Lesson 36: Administering Blood Products
Transfusion Equipment
1. Red blood cell (RBC) - Also known as an erythrocyte, this
cell contains hemoglobin, which binds to oxygen in the
lungs, and carries the oxygen throughout the body by way
of the circulatory system. Packed RBCs, a type of blood
product, are used to replace erythrocytes lost as a result of
trauma or surgical intervention or in clients with bone
marrow suppression.
2. Whole blood - Blood, unaltered, as it is taken from the
donor. Composed of RBCs, plasma, and plasma proteins, it
is administered primarily to treat hypovolemic shock
resulting from hemorrhage.
3. Platelet - A type of blood cell that is involved in the clotting
process. Platelets are administered to clients with low
platelet counts as a means of preventing hemorrhage and
to thrombocytopenic clients who are actively bleeding or
scheduled for invasive procedures.
4. Fresh-frozen plasma - A type of blood component
administered to augment clotting factors in clients who are
deficient in such factors.
5. Albumin - A type of plasma protein that is used to treat
hypovolemic shock or hypoalbuminemia.
6. Cryoprecipitates - Various blood components used to
remedy deficiencies of clotting factors in conditions such as
hemophilia or von Willebrand disease.
Types of Blood Donation
An autologous donation reduces the risk of disease
transmission and potential transfusion complications but is
not an option for a client with leukemia or bacteremia.
Blood obtained through blood salvage may need to undergo
washing, a process that removes tissue debris, before being
infused.
Infusion of blood taken from a designated donor does not
reduce the risk of bloodborne infection, but recipients often
feel more comfortable about taking blood from a donor they
know and approve of.
Determining Compatibility
Client blood samples are drawn and labeled at the bedside;
the client is asked to state his or her name, which is
compared with the name on the client's identification band or
bracelet.
The recipients ABO and Rh types are identified.
An antibody screen is performed to determine whether
antibodies other than anti-A and anti-B are present.
Crossmatching is performed: Donor red blood cells (RBCs) are
combined with the recipients serum and Coombs serum.
The crossmatch is compatible if no RBC agglutination occurs.
The universal RBC donor is O-negative; the universal recipient
is AB-positive.
Infusion Pumps
Infusion pumps may be used to administer blood products if
they are designed to function with opaque solutions;
however, the negative pressure exerted by the cassette of the
machine may cause hemolysis of RBCs.
Always consult manufacturer guidelines for the pump before
using it.
Special manual pressure cuffs may be used to increase the
flow rate, but pressure should not exceed 300 mm Hg.
Because they do not exert uniform pressure against all parts
of the bag, standard sphygmomanometer cuffs should not be
used to increase the flow rate.
Blood Warmers
A blood warmer may be used to prevent hypothermia and
adverse reactions when several units of blood are being
administered.
Special warmers have been specifically tested and approved
for this use, and only such devices should be employed. Never
warm blood products in a microwave or in hot water.
Precautions and Nursing Responsibilities
General Precautions
A large volume of refrigerated blood infused rapidly through
a central catheter into the heart can cause cardiac
dysrhythmias.
No fluid other than normal saline solution should be added to
blood components, nor should medications be added to a
blood transfusion.
As a means of reducing the risk of septicemia, infusion time
(of 1 unit) should not exceed 4 hours and the administration
set should be changed every 4 hours or in accordance with
agency policy.
Always check the blood bag for the date of expiration;
components expire at midnight on the day marked on the bag
unless otherwise specified.
Inspect the blood bag for leaks, abnormal color, clots, air, and
bubbles.
Blood must be administered within 30 minutes of its being
received from the blood bank; this is the maximal allowable
time out of monitored storage.
Never store blood in a refrigerator other than those used in
blood banks (blood bank refrigerators are equipped with
controlled temperatures designed for blood storage); once
removed from the blood bank, if the blood is not
administered within 30 minutes, return it to the blood bank.
The recommended rate of infusion varies with the blood
component being transfused and the client's condition, but
generally blood is infused as quickly as the client's condition
will allow.
Blood products containing few RBCs, such as platelets, may
be infused rapidly (over 15 to 30 minutes), but care should be
taken to avoid circulatory overload.
 Vital signs and lung sounds should be assessed before the
transfusion, again after the first 15 minutes of transfusion,
and every hour until 1 hour has passed since the transfusion
was completed.
Blood Bank Precautions
Blood is released from the blood bank only to personnel
specified under agency policy.
The name and identification number of the intended recipient
must be provided to the blood bank; a permanent record of
this information is maintained.
To help prevent delivery to the wrong client, blood products
should be transported from the blood bank to a single client
at a time.
Client Identity and Compatibility
The most critical steps in the transfusion process are
confirmation of product compatibility and verification of
client identity.
Two licensed nurses must check the health care providers
prescription, the clients identity, and the clients ID band and
number, verifying that the name and number are identical to
those on the blood component tag.
At the bedside, the client is asked to state his or her name,
which the nurse compares with the name on the clients ID
band.
The blood bag tag and label and the blood requisition form
are assessed to ensure that the clients ABO and Rh types are
compatible with the blood product.
If inconsistencies are noted during verification, the blood
bank is notified.
Client Assessment
Assess the client for cultural or religious beliefs regarding
blood transfusions (e.g., a Jehovahs Witness cannot receive
blood or blood products, because members of this faith
believe that receipt of a blood transfusion has eternal
consequences).
Ensure that informed consent has been obtained.
Determine whether the client has ever experienced a
reaction to a blood transfusion.
Check the clients vital signs; assess renal, circulatory, and
respiratory status and the clients ability to tolerate
intravenous (IV) fluids.
If the clients temperature is increased, notify the health care
provider before beginning the transfusion; fever may be a
reason to delay the transfusion and could mask symptoms of
an acute transfusion reaction.
Administering a Transfusion
Maintain standard precautions.
Insert an IV line and infuse normal saline solution,
maintaining flow at a keep-vein-open rate.
To help prevent circulatory overload, always check the
bag for its volume before starting the infusion.
Premedicate the client with acetaminophen or
diphenhydramine hydrochloride as prescribed if the client
has a history of adverse reactions.
If prescribed, oral medications used to prevent an adverse
reaction should be administered 30 minutes before the
transfusion is started; IV medications should be given
immediately before the transfusion is started.
Instruct the client to report any unusual sensations or
emotions immediately.
Determine the rate of infusion by consulting the health
care providers prescription or, if not specified, agency
policy.
Begin the transfusion slowly and monitor the client
closely; if no reaction is noted during the first 15 minutes,
the flow may be increased to the prescribed rate.
During the transfusion, monitor the client for signs and
symptoms of transfusion reaction; the first 15 minutes of
the transfusion are the most critical, and the nurse must
stay with client.
A major ABO incompatibility or severe allergic reaction
will usually become evident during infusion of the first 50
mL of the transfusion.
Document the clients tolerance of the administration of
the blood product.
Monitor appropriate laboratory values and document the
effectiveness of treatment.
Transfusion Reaction
Description
An adverse and potentially life-threatening event that occurs
when a client receives blood that is incompatible with his or
her blood type or Rh type. Signs may occur during the
infusion or days or even years afterward as a delayed
reaction.
Immediate Signs
Chills and diaphoresis
Muscle aches, back pain, chest pain
Rashes, hives, itching, swelling
Rapid, thready pulse
Dyspnea, cough, wheezing
Pallor and cyanosis
Apprehension
Tingling and numbness
Headache
Nausea and vomiting, abdominal cramping, diarrhea
Delayed Signs
Fever
Mild jaundice
 Decreased hematocrit

Interventions
If a transfusion reaction occurs, stop the transfusion, change
the IV tubing down to the IV site, and keep the IV line open
with 0.9% normal saline solution.
Notify the health care provider and the blood bank.
Remain with the client, observing signs and symptoms and
checking vital signs as often as every 5 minutes.
Prepare to administer emergency medications (e.g.,
antihistamines, corticosteroids, vasopressors) and fluids as
prescribed.
Obtain blood and urine specimens for laboratory studies.
(Free hemoglobin in the urine indicates that hemolysis of
RBCs has occurred.)
Return the blood bag, tubing, attached labels, and tranfusion
record to the blood bank.

Priority Points to Remember!

In an emergency, O-negative blood can be safely

administered to most clients without serologic testing.
No solution other than normal saline solution should be
added to blood components.
As a means of avoiding septicemia, the nurse should not
allow an infusion of 1 unit of blood to take longer than 4
hours; the blood-administration set should be changed every
4 to 6 hours, or in accordance with agency policy, if more
than 1 unit is to be administered.
Blood products must be administered within 30 minutes of
their being received from the blood bank.
Never store blood in a refrigerator other than those used in
blood banks (blood bank refrigerators are equipped with
controlled temperatures designed for blood storage); if blood
obtained from the blood bank is not administered within 30
minutes, return it to the blood bank.
Vital signs and lung sounds should be checked before the
transfusion, again after the first 15 minutes, and every hour
until 1 hour has elapsed since the transfusion was completed.
The most important part of the transfusion process is
confirmation of product compatibility and verification of
client identity.
A Jehovahs Witness may not receive blood or blood
products.
Ensure that informed consent has been obtained before
administering a blood transfusion.
The first 15 minutes of the blood transfusion are the most
critical part of the transfusion, and the nurse must stay with
the client.
Instruct the client to immediately report anything unusual
while receiving the transfusion.
If a transfusion reaction occurs, stop the transfusion
immediately.