What is the standard procedure for blood transfusion?

Standard Procedure for Blood Transfusion

Blood transfusion must follow strict protocols for patient identification, blood product handling, and monitoring to ensure patient safety and prevent adverse reactions.

Pre-Transfusion Procedures

Patient Identification

• Verify patient identity using at least two identifiers (name, hospital number, date of birth)
• Confirm blood product matches patient information
• Pre-infusion identity checks are mandatory and should follow hospital's standard procedures 1

Blood Product Handling

• Blood products must be properly labeled with:
  • Patient's full name
  • Hospital number
  • Date of birth
  • Date and time of collection
  • Name of person performing collection
  • Clear labeling of blood type and product type 1

Storage Requirements

• Blood removed from controlled temperature storage must be handled according to time limits:
  • Standard practice limits blood to be out of refrigeration for up to 6 hours at room temperature 1
  • Blood must be stored in appropriate containers to minimize temperature fluctuations 1
  • Blood products should remain with the patient and not be removed to general blood storage 1

Transfusion Administration

Immediate Pre-Transfusion Steps

1. Verify patient identity and blood product match at bedside
2. Assess patient's baseline vital signs (temperature, pulse, blood pressure, respiratory rate)
3. Establish patent IV access of appropriate gauge
4. Document pre-transfusion assessment

During Transfusion

1. Begin transfusion slowly for first 15 minutes
2. Monitor patient closely during initial period for signs of reaction
3. Record vital signs at regular intervals (typically 15 minutes, 30 minutes, hourly thereafter)
4. Complete transfusion within time limits (typically 4 hours per unit) 2

Post-Transfusion

1. Document completion of transfusion
2. Record post-transfusion vital signs
3. Monitor for delayed reactions
4. Document volume transfused in patient's medical record 1

Managing Transfusion Reactions

Recognition of Reactions

• Monitor for signs of reactions:
  • Fever, chills
  • Urticaria, pruritus
  • Respiratory distress
  • Hypotension
  • Back/flank pain
  • Hemoglobinuria 3

Management of Suspected Reaction

1. Stop transfusion immediately
2. Maintain IV access with normal saline
3. Notify physician
4. Check vital signs
5. Reconfirm patient and blood unit identification
6. Return blood bag and tubing to blood bank for investigation
7. Collect post-reaction blood and urine samples as indicated 3

Documentation Requirements

• Record in patient's medical record:
  • Number of units transfused
  • Total volume transfused
  • Time transfusion started and completed
  • Patient's response to transfusion
  • Any adverse reactions 1

Reporting Requirements

• Report all serious adverse events to:
  • Hospital transfusion committee
  • Appropriate national reporting system 1
  • Hemovigilance reporting system for any symptoms occurring within 24 hours of transfusion 3

Special Considerations

Autologous Blood

• Label clearly as "UNTESTED BLOOD: FOR AUTOLOGOUS USE ONLY"
• Keep with patient and do not remove to general blood storage
• Dispose of unused autologous blood as hazardous waste 1

Timing Considerations

• While traditional practice limits blood out of refrigeration to 30 minutes before return to storage is prohibited, evidence suggests this could potentially be extended to 2 hours without increased risk 4
• Complete transfusion within 4 hours of removal from controlled temperature storage 2

Quality Assurance

• Regular audit of transfusion procedures should be conducted
• Documentation of all transfusions and outcomes
• Review of adverse events and implementation of preventive measures 1

Remember that the best way to prevent transfusion reactions is to avoid unnecessary blood transfusions and maintain a transfusion-restrictive strategy 3.