[nursing04]

Hello. I'm new to practice and have a question on blood transfusions. My pt last night had a temp of 100.8- the doc still wanted her to get the blood- so I gave her tylenol, her temp went too 100.4 and then back to 100.8 within a half hour, I ordered the blood and started the transfusion as the doc ordered. Is this ok? Her temp obviously wasn't dangerously high but isn't it just going to get higher during the transfusion? I don't know what the final outcome was if her temp went up and if they needed to stop the transfusion b/c my shift was over. Does anyone know what the protocol is for pts temp? Also, what does the temp need to be to halt a transfusion? I just felt like I kept asking the MD every 5 min. Thanks!

[meownsmile]

Patients temps dont necissarily go up just because of a transfusion. Starting blood with a temp isnt really a problem, problems arise out of the patients temp increasing with after the start of the transfusion. We usually will watch vitals in the first 15 min, and if there is a increase in temp will retake the temp in another 15 min. Usually one full degree above temp at time of the start of the transfusion we will call the doctor. Usually, if that is the only symptom they will have us give tylenol and complete the transfusion. We have cases that people come in for transfusions and they have tylenol and benedryl ordered to give prior to transfusion also.
Check you facilities protocol, its in the book as to how they want you to handle any possible reaction.
But 4tenths of a degree isnt something i would consider a reaction.

[nursing04]

Originally Posted by meownsmile

Patients temps dont necissarily go up just because of a transfusion. Starting blood with a temp isnt really a problem, problems arise out of the patients temp increasing with after the start of the transfusion. We usually will watch vitals in the first 15 min, and if there is a increase in temp will retake the temp in another 15 min. Usually one full degree above temp at time of the start of the transfusion we will call the doctor. Usually, if that is the only symptom they will have us give tylenol and complete the transfusion. We have cases that people come in for transfusions and they have tylenol and benedryl ordered to give prior to transfusion also.
Check you facilities protocol, its in the book as to how they want you to handle any possible reaction.
But 4tenths of a degree isnt something i would consider a reaction.

Thanks a lot! Makes sence.

[barefootlady]

I have given blood under a physicians orders to patients with temps higher that 100.8, usually given tylenol and at times have been ordered to give benadryl, but I do keep a closer eye on that patient, attempt to encourage fluids as able to tolerate, and monitor for other complaints.

[lifeLONGstudent]

Originally Posted by barefootlady

I have given blood under a physicians orders to patients with temps higher that 100.8, usually given tylenol and at times have been ordered to give benadryl, but I do keep a closer eye on that patient, attempt to encourage fluids as able to tolerate, and monitor for other complaints.

I work in the blood bank and our policy is 2 degrees to call it a transfusion reaction. Also, majority of (heme/onc) docs premed with 650 mg Tylenol and 25 or 50 mg Benadryl -- we (blood bank techs) must double check and sign off the orders when the nurse signs out the blood.

[Tweety]

Good answers so far.

I've given blood with temps before. Our policy I believe is we can't start a transfusion on a febrile patient greater than 101.5 without an MD order. Many times the MD has ordered o.k. to transfuse with temp. I believe our policy is a temp spike of 2 degrees after starting the transfusion is considered a reaction.

[RealNurseWitch]

I don't have much to add, I just wanted to check out my NEW PREMIUM membership with all the cool add-ons!

Seriously though... at my hospital it is about the same story... yeah, we've given blood to folks with low-grade temps, around 100 degrees or so. I wouldn't get too concerned unless it's about 101, or unless it rises a degree while giving the infusion.

[nurse educate]

Originally Posted by RealNurseWitch

I don't have much to add, I just wanted to check out my NEW PREMIUM membership with all the cool add-ons!

Cool avatar (I miss mine, maybe I'll check out membership so I could express my personality again)!!!

Anyway, our heme/onc kids are febrile more than they are afebrile. They'd hardly get products (that they really need) if we held them for temps. I think you (actually the doc) needs to weigh the pro's and con's of giving the blood vs. holding it. If the H/H is dangerously low, that that might be the lesser of two evils.

On the other hand, we hold platelets if the temp if very high, b/c the platlets get 'eaten up' and don't work.

[nursing04]

Thank you very much everyone. I get nervous w/ these temps and its such a pain to keep calling the doc- can't wait till I have some experience under me.

[vortex72]

Transfusion reactions are notoriously overrated in nursing school.

I've worked in various acute settings for 7 years and only seen ONE transfusion reaction. This was an increase in heart rate from 80 to 150 about 2 minutes after starting the transfusion. Of course, it is still debateable if this was a transfusion reaction or something else.

It is always good to call the md and stop the transfusion if you are unsure, but things arent how they teach you in nursing school.