BLOOD TRANSFUSIONS

Erica Lang
Scott
Weigand
Melissa Wise

Why Blood Management?

Blood management consists of prevention, early identification, and

treatment of Anemia combined with best possible transfusion
practices.

Blood transfusion is the most commonly performed procedure in

the United States.

Time consuming for nurses (75 nursing minutes per transfusion)

Increasing costs
Current supply of blood products is limited

The American Red Cross estimates that about every 2 seconds

someone in the U.S. requires a blood transfusion.

What are some reasons

why someone would
need a blood
transfusion?

Why Administer Blood Products?

Anemia is a sign of an underlying illness or condition

Nutritional deficiency
Acute or chronic blood loss
Anemia of chronic disease

Hemoglobin value of 7g/dL or less is commonly used as a guideline for red cell
transfusion

Blood component therapy is only temporary until underlying cause is resolved

Decision to transfuse should be based on patients clinical status

S/S reflecting possible need for transfusion:

Dyspnea
Orthostatic Hypotension
Syncope
Tachycardia
Chest pain

Types of Blood Products

Whole blood
Packed Red Blood
Platelets
Fresh Frozen Plasma
Cryoprecipitate
Granulocytes

Auburn Community Hospital

Policy and Procedures

The transfusion process begins with a physicians assessment of

the patient, a formal order specifying the blood products to be
transfused, the quantity and any special requirements necessary.

Patient will be typed and cross matched per physicians order

Consent form must be signed prior to transfusion

IV access with #20 gauge catheter or greater

Physicians orders must be double checked

2 People, one of which must be an RN, must verify blood unit

tag, patients lab report, type & cross match, and IV solution
running

Expiration of blood product must be checked

Identify patient by asking name and DOB at bedside also

verify patients ID band with the blood tag

Obtain patients vitals prior to transfusion, 15 minutes and 30

minutes into the beginning of the transfusion and at
completion of the transfusion

Normal Saline is the only solution that is to be hung with blood

Blood tubing is to be used only for blood administration only

During transfusion all IV solution will be placed on hold, unless specified by MD

For the 1st 15 minutes of transfusion the rate is 100 mL/hr if no reaction occurs
set the rate to be deliver in 1 and to 2 hours, unless specified by MD

NO transfusion should run longer then 4 hours

Documentation on transfusion record is required throughout the course of

transfusion

Hospital policy requires H & H ordered by MD within 24 hours of transfusion

Does Auburns policy follow

NPSGs?

National Patient Safety Goals

NPSG.01.01.01

Use at least two patient identifiers when providing care,

treatment, and services
1.

Use at least two patient identifiers when administering medications, blood, or blood
components; when collecting blood samples and other specimens for clinical
testing; and when providing treatments or procedures. The patient's room number
or physical location is not used as an identifier.

2.

Label containers used for blood and other specimens in the presence of the
patient.

National Patient Safety Goals

NPSG.01.03.01

Eliminate transfusion errors related to patient misidentification

Before initiating a blood or blood component transfusion:
- Match the blood or blood component to the order.
- Match the patient to the blood or blood component.
- Use a two-person verification process or a one-person verification process
accompanied by automated identification technology, such as bar coding.
2. When using a two-person verification process, one individual conducting
the identification verification is the qualified transfusionist who will
administer the blood or blood component to the patient.
3. When using a two-person verification process, the second individual
conducting the identification verification is qualified to participate in the
process, as determined by the critical access hospital.
1.

What gauge catheter

should be used for
Administering Blood
products and Why?

Evidence Base Practice

EBP is proposing changes in policy and practice of blood

transfusions

Barbara Ann Karmanos Cancer Institute in Detroit, policy states

that when a blood transfusion is needed, start an 18 gauge
angiocath if possible but provides no limit on catheter size.

Catheter Gauge

Clinical Application r/t Transfusion

14, 16, 18 gauge

Reserved for rapid infusion of blood

20 gauge

Routine blood transfusion

22 gauge

To Accommodate vein size or patient preference

24 gauge

May be used for small veins

EBP: Catheter Size

They conducted a study with a goal to find scientific evidence that

supports the use of a 20 gauge or greater catheter for blood
transfusion
One article that was found did a trial where blood was run through
a catheter of a particular size on a number of occasions most of
the studies reported that there was no significant different in
hemolysis.
The catheters used ranged from 16 to 27 gauge
They compared and contrasted 8 articles to determine if the
catheter gauge affected hemolysis
Evidence suggests that smaller than 20 gauge catheters can be
used safely for blood transfusions

When should transfusions be

given?

EBP: Recommendations for

Transfusions

Currently the AABB recommends a restrictive transfusion

policy in hemodynamically stable patients (adult and
pediatric) of 7g/dL or less
8g/dL is recommended in postoperative surgical patients
or for symptomatic patients experiencing chest pain,
orthostatic hypertension, tachycardia, or with a history
of CHF
The evidence for these levels was based on 19 clinical
trials including 6264 patients
A more liberal strategy of transfusing above the
recommended levels showed no benefit in patient

What are the differences

between Auburns
policy/what you learned in
the lab and what EBP says?
Recommendations/Opinions
on Auburns policy?

References
Auburn community hospital. (2013). Blood transfusions-principles of blood and blood products administration.
Unpublished internal document.
Auburn community hospital. (2014). Adverse transfusion reactions blood/blood components. Unpublished
internal document.
Carson, J., Grossman, B., Kleinman, S., Tinmouth, A., Marisa B. Marques, M., . . . Djulbegovic, B. (2012, March 27).
Red blood bell transfusion: A clinical practice guideline from the AABB*. Annuls of Internal Medicine. Retrieved
February 6, 2015, from http://annals.org/article.aspx?articleid=1206681
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2011). Medical-surgical nursing: Assessment and
management of clinical problems (8th ed., pp. 705-710). St. Louis, MO: Elsevier/Mosby.
National patient safety goals effective January 1, 2015. (2015, January 1). The Joint Commission. Retrieved
February 6, 2015, from http://www.jointcommission.org/assets/1/6/2015_NPSG_CAH.pdf
Stubbs, J. M. (2013). Blood transfusion. Magills Medical Guide (Online Edition).
Stupnyckyj, C., Reeves, C., & Magnan, M. (2014). Changing blood transfusion policy and practice. American
Journal of Nursing, 114(12), 50-59.
Tolich, D., Blackmur, S., Stahorsky, K., & Wabeke, D. (2014). Blood management: From evidence to practice.
Nursing
2014 Critical Care, 9(1), 17-24.
Upchurch, S., Henry, T., Pine, R., & Rickles, A. (Eds.). (2014). HESI: Comprehensive review for the nclex-rn
examination (4th ed., pp. 32-33). St. Louis, MO: Elsevier.