Blood transfusions

margyh · Nov 17, 2005

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,

meownsmile, BSN, RN · Nov 18, 2005

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,

Absolutely,, why wouldnt you proceed with the transfusion? The dr ordered it for a reason. Its not up to the nurse to decide the patient is stable enough to wait. The patient is there, the blood isnt going to interfere with his nights sleep, they are more than likely getting iv's anyway. Why wouldnt you give a transfusion in the night? If you hold it because its after 2100,and they are clincially stable then, they may not be clincially stable by morning.

You have to remember the blood infusion is going to help transport oxygen and nutrients too, not just to add volume.

pricklypear · Nov 18, 2005

I've been lucky enough to never see an adverse blood reaction in 6 years. And I've given a boat load of blood.

To the OP - it's a GREAT idea to know your institution's policy regarding blood reaction parameters before giving blood. Most places have specific guidelines for symptoms like heart rate and temp. For temp, ours is 2 degrees.

Never held blood after 2100 hours for any reason, even on the floor. Why would you?

ReinventingMyselfAgain, MSN, RN · Nov 19, 2005

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,

clinically stable, well no need to do it overnight, i suppose. but we must define what clinically stable means. i was going to tell you about all the ovenight transfusions (mostly platelets on the bmt unit) for pts with a platelet ct of 2k who may or may not be bleeding, but you did specify stable.

btw, i've only seen one so-called reaction, after giving numerous numerous blood products (essentially, every time i work on this unit). it was to platelets, with a pre-medicated pt, who began to itch at the end of the transfusion. no other remarkable s/s, but we treated it as a reaction. the platelets were already in anyway. and like vortex said with her 'reaction' it could have been from something else, as these kids are on a load of abx and other meds.

i'm with vortex. we all know what could happen, but it is so unlikely.

ljds · Nov 22, 2005

I've worked in a small hospital for 5 years now, 1 1/2 as a nurse, and I *have* seen two extremely nasty blood transfusion reactions (not your run of the mill fever or itching, but one coded and one went into pretty severe resp distress--I didn't get to see the end of it because when he became suddenly confused, his face and upper body turned beet red/blue, and he couldn't breathe very well, he got shipped to ICU immediately); and frankly, we don't give blood very often. I must be lucky! :uhoh21:

Hopefully I've had all the excitement I will ever see in regards to blood transfusion reactions then. It *is* reassuring to know that they don't happen very often. But dang, when a big one does happen, it scares the shite out of you.

Toothbrushx2 · Nov 23, 2005

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.

Hi, I am a LPN, so of course ,I do not administer blood. But I was just wanting to know if you could cause fluid overload by encouraging fluids? Isn't lasix given?

meownsmile, BSN, RN · Dec 1, 2005

NO toothbrush, you wouldnt necissarily cause fluid overload. Lasix is given sometimes between units and after IF the patient has had a hx of CHF or exhibits the s/s of having CHF while the units are transfusing. But oral fluids wont cause overload. If the patient has a temp, fluids should be encouraged to prevent dehydration, along with tylenol to reduce fever.

hjmcenti · Dec 9, 2005

It is important to stop a transfusion if the pt gets a temp during the transfusion because this can be a sign of a reaction. But most likely a patient in need of a transfusion is pretty sick and will have some abnormal vitals to begin with. Definately give Apap, but only worry if the temp increases significantly during the transfusion.

christvs, DNP, RN, NP · Dec 9, 2005

You guys are all awesome! I'm a new RN & I have given many blood transfusions but now I feel I know more regarding why we do certain things, thanks to all the responses you guys gave. Very helpful to us new nurses! :) Here is one more question: on my unit the docs order for us to premedicate with 650 mg po Tylenol and 25 mg po Benadryl. Is this to prevent a reaction to the blood or am I totally off? Thanks!

-Christine

kadokin, ASN, RN · Dec 18, 2005

clinically stable, well no need to do it overnight, i suppose. but we must define what clinically stable means. i was going to tell you about all the ovenight transfusions (mostly platelets on the bmt unit) for pts with a platelet ct of 2k who may or may not be bleeding, but you did specify stable.

btw, i've only seen one so-called reaction, after giving numerous numerous blood products (essentially, every time i work on this unit). it was to platelets, with a pre-medicated pt, who began to itch at the end of the transfusion. no other remarkable s/s, but we treated it as a reaction. the platelets were already in anyway. and like vortex said with her 'reaction' it could have been from something else, as these kids are on a load of abx and other meds.

i'm with vortex. we all know what could happen, but it is so unlikely.

i'm confused. work in psych. have never hung blood. how can a pt be considered stable if they are in need of a blood transfusion?

Burnt Out, ASN, RN · Dec 18, 2005

Here is one more question: on my unit the docs order for us to premedicate with 650 mg po Tylenol and 25 mg po Benadryl. Is this to prevent a reaction to the blood or am I totally off? Thanks!
-Christine

Yes, it does help decrease the chance of a reaction to maybe some of the antibodies that might be in the donor blood, although the blood bank usually screens very carefully for any potential problems with antibodies in the patient's blood.

I think our policy is to stop the transfusion for any temp increase to 101 or > and call the M.D. Sometimes you will have a febrile patient whose temp is 102 or > whose temp will decrease once they get the blood in-I've seen this more than once.

caroladybelle, BSN, RN · Dec 19, 2005

Each MD has their particular limit on temp limit before starting blood, continuing or discontinuing blood. It also depends on the products.

There are MD theories about platelets, that transfusing them when the temp is too high, will damage them and hasten the breakdown.

In onco, we prevent mild reactions to minor antibodies (not lifethreatening ones) by premedding with benedryl and tylenol. This helps prevent some minor temps that would occur otherwise.

If there is a lifethreatening incompatibility, all the NSAIDs/tylenol in the world, will not stop it. These generally occur within minutes, with numeroussevere symptoms that are impossible to ignore. And the temp will rise 1.5 to 2.0 or more degrees in mere minutes.

Bacterial contamination will cause a slightly slower rise in temp, with less dramatic symptoms, but can also cause problems.

And minor antibody issues may cause a slower rise on a smaller scale (1-2 degrees over several hours).

Also, our patients are sick and that may be why they temp.

I don't worry about 0.4 degrees, I worry about 2 degrees or more, especially with resp distress and cardiac pain or in a matter of minutes.

Many MDs will transfuse up to 101, and then hold off.