The following measures should be taken during transfusion therapy: screening donors for transmissible diseases; testing blood for pathogens; ensuring that cross-matched blood products are given to correctly identified patients; intervening promptly in transfusion reactions; avoiding unnecessary transfusions; avoiding volume overload during transfusions; and avoiding hypothermia, electrolyte, and clotting disorders.

Administration of a single unit may be indicated in young or old surgical patients, in those with coronary disease, and in patients who have an acute blood loss of several units but whose blood pressure, pulse, and oxygen are stabilized by use of one unit.

The risk of HIV, HBV, or HCV on blood collected and distributed in the U.S. is very low.

Patient care

The patient is identified from both the hospital identification band and blood bank band. Two health care professionals (one the administering nurse) verify the patient's ABO and Rh blood type and its compatibility with the unit of blood or packed cells to be administered, as well as the unit's expiration date and time. Outdated blood is not used; it is returned to the blood bank for disposal. The blood or blood product is retrieved from the blood bank refrigerator immediately before administration because blood should not be stored in other than approved refrigerators. Blood cannot be returned to blood bank storage if the unit's temperature exceeds 50°F (10°C), a change that will occur within about 30 min of removal from storage.

Before the transfusion is started, the patient's vital signs (including temperature) are checked and recorded. The blood is inspected visually for clots or discoloration, and the transfusion is administered through an approved line containing a blood filter, preferably piggybacked through physiological saline solution on a Y-type blood administration set. No other intravenous (IV) solutions or drugs should be infused with blood (unless specifically prescribed) because of potential incompatibility. In the first 15 min, the blood flow rate is slowed to limit intake to no more than 50 ml. A health care professional remains with the patient during this time and instructs the patient to report any adverse reactions, e.g. back or chest pain, hypotension, fever, increase in temperature of more than 1.8°F (1°C), chills, pain at the infusion site, tachycardia, tachypnea, wheezing, cyanosis, urticaria, or rashes. If any of these occurs, the transfusion is stopped immediately; the vein is kept open with physiological saline solution, and the patient's physician and the blood bank are notified. If incompatibility is suspected, the blood and set are returned to the blood bank; samples of the patient's blood and urine are obtained for laboratory analysis of: hemoglobin in the urine; protime/INR; blood culture; complete blood count; chemistries; and identifying data are recorded from the unit. If no symptoms occur in the first 15 min and vital signs remain stable, the transfusion rate is increased to complete the tranfusion within the prescribed time, or (if necessary) the transfusion is administered as fast as the patient's overall condition permits. Once the transfusion begins, the blood is administered within a maximum of 4 hr to maintain biological effectiveness and limit the risk of bacterial growth. (If the patient's condition does not permit transfusing the prescribed amount within this time frame, arrangements are made to have the blood bank split the unit and properly store the second portion.) The patient's vital signs and response are monitored every 30 min throughout the transfusion and 30 min afterward; stated precautions are observed, and caregivers monitor for indications of volume overload (distended neck veins, bounding pulse, hypertension, dyspnea). Blood should not be administered through a central line unless an approved in-line warming device is used. A warmer should also be used whenever multiple transfusions place the patient at risk for hypothermia, which can lead to dysrhythmias and cardiac arrest. Patients planning elective surgery, e.g., hip, knee replacement, hysterectomy. may bank one or two units of their own blood in the weeks before surgery for use if needed. Blood-saving devices are also used in such surgeries, and this blood is returned to the patient before he or she leaves the operating theater.

CAUTION!

Patient care

To address complications of massive transfusion in the acutely bleeding patient, the patient's vital signs, complete blood count, serum chemistries, acid/base balance and PT/PTT should be monitored frequently. Coagulation factors, donated plasma, platelets, and electrolytes should be given as indicated by test results.