Blood and Blood Products

Overview

Welcome to our deep dive into the safe administration of blood and blood products! By the end of this guide, you’ll confidently understand the step-by-step protocols for transfusion, how to identify and respond to transfusion reactions, and the essential documentation and verification processes. We’ll break down the reasoning behind best practices, clarify common misconceptions, and walk through generic examples to cement your understanding. Mastering these concepts will help you provide safe, evidence-based care during blood product administration.

Concept-by-Concept Deep Dive

Safe Blood Administration Procedures

What it is:
Administering blood and blood products safely means following strict protocols to prevent errors, infections, and reactions. This includes correct identification, preparation, monitoring, and documentation at every stage.

Components and Subtopics

• Patient and Blood Product Verification:
  Always perform a two-person verification (nurse-to-nurse or nurse-to-patient) to confirm the patient's full name, date of birth, medical record number, and the blood unit details (donor number, blood type, expiration date) before starting a transfusion.

• IV Access and Equipment Selection:
  Choose the appropriate IV site and catheter size for the product. For packed red blood cells (PRBCs), a larger bore (often 18-20 gauge) helps prevent hemolysis and allows adequate flow. Some products, like platelets, can go through smaller gauges or central venous catheters if required.

• Preparation Steps:
  Verify orders, consent, and pre-transfusion vitals. Assemble necessary supplies (blood tubing with filter, saline, infusion pump if needed), and ensure emergency medications are on hand.

Step-by-Step Reasoning

1. Confirm all patient identifiers and blood product details with a second qualified person.
2. Assess the IV site and select the correct size and type of catheter.
3. Prime the tubing with 0.9% saline only—other fluids can cause hemolysis.
4. Start the transfusion slowly, especially for the first 15 minutes, observing for any reactions.
5. Monitor and document vital signs per protocol.

Common Misconceptions

• “Any IV line is fine for blood products.”
  Not all IV lines or sizes are suitable; using an inappropriate size may damage cells or slow the transfusion.
• “Double-checking can be skipped if I’m busy.”
  Skipping this step is a leading cause of fatal transfusion errors.

Recognizing and Responding to Transfusion Reactions

What it is:
Transfusion reactions are adverse responses to blood products, ranging from mild (hives) to life-threatening (anaphylaxis, acute hemolytic reactions). Prompt recognition and immediate action save lives.

Types of Reactions

• Acute Hemolytic Reaction:
  Symptoms include fever, chills, back/flank pain, hemoglobinuria, and hypotension, often due to ABO incompatibility.
• Allergic Reaction:
  Presents as urticaria (hives), itching, sometimes progressing to anaphylaxis.
• Febrile Non-Hemolytic Reaction:
  Fever and chills without evidence of hemolysis.

Step-by-Step Response

1. Stop the transfusion immediately at the first sign of reaction.
2. Maintain IV access with normal saline (using new tubing).
3. Notify the provider and blood bank; document findings.
4. Monitor vital signs and provide supportive care as needed.