BLOOD ADMINISTRATION/ TRANSFUSIONS

Type of Blood
Product
Packed RBCs

Frozen RBCs

Platelets

Fresh Frozen
Plasma

Description
ONE Unit = 250-300 mL
-can replace blood loss of 500
mL
- will raise Hgb 1g/dL and Hct
3%
RBC+glycerol frozen and can be
stored for up to 10 yrs
-prepared from fresh whole
blood of multiple donors
-expected increase is 10,000/uL
per unit
-used when platelets <1020,000
ONE Unit = 200-250 mL
-rich in clotting factors, NO
PLATELETS

Considerations for
Administration
-check CBC 1-4 hrs post
-leukocyte depletion used
to allergic rxns

-prepared from plasma

-available in 5% or 25%
solutions

Cryoprecipitate
s or
Commercial
Conc.

- prepped from FFP

Step 1: Assessment

Gather Equipment- NEVER CALL FOR BLOOD

PRODUCTS UNTIL READY (blood warmer
chance on dysrhythmias)

IV Line/Access: usually 19 g or LARGER (20g,

18g, 16g)

IV Setup (verify patency) and Solution- Y tubing

o One clamp for blood
o One clamped with primed tubing 0.9%
NS (ISOTONIC only, others can cause
RBC hemolysis) (switch every 4 hours)

Draw Labs: CBC, type and screen

Assess lung sounds and fluid volume balance

Check Orders r/t blood transfusion

o Common orders include Lasix,
Benadryl, Tylenol
Step 2: Planning

Consent per hospital/facility

o Make sure patient has all questions
answered

Lab Work
o Type and Cross match
o Place blood bracelet on patient

Paperwork
o Request for blood filled out and
brought to blood bank

Anemia
(severe/symptomatic)

-must be used within 24

hours of thawing

-autotransfusion
-stockpiling
-rare donors

-agitate bag periodically

-give HLA typed to prevent
alloimmune
LABS: platelets within 1
hr and PT/INR

Bleeding caused by
thrombocytopenia
-DIC
-preop for any pt on
thinners

-must be used within 24

hours of thawing

Bleeding caused by
deficiency of clotting
factors
-DIC, hemorrhage,
massive transfusion,
liver disease, excess
warfarin, vitamin K)
-hypovolemic shock
-hypoalbuminemia

LABS: CBC and Coag.

studies

Albumin

Indications for Use

-albumin 25 g/dL is
osmotaically equal to 500
mL plasma (moves fluid
into intravascular space)
-heat treated, does not
transmit viruses
-once thawed, must be
used in 5 days

Step

Replacement of clotting
factors (vWF, VIII,
fibrinogen)

MD Order for Blood

o For what? Platelets, FFP, Whole Blood
o When to transfuse
o How much to transfuse- make sure
300-400 mL of fluid can be tolerated by
patients heart
o Unit quantity and rate (2 ml/min
common)
3: Implementation
Call for blood when everything is ready: OK to
be hung for next 30 minutes (20 min in kim
ppt), if not hung return to lab. Must be
transfused within 4 hours of arrival from blood
bank
Patient Identification- TWO IDENTIFIERS
Vitals (can be delegated to PCA) and listen to
lung sounds for fluid overload
o Pre-administration
o 15 min (RN is there for whole 15 min)
o Every 1 hour until transfusion is
complete or per hospital policy
Paperwork
o Requires 2 RN signatures AT THE
BEDSIDE
o Consent
o MD orders
Check Blood

BLOOD ADMINISTRATION/ TRANSFUSIONS

o
o

Inspect for clots, type, and expiration

date
SIGN PINK SLIP AFTER ALL NUMBERS
MATCH

Discard empty blood container and blood

administration set in red biohazard
bag/container
Record blood given in I&Os

Blood Transfusion Reactions

Two types: Acute and Delayed
If reaction is suspected STOP BLOOD, KVO 30 ml/hr NS, CHECK VITALS, CALL LIP (but do not
disconnect), collect 7ml purple top and send STAT to lab, check all labels forms and ID, send blood
and tubing with rxn report to blood bank