"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.