Blood Transfusions

  1. Our hospital is revamping our blood transfusion policy. We are trying to find out what other institutions do. We contacted the Blood Bank Registry and it is very broad with their policies.
    Our biggest snag is, when checking the blood product with two people, do both of the people have to be licensed care providers?

    Also, what kinds of vital signs do you do pre and post transfusion?

    Also, who is "qualified" to give blood?

    Any input would be greatly appreciated



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    About dbauer

    Joined: Dec '98; Posts: 2
    Registered Nurse


  3. by   nsgsup
    Our bld transfusion policy states that blood must be checked in the patient's room by 2 nurses. A full set of vitals are done before, 15 minutes into, and post transfusion. RNs are the only ones allowed to hang blood at our facility. I work at a 95 bed hospital in Illinois.
  4. by   Colleen
    I work in a 36 bed Surgical Unit. Our current blood transfusion policy states that 2 nurses check the blood at the patient's bedside prior to administration. Observations (TPR & BP) are taken 15 minutely for the first hour and then hourly.
  5. by   1OldDinosaurRN
    RN's and MD's are the only staff persons permitted to administer blood in our facility.
    We require 2 licensed people to check the blood.
    We do TPR and B/P within 30 minutes of transfusion, again at 15 minutes into the infusion, then every 30 minutes until the blood is infused. Then, 1 hour post-infusion we get them again.
    You need to check with your State Board of Nursing for some guidelines and assistance. Also, I would suggest contacting the IV Nurses Society for additional assistance.
    Hope this was of some help!
  6. by   WAMI
    Our facility uses a form. Anyone can pick up blood from the blood bank. Two RN's or RN and physician must sign after checking information off the blood bank band and ID band on the patient at the bedside. Vitals just prior to pickup, vitals 15mins after start and every 30 mins. thereafter; 3hr. max transfustion time. Evaluations on the side column next to each set of vitals, necessary only if unusual occurrence.

    The form eliminates guess work when a nurse from an agency might be called on to transfuse.

    Our policy is no transfusion for Hgb <8.0 unless special circumstance, per Red Cross local guidelines.
  7. by   TAM
    Our facility allows any licensed staff member to pick up blood from the lab but two RNs or an MD and an RN must verify at the bedside. We check B/P temp, pulse, resp rate prior to infusion, q5min during the first 15 mins and the RN must remain at the bedside during this time (15 mins)then q 15 mins for the remaining hour (45 mins)then q 30 for the remaining infusion time. The most severe reactions will normally occur during the first 10 mins of a transfusion.
  8. by   Janis Noone
    Only an RN can administer blood products in our system facilities. You may want to check the current AABB (American Assoc of Blood Banks) for transfusion guidelines. Most follow their recs for vs at the time blood is hung, 15 min later, and at the end of the transfusion. An RN checks the blood with another licensed person who can be an LPN, med tech from lab, etc. We also have someone stay in attendance during the first 15 minutes as this is the time inwhich the most severe reactions occur. This person in attendance must watch for wheezing, trouble breathing, hives, coughing, urticaria, etc but need not be an RN. May even be a family member so long as instructions are given and the person is deemed reliable by the RN.
  9. by   iamme8557
    Blood must be checked by 2 RNs or RN and MD prior to transfusion. Noncrossmatched blood must have the ordering physicians signature on the blood slip.
    Vitals are taken before transfusion The variances I have seen are vitals Q5mins for 15 mins then Q30 for duration of infusion, Q15 for first hour then hourly, to Q15 for 30 minutes then follow the orders for this patient (Q1, Q2, Q4) then follow with a post transfusion set of vitals.
    If the nurse is not overwhelmed with work and can visually assess this patient throughout the transfusion and/or instructs the patient or patients family member of signs of reaction to watch for then the initial observance CONSTANTLY for the first 15 minutes should suffice. This is the time period when a reaction usually occurs.
    A patient with previous reactions or a very unstable patient of course demands more intense monitoring.
    You should probably suggest one of the more stringent protocols as the patients life will be the big consideration. This will allow for better nursing coverage justified by protocol.....If you need to take vitals Q5 and be at bedside for the first 15 minutes and return to bedside to assess this patient every 15 minutes this boosts the patient care hours and the hospital can justify the one or two more nurses for staffing on a unit that infuses blood often.
    This is probably the work you do anyhow..but put it into the protocol and you get the staff to cover you for it.
    If you need some documented occasions where not having proper staffing or not stringent enough guidelines and the patient suffered I am sure you can get them on the internet or from this site. These with successful lawsuits will convince the Nonmedical persons who run our facilities at this point in Health Care Reform that you need the protocols you are desiring.
    Welcome to the Game
    Good luck
  10. by   jmccrn
    Our facility requires 2 RNs to check the blood in the patient's room. Anyone can pick it up at the blood bank. Vitals are checked prior to administration, 15 minutes after the start of transfusion, 1 hour after start, then on completion.
    The only instance when blood is not checked by 2 RNs is when blood is given through a level 1. It can then be checked by a nurse and respiratory therapist (who runs the level 1) or by 2 therapist. Then at this point vital signs are not really written on the blood forms since so much is given so fast; the vitals are just recorded on the patient care flowsheets.
  11. by   kmfrick2s
    I was reading this post and I realized that our hospital is doing the same thing. Our main concern is in trying to find evidence based practice stating weather or not it decreases the amount of transfusion reactions if an RN is the one documenting the 15 minute vitals. If anyone could help, I would greatly appreciate it.
  12. by   NAURN
    Our hospital is revamping our blood transfusion policy. We are trying to find out what other institutions do. We contacted the Blood Bank Registry and it is very broad with their policies.
    Our biggest snag is, when checking the blood product with two people, do both of the people have to be licensed care providers? yes i am not sure if an lpn can give blood in my hospital tho... i work in icu and we dont have lpns.

    Also, what kinds of vital signs do you do pre and post transfusion? We do pre, 15 minutes x2 then q 30 min until complete then one hour post. blood has to be given within 4 hours of checking it out

    Also, who is "qualified" to give blood? RNs I believe in our hospital, but LPNs may be able to give it, I am not sure.

    RN has to pick the blood up, double check it with the lab then 2 RNs double check it again at the bedside
  13. by   MunoRN
    Our policy which is required by our DOH is that only RN's and MD's can be the double check for blood; if you can't hang blood then you can't be the double check.
  14. by   iluvivt
    OK first of all you need to check with the LVN and RN boards in your state. In CA they consider any blood product a normal human component and thus LVNs can hang it. Once you have that info each health care facility can decide if they want to allow that or not. Next you need to go to your blood bank and look for the AABB technical manual and make sure it is the newest version...You will find all the updated recommendations for vital signs,filters,hang times..all that stuff.
    Last edit by iluvivt on Feb 12, '11 : Reason: spelling correction