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Focussed Experience and Transition
PBL Feedback Summary
Names :
Renita, Murray, Rachel, Jinky and Alana
PBL :
Tu Meke
Action Point:
2, Blood transfusion
Team Number:
2
Summary of key findings
As a group we thought the importance of understanding the policy and guideline for
blood administration was essential when providing a holistic care plan for our clients.
Safe transfusion of blood products in accordance with all relevant clinical policies of
Counties Manukau District Health Board.
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Ensure IV access for patient and maintain patency with Normal saline or other
solution compatible with blood
Check that informed consent has been given
Ensure that the component has been prescribed on the patient's fluid balance chart,
including date, time and rate of infusion. This must be also signed by the prescribing
doctor
Order the component from the blood bank using the IV Blood Component/Product
Collection & Safety Checklist
Check with the orderly that the unit delivered is the correct unit for your ward or
patient
Check the components expiry date
Check the patient's identity: verbally, if possible, and on front sheet of the clinical
notes
Check the patient's wrist band details against those on the hanging label on the bag
Check the ABO and rhesus compatibility of patient with donor component
Both the person administering the component and the person checking must sign the
label attached to the bag which must also be dated and timed. This must remain on
the component being transfused until it has completed
Transfusion of the product must commence within 30 minutes of issue from blood
bank. Red blood cells must be completed within 4 hours; Fresh frozen plasma and
Cryoprecipitate once thawed should be transfused within 4 hours; Platelets should be
completed within 60 minutes
Baseline observations: temperature, pulse, blood pressure and respiration rate should
be recorded in a PUP sheet
Attached the product bag to the giving set and adjust the rate. Alaris GP volumetric
pump may be used to regulate the flow
Remain with the patient for the first 20 – 30 minutes – this is when most severe
reactions are likely to occur
Repeat all baseline observations at 15 to 30 minutes after commencement
After the first 30 minutes: record pulse and respiration rate half hourly; temperature
and blood pressure hourly
At the completion of the component: Attach the hanging check label to a Blood
Products Label Sheet bearing the correct patient's label and document the completion
time in the box provided and record the amount given on the fluid balance chart.
Document the transfusion in the patient's notes
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Focussed Experience and Transition
Return the empty product bag to the Blood Bank
Discard giving set after the transfusion is completed
Continue to observe the patient closely for further 30 minutes after transfusion.
The most common cause of haemolytic reactions is transfusion of ABO-incompatible blood.
When an acute haemolytic reaction occurs, antibodies in the recipient's serum react with
antigens on the donor's red blood cells. This results in agglutination (clumping) of cells,
which can obstruct capillaries and block blood flow. Haemolysis of the red blood cells
releases free haemoglobin into the plasma. The haemoglobin is filtered by the kidney and
maybe found in the urine (haemoglobinuria). Haemoglobin may obstruct the renal tubules
leading to acute renal failure.
Anaphalaxis on the other hand is another reaction that occurs within minutes and can be life
threatening because of bronchial constriction and subsequent airway obstruction and
vascular collapse. Initial symptoms include oedema and itching and can occur rapidly and is
manifested by rapid, weak pulse, hypotension, dilated pupils, dyspnoea (difficulty
breathing), and possibly cyanosis. This is compounded by bronchial oedema and
angioedema. Death will occur if emergency treatment is not initiated.
If an acute transfusion reaction occurs the following steps should be taken:
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stop the transfusion
maintain patent IV line with saline solution
notify the blood bank and the doctor immediately
recheck identifying tags and numbers
monitor vital signs and urine output
treat symptoms per doctor's order
- initiate CPR if needed
- have adrenaline ready for injection
save the blood bag and tubing and send it back to the blood bank for examination
complete incident report and transfusion reaction reports
collect required blood and urine specimen and send it to the laboratory to evaluate
haemolysis
document on transfusion reaction form and into the patient chart
Implications for nursing practice
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Tu Meke also felt that a competent nurse must be able to indentify significant
blood reactions like haemolytic and anaphalaxis and their pathophysiological
differences.
A competent nurse must also be able to manage a patient who shows signs and
symptoms of haemolytic and anaphylaxis.
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Focussed Experience and Transition
Reference sources & resource with Rationale for use
MMH Gudielines : Procedure: Transfusion of Red Blood Cells, Platelets,
Fresh Frozen Plasma and Cryoprecipitate.