BLOOD

TRANSFUSIO
N
Introduction of
blood or its
component
directly into the
circulatory
INDICATIONS

Blood loss

Correct Physiologic disorders

Surgery
TYPES OF BLOOD
 Type A
 Has A antigen and has anti-B antibodies

 Type B
 Has type B antigen and has anti-A antibodies

 Type AB
 has both A and B antigen and has no A or B antibodies,
universal recipient

 Type O
 Has no A or B antigen, and has both A and B antibody,
universal donor
COMPONENTS OF BLOOD
NURSING CONSIDERATIONS PRIOR TO
BT
 Check doctor’s order
 Cross matching, blood typing

 Obtain consent

 Obtain history of allergy and fluid status

 Prepare and provide checklist

 Vital signs, pre-BT, intra BT, post-BT

 baseline then Q15 x 4; Q30 x 2; then q h
EQUIPMENTS

 Blood product

 G18 needle, sterile

 0.9 NaCl (Plain NSS)

 Blood transfusion test with filter

 Venipuncture set

 Gloves, tape, alcohol swab

PROCEDURE
 Get pre-transfusion vital signs

 Determine previous blood transfusion reactions

 After label is checked by the physician, With

another nurse, verify:
 client’s identity
 Blood unit labels and expiration
 Blood group and Rh compatibility
 Set-up the infusion set
 Close all the clamp on the Y set, the main flow rate
clamp and both Y-line clamp
 Spike in twisting motion
 Hang on the container on the IV pole about 1meter or
3 feet
 Start the saline solution, attach the blood
tubing primed with NSS to the intravenous
catheter
 Prime drip normal saline and flush IV line with
normal saline to prevent blood from mixing
dextrose solution
 Invert the blood bag gently several times to mix
cells with the plasma, pull the tab and spike the Y
set

 Infuse slowly for 1st 15 minutes at 10gtts/min,

severe blood transfusion reactions occurs within
15-20 minutes of transfusion or within the
transfusion of 100ml of blood

 Stay with the client within 15 minutes, monitoring

vital signs every 5 minutes, noting for ractions.
Altered vital signs is the early sign of blood
transfusion reaction.
 After 15 minutes without noticeable reaction,
adjust to consume blood products within ordered
duration

 If any reaction, STOP THE INFUSION OF BLOOD,

maintain infusion of NSS and notify physician

 Obtain blood (patient’s blood and the transfusing

blood) and urine and send to laboratory per
doctor’s order

 After transfusion, open normal saline and infuse

ubtil tubing is clear
 Blood should be transfused within 4 hours
from the laboratory, as it is “old blood” rising
hyperkalemia

 Document relevant data

 Reactions
 Vitalsigns
 Blood information
 #of blood to transfused
 Drip rate
 Time started and finished
 TRANSFUSION REACTIONS
 Febrile reactions:
 Fever
 Chills
 Headache
 Body malaise
 Allergic reactions
 Flushing
 Urticaria
 Wheezing
 Rashes
 Hemolytic reactions
 Facial flushing
 Chills
 Low back pain
 Hypotension
 Hematuria
 Anaphylactic shock