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St. Luke’s University Health Network
September 2012
Directions for Completing Educational Requirements for Annual Blood Transfusion/Transfusion Reaction Education
This education material is MANDATORY for all RNs who may care for patients receiving blood transfusions.
The purpose of the education is to review safe administration of blood and blood products and to review important information related to blood transfusion reactions.
· The entire program takes approximately 20 minutes to complete.
· Read the pages that follow.
· Complete theposttest.
· The posttest will be automatically submitted electronically.
· A posttest score of 100% is required.
This educational program must be completed by October 15, 2012.
Annual Blood Transfusion/Transfusion Reaction Annual Education
Key points:
§ The NPPM # D-45 Blood Transfusion/Transfusion Reaction has been revised effective 9/6/2012. Refer to the on-line policy for details.
§ Several of the policy changes are in direct response to recommendations made after recent laboratory accrediting surveys found areas of improvement related to education.
§ Blood transfusion and transfusion reaction education is required upon hire (orientation) and annually for those involved in patient care.
Summary of Policy Changes:
§ Consent will be obtained by the patient’s Physician or Advanced Practitioner as defined in the Administrative Policy for Informed Consent.
§ Documentation is required for patients who receive non-emergent transfusions. Documentation must include: procedures, alternatives, risks and benefits of blood and blood products, agreement to receive the blood and blood products.
§ Type and crossmatch is good for 3 days.
§ Transfusion of blood products must be initiated within 30 minutes of release from Blood Bank. If this is not possible, the blood product must be returned to the Blood Bank within the 30 minutes. NEVER store blood in the refrigerator on the unit.
Exception: Multiple units may be stored in Blood Bank cooler for emergency situations (e.g.
trauma, code crimson, or OR. Blood will maintain acceptable temperature (1˚C-10˚C) for up
to 6 hours under normal room temperature conditions if kept in closed blood bank-issued
cooler with an ice pack or wet ice.
§ The following rates are presented as administration guidelines for routine blood products for the adult patient. An infusion pump may be used for the administration of the blood products outlined in the following table.
Product / Recommended Rates / CatheterSize / Administration Set / Comments
Packed Red Cells (PRCs) / 90-120 minutes / 22G or larger / Y-type or straight blood administration set obtained from storeroom / Do not exceed 4 hours
Platelets (SDP) / 20-60 minutes / 22G or larger / Filtered administration set obtained from blood bank / 1 SDP = 6-10 units random pooled platelets
Thawed Plasma (FFP) / 15-30 minutes / 22G or larger / Y-type or straight blood administration set obtained from storeroom / 5-day expiration after thawing
Cryoprecipitate / 3-15 minutes / 22G or larger / Filtered administration set obtained from blood bank / Pooled product-must be administered within 4 hours of thawing
***NICU and Pediatrics may use 24G catheter size or larger. Rate will be specified in the physician order.
Policy Addition:
Transfusion Reaction Identification and Response
§ Nurses administering blood components should be well aware of the signs and symptoms of a possible reaction and be prepared to take steps to mitigate the current episode as well as prevent future similar reactions when possible.
§ Many common signs and symptoms are associated with more than one type of adverse reaction. Signs and symptoms may include:
· Fever (temperature increase ≥1˚C from pre-transfusion temperature)
· Chills with or without rigors
· Respiratory distress, including wheezing, coughing, and dyspnea
· Hyper- or hypotension
· Abdominal, chest, flank, or back pain
· Pain at the infusion site
· Skin manifestations, including urticarial, rash, flushing, pruritus, and localized edema
· Jaundice or hemoglobinuria
· Nausea/vomiting
· Abnormal bleeding
· Oliguria/anuria
The most common reactions are listed in the chart below:
Febrile Reaction / Allergic Reaction / Hemolytic Reaction / Circulatory Overload / TRALIMost common kind of reaction
Etiology: reaction between antibodies in the recipient and the donor WBCs or platelets
Symptoms: fever, chills, headache, flu-like symptoms, nausea
Onset: 15 minutes – 2 hours
Treatment: If expected, pre-treat with Tylenol or ASA. May use leukocyte removal filter. May use washed cells. / Approximately 3% of all transfusions.
Can be potentially serious if causes anaphylaxis.
Symptoms: Urticaria, hypotension, flushing, wheezing, N/V and diarrhea.
Onset: Within minutes
Treatment: If patient has a history of previous reactions, pre-treat with Benadryl 25-50 mgs. May use steroids-Solumedrol 1:1000, Epinephrine SQ, supportive care. / Uncommon but may be fatal.
Etiology: Incompatibility (ABO, Rh, other), improper handling-freezing, overheating, rough handling, and bacterial growth.
May be acute or delayed.
Signs and symptoms:
Anxiety, pain or burning at the infusion site, fever, chills, hypotension, ↑P, ↑RR, hemoglobinuria, flank pain, chest pain, headache, shock, DIC and death.
Onset: Within 15 minutes (acute); up to 4-21 days if delayed response.
Treatment: Oxygen, protect kidneys-fluids, Dopamine, Lasix/ Mannitol, lab specimen, support organs. / Not a reaction as much as a possible side effect.
Etiology: Too much fluid for the heart to manage.
Signs and symptoms: overload, crackles, severe headache, dyspnea, SOB,
hypertension.
Onset: Within 1 hour
Treatment: ↓ infusion rate, with ↑risk patients-diuretics. / Noncardiogenic pulmonary edema usually caused by passive transfer to either granulocyte or HLA antibodies or lipid activators of neutrophils contained in donor plasma.
Signs and symptoms: Usually starts within 6 hours; severe pulmonary edema, moderate to severe hypoxemia, hypotension, chills, fever.
Treatment: Ventilatory support, supplemental oxygen, vasopressors.
Nursing Responsibilities:
§ Stop transfusion; disconnect blood tubing from IV site. Send connected blood tubing along with the discontinued bag of blood or blood component, IV fluid, administration set and all unit tags and labels to Blood Bank.
§ Maintain IV site with new bag of saline.
§ Perform clerical check of all labels, unit tags, forms, and patient identification to determine if patient received correct blood product and notify Blood Bank of findings.
§ Notify physician and Blood Bank immediately.
§ Complete bottom portion of the transfusion record.
§ If physician requests transfusion reaction investigation obtain order for test #2170: Transfusion Reaction Investigation and send a barcode-labeled blood sample (7ml lavender tube) to the Blood Bank. Draw the blood carefully to avoid induced hemolysis. Place order for test #3950: Blood Reaction Urine. Submit a post-transfusion urine sample to the lab.
§ Monitor vital signs and urine output.
Practice Tips
§ If a patient reports having a previous blood transfusion reaction, notify physician before administration for potential pre-medication orders (i.e. Benadryl, Solumedrol, etc.).
§ If it looks like the reaction is potentially anaphylactic or hemolytic, physician intervention is emergent, call rapid response.
§ RNs should communicate with assistive personnel what they should be looking for and reporting back to the RN when patients have blood transfusing.
You have completed the educational component of this activity. Please close this document and complete the posttest (Take Test).