Blood transfusion question

[justme1972]

We are working on a small class presentation on blood transfusions.

This is in reference to whole blood.

Everything that we have been given, read, etc..says that blood must be transfused with 4 hours of the start or it has to be discarded.

However, I can't find anything concrete stating WHY it has to be discarded.

I have heard that the blood starts to decompose, or that the plasma, etc starts separating, but I would rather see it written somewhere.

Anyone have a source? I have tried Googling and can't find it.

[bekindtokittens]

Here is a small blurb one of my med/surg books gives on the subject.

"Generally, two hours is a good time frame to transfuse each unit of packed cells. If it must transfuse more slowly because of the patient's condition, make sure that the unit does not hang longer than four hours to prevent deterioration and bacterial proliferation."

I'm assuming by deterioration, they mean RBC lysis.

It's not very specific, but if you want to use it as a cited reference, I can give you the book information.

[Melinurse]

As I understand it, it is to infuse within 4 hours and you would change the tubing after each unit ( or 2 depending on facility ) to minimize risk of bacterial growth at warmer room temperatures.

[uscstu4lfe]

yes that's right. i hang blood fairly often and we're told that the 4 hour or less thing is used so that bacterial growth is minimized as the blood starts to warm. also, once we get the blood in our hands, we have 15 minutes or less to hang it or it must be sent back to the lab. hmm what else.... we must stay with the patient for 15 minutes once the infusing begins to monitor for a transfusion reaction (fever, pain, cyanosis, difficulty breathing). we take 3 sets of vitals: one pre-transfusion, one post 15 minutes, and one post blood transfusion. blood must be cosigned/verified at the bedside with two nurses. blood can only be transfused with normal saline. that's all i can remember off of the top of my head!

[Daytonite, BSN, RN]

see the weblinks on this post (https://allnurses.com/forums/1458776-post6.html) that include:

• http://www.muw.edu/nursing/iv.htm - this resource states "you can safely give blood over 1 1/2 - 2 hours. it should be in in no more than 4 hours (secondary to bacterial count in blood greatly increased over that time)"
  

in addition, the intravenous nurses society practice criteria regarding transfusion therapy states "single units of blood and blood components should be administered within a 4-hour time period."

[iluvivt, BSN, RN]

Cite the AABB technical manual. The American Association of Blood Banks. They put out a new manual every year with all current recommendations and rationals. I go down to our blood bank if I need to see it for any reason. Oh yes,it is the risk for bacterial proliferation.

[cminmd]

This is what makes me nervous. At our school we are taught that you

1. Must always use Y tubing with normal saline.

2. You have 30 minutes to start a transfusion (not 15)

3. that the blood should transfuse slowly 3-4 hours.

4. use at least an 18 gauge needle to avoid RBC trauma

5. if you have any type of reaction to stop the transfusion and send the tubing and blood back to blood back and start a new bag of saline to dilute irritant.

We also have a different schedule of vitals- before you get the blood, before you start transfusion, +15, +30, + 1 hour, +2 hour, +3 hour and after transfusion finishes. I am worried when we take the NCLEX that someone is going to get something wrong because we are all taught something slightly different!

[Daytonite, BSN, RN]

The questions on the NCLEX are specifically checked to make sure that no state-specific rules or facility-specific rules have crept into them. The questions are reviewed by groups of nurses who check for this before the questions go on the test. Licensing tests address what you minimally need to know to be a licensed nurse. Certification, on the other hand, is what you want nurses to know above and beyond licensure in an area of specialization. The NCLEX, you will find, has very fair questions asked on it. Not the kind of questions that you sometimes end up arguing with your instructors about. I have yet to hear of someone coming away from the NCLEX claiming a question was unfair.

[uscstu4lfe]

The previous poster is right. The NCLEX will NOT ask you a question about blood transfusion when it's not clearly known and accepted across the board. You'll find that it'll probably be a lot easier than you're thinking!

[windowxp]

Can anyone help me find the answer for.

Do we need to check pt urine output as nursing intervention before blood transfusion.?

Please provide me reference with your answer Thanks.