Administering Blood Transfusion process

Administering Blood Transfusion process
13. Remove primary IV tubing from catheter hub, and cover
end with sterile protector.
14. Attach blood administration tubing to catheter hub, and
secure with tape. The IV should be started into an 18- or
19-gauge catheter.
15. Open clamp to blood component. Open roller clamp
below drip chamber and begin transfusion. Program EID
to infuse blood slowly for first 15 minutes.
16. Observe and document patient’s condition during first
15 minutes, assessing for chilling, back pain, headache,
nausea or vomiting, tachycardia, hypotension, tachypnea,
fluid overload, or skin rash. (Note: If any adverse reactions
occur, close clamp to blood, open clamp to 0.9% NaCl,
and notify physician immediately. Follow agency policy for
laboratory notification and obtaining blood and urine
17. If no adverse reactions occur after 15 minutes, reprogram
EID to increase infusion according to physician’s orders. A
unit of RBCs is usually administered over 2 to 4 hours.
Observe the patient for signs and symptoms of transfusion
reaction at least every 30 minutes throughout the transfu-
sion. Obtain vital signs when observations warrant. Docu-
ment observations, including the absence of any signs of
transfusion reaction, in the medical record.
18. When blood transfusion is complete, clamp roller to blood
and open roller to 0.9% NaCl. Infuse until tubing is clear
(usually no more than 50 mL of normal saline).
19. Obtain and document vital signs.
20. If second blood component unit is to be transfused, slow
0.9% NaCl to keep vein open until next unit is available.
Follow verification procedure and vital sign monitoring for
each unit.
21. If transfusion orders are complete, disconnect the blood
administration tubing from the IV catheter hub. Recon-
nect the primary IV solution and tubing and adjust to
desired rate.
22. Wash hands and document procedure
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