N320
Blood
Administration
Ann V. Thiel-Barrett DNP, RN, FNP-BC, CNE
Revised 12-23
Blood Administration
Objectives:
Identify manifestations of blood infusion
reactions
 Implement the needed steps when a blood
reaction occurs
 List the protocol steps in the administration of
a blood product

Blood Administration

Transfusion Therapy
Injection/administration
of blood or blood
products into the blood
stream
Blood Administration
Blood Types – Top Hat Homework
Type A
 Type B
 Type AB
 Type O

Blood Administration
Rh Factor
Rh factor is an antigen that is a component of the Rh
blood groups and is made up of numerous complex
antigens


Rh(+) indicates a person has Rh factor on surface of RBCs
Rh(-) indicates person does not have Rh factor on surface
of RBCs
Blood Administration
Rh Factor
Rh factor is a powerful antigen
 Rh(-) person may only be transfused
with Rh(-) blood to prevent formation
of antibodies to Rh(+) blood
 Rh(+) person may be transfused with
either Rh(-) or Rh(+) blood

Blood Administration
ABO Blood Groups & Compatibility
Blood Administration
Fresh Frozen Plasma (FFP)
With FFP…
Liquid portion of blood
(no cells)
 Contains clotting factors
 AB is considered the
universal donor
 O is the universal
recipient

Blood Administration
Blood Typing and Cross-Matching
Blood Typing: Blood test that
determines blood type
 Cross-matching: Blood test that
indicates compatibility between blood of
donor and recipient

Clumping of blood noted in
this test tube
Blood Administration
Whole Blood
 Packed RBCs
 Platelets
 Granulocytes
 Fresh Frozen Plasma
(FFP)
 Anti-hemophilic
Factor VIII

Cryoprecipitate
 Albumin
 Immune Serum
Globulins

Blood Administration
Blood Administration
Protocols and Nursing Care







18-20 gauge IV line or greater
Establish patency before requesting blood!
Sterile technique
NSS/”Y-type” IV tubing set-up at bedside (or as per institution
protocol)
Baseline VS
Check orders
Double-check patient ID and blood product ID data with another
licensed RN (or RN and MD)
Blood Administration
Protocols and Nursing Care (cont.)

Administer blood as soon it arrives to floor
(must be infused within 4 hours)
Minimal handling of bag
 Vital signs at start of infusion, 15 minutes into
infusion (and as per institution protocol)
 Stay with patient for first 15 minutes
 Administer very slowly for the first 15 minutes

Blood Administration
Safety Alert…
Saline (0.9% NaCl) only solution
infused with blood – isotonic –
prevents fluid shifting with RBC’s
Do not use dextrose solutions or
LR for blood administration – will
cause RBC hemolysis!
Do not give any additives
(including meds) via same tubing
unless cleared with NSS

Blood Administration
Post Transfusion
Vital signs/necessary assessments at end of
transfusion
 Document findings after transfusion
 Complete any adverse reaction forms if needed
 Monitor lab values

H/H (generally one unit of packed RBC raises the HCT by 3% and
hemoglobin by 1g/dL)
Blood Administration
Transfusion Reactions
Nursing Responsibilities
Stop the infusion
 Maintain patency of cannula via NSS
 Monitor vital signs and urine output
 Notify the physician
 Emergency equipment at bedside
 Implement appropriate interventions
 Written documentation
 Follow appropriate protocol for reporting
incident and collecting blood bag for lab

Blood Administration
Reactions - Acute
Acute Hemolytic
Reaction
Most dangerous
 Infusion of ABOincompatible whole
blood, RBCs, or
components containing
10 mL or more of RBCs
 Antibodies in recipient’s
plasma attach to
antigens on transfused
RBC = RBC destruction

Blood Administration
Reactions - Acute
Acute Hemolytic Reaction (cont.)


Chills, fever, low back pain, chest tightness, dyspnea,
hypotension, acute kidney injury, vascular collapse,
cardiac arrest, and death
Nursing Actions
 Discontinue blood
 Emergency fluids/drugs/dialysis to maintain renal
perfusion/blood pressure
 Treat shock
 Red urine appears on next void – need to collect urine
 Collect blood specimen
Blood Administration
Reactions - Acute
Allergic Reaction





Can be mild or severe
Results from recipient's
sensitivity to donor plasma
proteins
Flushing, itching,
Antihistamines/
corticosteroids
Monitor closely – may be
able to restart blood but a
slower rate
Can lead to anaphylaxis
Blood Administration
Reactions - Acute
Anaphylactic
Reaction




Sensitivity to donor plasma
proteins
Usually follows quickly - after
only a few milliliters of blood
Anxiety, urticaria, dyspnea,
wheezing, bronchospasm,
shock, possible cardiac
arrest
Emergency situation – rapid
response – maintain ABC’s
Blood Administration
Reactions - Acute
Circulatory Overload Reaction
Occurs when blood is administered more rapidly that
the circulatory system can accommodate
 Cough, dyspnea, chest tightness, tachycardia,
pulmonary edema, HTN, restlessness, JVD
 Nursing actions
 Stop transfusion
 Increase HOB
 IV NSS to KVO
 Notify MD
 May restart blood at a lower rate

Blood Administration
Reactions - Acute
Sepsis Reaction
Due to transfusion of bacterially infected blood
components, or when blood sits around too long
 Rapid onset chills, high fever, vomiting, diarrhea,
marked hypotension, shock
 Nursing actions

Stop blood
 NSS to KVO
 Notify MD
 Blood bag and tubing
sent back to lab

Blood Administration
Reactions - Delayed
Delayed Hemolytic Reaction
Occurs days to weeks after infusion
 Usually less severe
 Fever, malaise, gradual decrease in H/H
 No red urine
 Important to monitor because may be a
precursor to a more severe reaction in further
transfusions

Blood Administration
Reactions - Delayed
Infections
Hepatitis B & C
 HIV
 Malaria
 EBV
 Lyme disease
 West Nile virus

Blood Administration
Reactions
Hyperkalemia

Prolonged storage of blood, cell destruction, improper
handling
Hypocalcemia

Preservative used to store blood binds with calcium to
cause a deficiency
Studying…
Items to review…
Blood types – donor and recipient
Blood administration protocols
Nursing care pre and post transfusion
Transfusion reactions – think nursing process
Collaborative care for reactions
