and the witness. Perform vein puncture. PREPARATION OF ARTICLES: 1. Blood transfusion set, mackintosh, tourniquet, cotton swabs, adhesive tape & scissor, sterile gloves, kidney tray, IV stand, normal saline 2. Blood or blood products with cover received from blood bank with the name of the recipient, consent form and reaction form.

3. DURING TRANSFUSION.. A – Aseptic technique Wash hands using techniques Wear gloves. Warm blood at room temperature to prevent chills. B – Be prompt Do not panic. Monitor baseline vital signs. Be prepared for any emergencies. Be with the patient throughout the transfusion. C – Check for label of blood transfusion with s.no, expiration date, blood group and Rh type, volume of the blood, colour changes, excess air and leakages. Check for pre – medication orders. D – Dare about the calculation of flow rate & methodical approach in documentation at every stage. During vein puncture, select the large vein which allows the patient’s mobility. K – Knowledge About potential reactions during transfusions such as febrile reactions, allergic reactions, transfusion transmitted infections etc. I – Inspect Inspect and observe the IV patency. Inspect for any clots, bubbles, cloudiness, abnormal colour etc. Vital signs throughout the procedure. Intake and output chart. N – Notify Time, date and duration. Start the infusion slowly at 2ml/min and notify the reactions. Adverse reactions usually occurs during the first 15 – 20 mins . Notify blood bank. G – Governance The transfusion nurse serves as an expert resource and has been fundamental in development of tools, resources and skills with 6 C’s.

4. TO REMEMBER ALWAYS: Administering blood transfusion as whole blood, packed RBC takes 4 hours for the completion and for plasma, platelets cryoprecipitate takes about 20 mins . Clotting factors can easily be destroyed. Administer 0.9% Nacl before, during or after blood transfusion. Never administer IV fluids with RL and 5 % dextrose based on IV fluids causes hemolysis. Do not mix medications with blood transfusion to prevent adverse effects. Patient can drink or eat after 15 mins of blood transfusion. Prepare to administer emergency drugs such as antihistamines, vasopressor fluids and steroids as per order. If u suspect a transfusion reaction , Stop transfusion immediately Monitor vital signs every 5 mins .(increased BP, increased respiration, increased temperature denotes adverse reactions. Maintain IV access. Start 0.9%Nacl. Place the patient in fowler’s position Inform physician immediately. 7. Documentation of procedure is very important.

5. CONCLUSION: Overall we the nurses have the responsibility to evaluate whether the patient maintains normal breathing pattern , demonstrates adequate cardiac output , reports any discomfort , maintains good fluid balance , remains normothermic , remains free of infection , good skin integrity , maintains normal electrolyte and blood chemistry values . Observe the patient at least for 6 days after blood transfusion for any complication. NURSING DIAGNOSIS: Deficient knowledge related to unfamiliarity with transfusion process or misinformation about risks of transfusion. Risk for injury related to blood transfusion reaction such as hemolytic reaction, allergic reactions, febrile reactions, circulatory overload etc. THANK YOU…..