blood transfusion and first 15 minutes

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Anyone work on a unit where the predominant attitude is one of it being ok to leave a pt. during the first 15 minutes of a blood transfusion due to the monitors attached to the pt.?

If the patient doesn't have a cardiac history or prone to overload there's no real reason to run it slow over a pump.

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We check vitals before transfusion, 15 mins after transfusion, then q hourly vitals during. We stay with the pt for the first 5 minutes

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WOW! How do you observe for transfusion reaction if you are not physically there for the first 10-15 mins? The guidelines and policies that some of these institution practices under is mind blowing! It is ultimately my responsible to ensure the safety of my patients and for that I would never leave such a patient unattended. I worked too hard for my license to risk it on some technicality case.

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Doesn't have cardiac history, or prone to overload? in ICU that's pretty much no one. And even those with normal cardiac function can overload with too fast of a transfusion- have seen it happen.

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Doesn't have cardiac history, or prone to overload? in ICU that's pretty much no one. And even those with normal cardiac function can overload with too fast of a transfusion- have seen it happen.

It depends on the ICU. I was appalled too when I moved from a hospital with strict infusion rate guidelines to to my current employer where blood is run off pumps, can be run wide open, and does not have to have a dedicated line. It's not the horror you think it is.

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Specializes in ED Clinical and Documentation.

Our policy is first 15 minutes, then 30 minutes, then 60 minutes so you have 3 sets of vital signs within the first hour of the transfusion. Then at the end we do another set. I usually try to stay in the room for the first 15 minutes. We have a total of 4 hours to transfuse from the time the blood bank documents on the paper they the blood was released. It's the nurse's judgement call to set the rate of the infusion unless otherwise specified by the physician.

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Thank you all for entertaining such a thorough discussion on the topic. When I originally posted the question, I was new in my setting, but questioning what isn't necessarily in line with what I have been taught is the standard of care.

I thought of printing this out and leaving it subtly in our breakroom. But, that seems passive-aggressive.

Statements like

1. "It doesn't matter, they are intubated..."

2. "They just had a transfusion and had no reaction..." (Which, as one poster pointed out, that could increase the likelihood of a reaction).

Annoy me. Especially when others look at me like I am doing the wrong thing for staying...

So, I practice as I feel I should. Others at work do as they feel they should. Some seem oblivious, some have said "Better nurse than I am..." if I stay in place.

As to rates...I work in a surgical/trauma icu. Rate depends on how fast it is coming out/or how much they have already lost...

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
For those of you who don't stay with the patient during the first 10-15 min, how do you observe the patient for signs of transfusion reaction during that time?

I've given a lot of blood in my career -- several years in hematology/bone marrow transplant where we gave incompatible blood to patients who were changing their blood type, and 30 years in ICU, most of it SICU. I've only seen four or five real transfusion reactions, and two of them were when the patient's were given (by another nurse, NOT me!) blood that had been typed and crossed for a different patient, and one was incompatible blood to a bone marrow recipient. I just haven't seen any transfusion reactions in at least a decade, even though we give blood by the cooler-full some nights.

That said, I usually hang the blood upon entering the room and stay to record I & O, vital signs, give meds -- anything I can get done in that room during the first minutes of the transfusion, but sometimes it's 18 minutes and other times more like 6.

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Specializes in Critical Care.
Not really sure why antibiotics would matter - patients can be allergic to anything. I had a patient who was allergic to Benadryl once. I always wondered if there was something else to give her besides just epi if she had a reaction to something else... but I digress.

I think the biggest problem with blood, and the reason patients have to be watched, is that blood is not standard in the slightest. I don't know how thorough a crossmatch really is but reactions happen because of foreign leukocytes, plasma proteins, etc. too. I know even a unit of leukocyte-reduced, irradiated PRBCs could potentially still have a few donor leukocytes in it, which can cause a reaction in the patient receiving that unit. I know crossmatches involve samples of both the donor blood and the recipient blood, but what if there are only a few leukocytes from the donor in the whole bag and the little sample they draw up from the unit doesn't have any of those leukocytes in it? It seems like something that could cause a reaction could get missed quite easily.

However, I've never worked in the lab so I honestly don't know how thorough a crossmatch really is. Does anyone know?

The reason I ask is that the risk of an immediately detectable and life threatening reaction could be argued to be higher with antibiotics than with blood transfusions, so if it's the level of risk and the likelihood of such a reaction that requires us to be at the bedside for the first 15 minutes, why wouldn't that also apply to antibiotics? I can see why it was necessary 50 years ago, before the current intensive serological studies became standard, or why it should be encouraged when giving non-cross matched blood, but there would seem to be much more reason to be concerned about an antibiotic infusion.

I've never known of a patient an acute hemolytic reaction to transfusion, but I have had two patients (I was TL, not their primary) with immediately life threatening reactions from antibiotics, both went into circulatory collapse, one did not survive. Ideally we'd never leave any patient's side, although I'm not sure we're really prioritizing well if we're hanging at the bedside of the patient getting a transfusion, which may mean totally ignoring the guy we just hung an antibiotic on.

Nursing is all about divvying up out time based on all the risks to all of our patients, a flat rule that doesn't take this into account seems like it could encourage potentially harmful practice. Quickly eyeballing another patient you have reason to be concerned about might actually be better practice than ignoring them even if it means leaving your transfusion patient for 90 seconds, that actually seems pretty obvious to me.

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Specializes in Med-Surg Nursing.

I used to stay with the pt for 1st 15min when I worked floor. Our policy doesn't state we have to physically be in room w/pt. It says VS pre transfusion, then 5 min after initiation, then 10 min, then 15 min, so basically q5min x3, then q15min for 60min then q30min till transfusion completed.

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Specializes in Quality, Cardiac Stepdown, MICU.

In all floors of both hospitals I have worked at it's initial vitals, stay with the pt first 15 minutes, then another set of vitals, then q1h until transfusion is finished (sometimes another one 1 hr post). As others have said, the monitor won't always tell you if they're having a reaction. If they start to feel really cold, or itchy, or whatever, I want to be there.

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