Prep Supplies
How long is this tubing and blood product good for once opened?
4 hours!
What is the maximum allowable time between retrieving blood from the blood bank and starting the transfusion?
30 minutes
What is the maximum allowable duration for completing a blood transfusion once it has been released from the blood bank?
All transfusions must be completed within 4 hours from the time released from the blood bank.
What immediate action should be taken if a transfusion reaction is suspected?
If Reaction suspected stop blood transfusion and keep IV site open with Normal Saline.
Who can pick up the blood from blood bank after it is released?
RN/ LPN, NA, Paramedic, US
These three pieces of equipment are needed in order to administer a blood transfusion.
What process involves confirming patient identity and blood compatibility by two individuals?
Independent double verification
When do you perform vital signs?
Baseline vitals usually 15 minutes prior
After 15mins of start of infusion
Every 1 hour
1 hour post infusion
What specimens should be drawn and sent to the Blood Bank if a transfusion reaction is suspected?
Draw specimens using 2 pink top tubes and send to Blood Bank.
How long is a type and screen good for?
72 hours
Where do you place the empty/used blood product tubing & bag?
Red biohazard bag in soiled utility
Name 5 top things you need to check (in the medical record) prior to administering blood products?
large bore IV site, type & screen, consent completed for blood products, blood product orders to prepare & transfuse, any previous reactions, and patient/family educated
How frequently should blood tubing be changed during a standard transfusion process?
Blood tubing is to be changed after transfusing 2 units
What will trigger an order to be placed for a transfusion reaction workup?
Best Practice Advisory will be triggered for an order to be placed for a transfusion reaction workup.
What is the recommended ratio for massive transfusion patients?
1:1:1
1 plasma, 1 platelet, 1 PRBC
Why do we use blood tubing?
There is a filter in place for any clotted blood product or precipitates. (Did you know we shouldn't squeeze the filter chamber and instead invert it while priming the line to prevent cracks? Hold the chamber upside down with the clamp open until you have enough in chamber, then invert and prime as normal)
What medications might be used to premedicate a patient who has had past transfusion reactions?
Tylenol, Benadryl, possibly Pepcid or a steroid depending on the patient
How should the infusion rate of Red Blood Cells (RBCs) be managed initially and after the first 15 minutes?
Start infusion slowly; 60-120 mL/hour for the first 15 minutes. Will increase 240 mL/hour after 15 minutes.
After confirming a transfusion reaction, what medical tests are ordered and how frequently?
Stat bilirubin and Hgb ordered every 6 hours for 24 hours after reaction.
What is a blood warming device?
Device for rapid transfusion of several units of blood to prevent hypothermia during massive transfusions.
True/False: I released the blood, I have it in my hands & I forgot I have an hour long antibiotic running. I can store the blood in the medication fridge as long as I transfuse within 4 hours.
FALSE. Blood has to be stored in a special cooler; if not ready for immediate use, return to blood bank
What do you need to read off the blood product, matching with what is scanned/written in Epic?
-Patient name, MRN, DOB (2 pt identifiers)
-Type of blood product (with any special considerations, ie: CMV negative, irradiated, leukocyte reduced)
-Patient blood type & the unit's type
-Unit # (usually starting with "W"); Part # (if receiving partial unit)
-Unit expiration date
Your patient's pre-transfusion VS are as follows: Temp 36.9C, HR 100, BP 100/50, Resp Rate 20, and sats are 99%. They call you back in the room asking for a warm blanket and to adjust the temp. While in the room, they tell you their IV burns. You check the IV, it flushes fine. The room is already on 90F and quite warm, so you decide to check VS. They are now: Temp 38C, HR 110, BP 73/37. You don't get a chance to count respirations as the patient asks for a bedpan right away. Their urine is red. What do you do?
Stop transfusion, keep PIV TKO to saline, page MD to inform of possible transfusion reaction. Anticipate a bolus of crystalloid fluids, repeating VS, UA, labs including coags to assess for DIC. The patient may also require diuretic like lasix depending on MD & signs of renal failure. This could indicate an immune, acute hemolytic reaction (usually caused by clerical error, transfusing incompatible blood types). This can result in shock, death, DIC, renal failure.
What steps should be followed if symptoms of Urticaria occur during a transfusion?
Do not disconnect blood, keep Normal saline running; Notify provider and obtain order for transfusion reaction workup; Notify blood bank; Give antihistamine if ordered; Resume transfusion if symptoms relieved as per provider orders; Complete an Event Report.
What is TACO?
This is a transfusion-associated circulatory overload reaction that initially presents with shortness of breath and dyspnea, along with hypertension and JVD, usually improved with the treatments of diuretics.