NURSING RESPONSIBILITIES IN BLOOD TRANSFUSION Patients Expectation of Nurses 1. 2. 3. 4. 5. . ". $.

Courtesy Care Patience Clarity of instructions Promptness in answering call bells Pro!ision of information Patient confi#entiality Competence

Purpose of %loo# &#ministration 1. 2. 3. 4. 'ncrease bloo# !olume (eplace certain bloo# constituent (eplace )emoglobin *upply an antibo#y

+efinition of (esponsibilities in %, -ospital .anagement Ensure t)at t)ere is senior management commitment to better %, Ensure appropriate members)ip / function of t)e -ospital ,ransfusion Committee Ensure appropriate %, policies are in place0 implemente# / monitore# -ospital ,ransfusion Committee Promote best practice t)ru local protocols base# on national gui#elines 1ea# t)e au#it of t)e practice of %, against t)e )ospital policy / national gui#elines 2ee#bac3ing of au#it / mo#ify existing protocols as nee#e# .e#ical *taff &re solely responsible for prescribing bloo#0 bloo# components / bloo# pro#ucts / for ensuring a#e4uate #ocumentation of %, in t)e me#ical notes (esponsible for informing t)e patient of5 'n#ication for t)e %, (is3s / benefits (ig)t to refuse %, &lternati!es to %, .e#ical6Nursing *taff (e4uest bloo#0 bloo# components / bloo# pro#ucts Carry out t)e proce#ure for t)e a#ministration of bloo# / bloo# components .onitor patients #uring t)e transfusion / carry out appropriate actions in t)e e!ent of a#!erse reactions

 (eport reactions or ot)er inci#ents (6, transfusion P)lebotomists ,a3e bloo# samples for bloo# grouping / compatibility testing pro!i#e# t)ey )a!e been gi!en for formal training / )a!e complete# competency assessment Consi#erations prior to transfusion Positi!e i#entification of patient is essential / must be base# on t)e following5 7uestioning t)e patient by as3ing surname0 first name / #ate of birt) C)ec3ing t)at t)e #etails on t)e patients i#entification matc) t)ose on t)e re4uest form 2or an uni#entifie# patient t)e patient i#entification no. an# gen#er are minimum patient i#entifiers 8enipuncture5 9 :nly one patient must be puncture# at a time to minimi;e t)e ris3 of error *ample labelling *ample tube #etails must be )an#written by t)e person extracting t)e sample0 #one at be#si#e *ample must not be pre9labelle# ,elep)one re4uests 9 )ospital bloo# ban3 must )a!e a policy for #ocumenting telep)one re4uests 9 i#entity of t)e person ma3ing t)e re4uest / t)e person recei!ing must be recor#e# 9 t)e following information must be pro!i#e#5 9 patients surname0 first name / patients case no. 9 number / type of bloo# or bloo# components re4uire# inclu#ing any special re4uirements 9 reason for t)e re4uest 9 time / #ate t)e bloo# or bloo# components are re4uire# %loo# must not be store# in war# or #omestic refrigerators %loo# must only be store# or transporte# in boxes #esignate# for t)is purpose *taff remo!ing bloo# from ban36lab must )a!e #ocumentation containing t)e patients i#entification #etails <)en bloo# or bloo# components are #eli!ere# to a war# or :( a member of appropriately traine# staff must c)ec3 t)at t)e correct bloo# )as been #eli!ere# by c)ec3ing t)e patient i#entification #etails Normally one unit of bloo# or bloo# components is to be collecte# at a time unless rapi# infusion is anticipate# %loo# / bloo# components are consi#ere# as me#icines for a#ministration purposes0 t)us0 must only be a#ministere# by a registere# p)ysician or nurse ,wo (Ns must c)ec3 t)e i#entity of t)e patient / t)e unit of bloo#. '#entity c)ec3 of patient / unit of bloo# must ta3e place at patients be#si#e prior to transfusion0 PN** may be prescribe# by t)e p)ysician

Technical aspects in the administration of lood ! lood components <)en bloo# is recei!e# in t)e clinical area0 transfusion must start as soon as possible =wit)in 3> min? %loo# for transfusion must be store# in a #esignate# bloo# ref at stable temp 29 C. 'f a unit of bloo# )as been out of t)e ref for more t)an 3> min / t)ere is no imminent transfusion0 t)e unit must be returne# to bloo# ban3 imme#iately %loo# must be transfuse# t)roug) a sterile set Electronic infusion pumps may #amage bloo# cells0 / must not be use# for t)e a#ministration of re# cells ,)e si;e of cannula s)oul# #epen# on t)e si;e of t)e !ein / t)e spee# at w)ic) bloo# is to be transfuse# %loo# is not routinely warme#. +rugs must not be a##e# to bloo# un#er any circumstances & single unit must be transfuse# in a maximum time of 4 )ours &#ministration set must be continuously use# in a maximum of 12 )rs to pre!ent bacterial growt) Empty bloo# bags must be returne# to t)e laboratory &*&P after t)e transfusion "are ! #onitorin$ of Transf%sed Patients Nursing staff are responsible for t)e care / monitoring of patients recei!ing a transfusion 8isual obser!ation of t)e patient t)roug)out transfusion is an essential assessment 86* relate# to t)e transfusion must be recor#e# separately from routine obser!ations / clearly #ate#0 or recor#e# ,emp0 pulse0 %P0 (( at t)e start / en# ,emp0 pulse0 %P0 (( 15 min after starting Doc%mentation Recommendation 1. 2. 3. 4. 5. . ". $. @. *ite %aseline 86* ,ime starte# / terminate# ,ype of bloo# pro#uct / '+ no. *ignatures of person initiating / !erifying pro#uct. ,otal no. of units0 !olume of bloo# / saline infuse#. Pre6Post me#ication use# for bloo# t)erapy Patients response 6 reactions &ll nursing inter!entions iniate# / performe# #uring t)erapy.

Tro% leshootin$ Tips

*luggis) '8 lines / clogge# filters t)at #ecrease t)e flow rate may be encountere# #uring transfusion. 'n!estigations inclu#e5 's t)ere a 3in3 in t)e setA 's t)e correct gauge of nee#le 6 cat)eter being use#A -as irrigation wit) normal saline been attempte#A -as t)e filter been use# for more t)an 2 unitsA -as t)e bloo# bag been rotate# to #istribute contents e!enlyA 's t)e bag 3 94$B abo!e siteA +oes t)e roller clamp nee# to be a#Custe#A 'f all negati!e0 consi#er use of pressure cuff. (eactions to ,ransfusion Reactions &llergic reaction "a%se &ntibo#y reactions to allergens in #onors bloo# Assessment Inter&entions

.il#5 )i!es0 itc)ing0 .il#5 *low %,0 Notify flus)ing +r.0 &#minister *e!ere5 *)ortness of anti)istamine as breat)0 or#ere#. bronc)ospasm0 *e!ere5 *top %,0 w)ee;ing .aintain '8 line0 Notify +r.0 Di!e anti)istamine0 epenep)rine Pre!ention5 &nti)istamine 1 )r before %,