Blood transfusions

  1. 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!
    •  
  2. 23 Comments

  3. 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.
  4. by   nursing04
    Quote from 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.
  5. 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.
  6. by   lifeLONGstudent
    Quote from 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.
  7. by   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.
  8. by   NurseCard
    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.
  9. by   ProfRN4
    Quote from 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.
  10. by   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.
  11. by   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.
  12. by   lifeLONGstudent
    "transfusion reactions are notoriously overrated in nursing school."

    maybe they are "overrated" because they can potentially kill the patient.


    "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."

    #1 - i would say you were lucky....wow, 7 years and no transfusion reactions (or maybe there were some and you did not think it warrented getting so upset about it because, after all, they are overrated).

    #2 - sorry, but just because you have worked in "acute settings" for 7 years doesn't make you the expert. the guidelines are set by the exerts (american association of blood banks, fda, the blood bank pathologist, etc, etc)

    #3 - transfusion reactions can be non-immunohematological, meaning, that you don't get a positive dat or hemolysis in the post blood sample and that there is no blood in the post urine. your patient could have still have had a reaction (for example if the donor took some medication [or eaten strawberries] and your patient was allergic to that med [or strawberries] - your patient would show signs of a reaction). a transfusion reaction does not always involve the wrong blood type. here is another one: the patient could be deficient of secretory iga and if the prbc are not washed to remove the protein (iga), then your patient will have a reaction.

    #4 - to the new nurse: it is good that you are scared. it will make you check and recheck and ask questions if you are not sure.



    "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."

    stop the transfusion first and then call the dr. if the transfusion is potentially causing harm, why let it continue while you try to get ahold of the doc? you can always start it back up again and adjust the rate to compensate for the time you spent calling the dr.

    and, if you ever feel uncomfortable with continuing the transfusion when the ordering dr (who is at home in his bed) tells you to do it, then call the blood bank pathologist - he/she will override the ordering doc and cover your bottom.
  13. by   vortex72
    Quote from lifelongstudent
    "transfusion reactions are notoriously overrated in nursing school."

    maybe they are "overrated" because they can potentially kill the patient.


    "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."

    #1 - i would say you were lucky....wow, 7 years and no transfusion reactions (or maybe there were some and you did not think it warrented getting so upset about it because, after all, they are overrated).

    #2 - sorry, but just because you have worked in "acute settings" for 7 years doesn't make you the expert. the guidelines are set by the exerts (american association of blood banks, fda, the blood bank pathologist, etc, etc)

    #3 - transfusion reactions can be non-immunohematological, meaning, that you don't get a positive dat or hemolysis in the post blood sample and that there is no blood in the post urine. your patient could have still have had a reaction (for example if the donor took some medication [or eaten strawberries] and your patient was allergic to that med [or strawberries] - your patient would show signs of a reaction). a transfusion reaction does not always involve the wrong blood type. here is another one: the patient could be deficient of secretory iga and if the prbc are not washed to remove the protein (iga), then your patient will have a reaction.

    #4 - to the new nurse: it is good that you are scared. it will make you check and recheck and ask questions if you are not sure.



    "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."

    stop the transfusion first and then call the dr. if the transfusion is potentially causing harm, why let it continue while you try to get ahold of the doc? you can always start it back up again and adjust the rate to compensate for the time you spent calling the dr.

    and, if you ever feel uncomfortable with continuing the transfusion when the ordering dr (who is at home in his bed) tells you to do it, then call the blood bank pathologist - he/she will override the ordering doc and cover your bottom.
    sounds like you spend too much time with the books and not enough time taking care of patients. like you, i can spew lots of textbook information if i desire(i'm a ccrn by the way) but the fact remains that it will be rare if ever that you see any type of transfusion reaction. the subtle reactions you are referring to are just that, subtle. you will undoubtedly not notice such a minor reaction while monitoring the patient. even if the patient did have a minor reaction, the md would likely order you to continue the transfusion since the benefit of the blood outweighs a minor reaction such as a slight temperature increase or other histamine related symptoms. if you see a sudden onset of anaphylactic symptoms, then by all means stop the transfusion!
  14. by   margyh
    all the previous answers give good sound advice,
    its just an observation. does anyone commence a transfusion after 21.00hrs. if the patient is clinnically stable. and the transfusion be commenced in the morning,

close