basically, remember that only normal saline can be added to blood components. that means you cannot add medications or piggyback medications with blood transfusions--ever! a unit of blood should be infused within 4 hours to avoid the risk of septicemia. each facility has it's policy regarding the changing of iv tubing, but if in doubt change the tubing with each unit of blood you hang. blood should not be out of the refrigerator for more than 30 minutes before it is hung. each unit of blood should be double checked for accuracy with another rn before hanging it. the patient's vital signs should be taken just before beginning the blood, after the first 15 minutes and then about every hour until the blood is completed. you should stay with the patient during the first 15 minutes of the infusion in case the patient has a reaction.
signs of a reaction are:
- development of wheezing or rales along with a cough
- fever spike
- chest pain
- back ache
- rapid, thready pulse
- pallor or cyanosis
- numbness and tingling in the extremities
- abdominal cramps
stop the transfusion immediately. get a set of vital signs. keep the vein open with normal saline. call and notify the blood bank. call and notify the patient's physician. you will probably need to get the first urine specimen to send to the lab. the bag of blood and blood tubing will need to be returned to the blood bank.
here are links to information on blood transfusions and transfusion reactions:
- your guide to safe transfusions. from rnweb. includes a blood compatibility chart at the very bottom of the page.
- the last half of this document has information about the procedure of blood transfusion and transfusion reactions
- indications for the use of red blood cells, platelets and fresh frozen plasma from the national heart lung and blood institute.
- tutorial on blood banking and blood transfusion. includes discussion on compatibility, crossmatching and transfusion reactions