Tuesday, April 9, 2013

Workflow Process for Blood Transfusion

The blood transfusion is the common and standard procedure that often occurs in healthcare organizations. The National Institute of Health (2012) mentioned that the blood transfusion is done to replace blood lost during surgery or a serious injury and also when person’s body cannot make blood because of an illness. This procedure takes one to four hours depending on the amount of blood needed for the transfusion and involves coordination of various healthcare providers including the registered nurse (RN), physician, laboratory technologist and the blood bank’s staff. Since a wrong blood transfusion to the patient can be life threatening, special consideration should be given in each step of the transfusion. The blood which is ready for the transfusion, passes from a tube through an intravenous catheter into the vein of the blood recipient. In order to perform safe blood transfusion, there are several steps where nurse need to be alert before, during and after the blood transfusion.
The nurse has responsibility to fully inform the patient about the procedure and the patient has right to know what is happening to their body and how the procedure is going to impact on their health. To start the process of blood transfusion, take informed consent from the patient after identifying the patient who needs blood transfusion. It is essential to explain about the transfusion in detail in order to take an informed consent of the patient. If a patient rejects to provide informed consent, a registered nurse should complete a patient release form for refusal of blood and ask the patient to sign the form. However, if the patient gives informed consent, then the nurse should record in the chart of the patient and call the laboratory personnel by phone to draw the blood. The nurse also needs to contact the Blood Bank by phone to make a request of the blood as prescribed by the doctor. Once the blood is received from the Blood Bank, two registered nurses should check the identification of patient, blood type, donor number, component name, component identification number and date to cross-match the blood and patient. More importantly, the nurses should carefully verify the dispensed time from the blood bank on the form. If that time crosses 30 minute of hand out time from the Blood Bank, it should be returned to the blood bank. Otherwise, the nurse has to sign the blood delivery form with the blood received date and time, then the nurse needs to send the signed form back to the blood bank.
During the transfusion of the blood, the nurse should be really cautious to identify the right patient and right blood because small mistake in identifying the patient and correct blood that cross matches with the patient can be life threatening. Another critical step that should not be avoided is to monitor patient temperature, pulse, respiration and blood pressure. The registered nurse should not forget to administer pre-transfusion medications if ordered by the physician. Patients with a fever should not receive the blood because a fever will mask the febrile reaction of the patient during transfusion. Additionally, blood should not be transfused from the same intravenous line from which patient is receiving drugs, lactated ringer’s solution and hypotonic solution. The intravenous line should be flushed by isotonic solution (0.9% sodium chloride or normal saline). During the first 15 minutes, blood should be given very slowly one milliliter per one minute and the patient needs to be watched carefully for adverse reaction. After that first 15 minutes if patient is okay, the flow of blood can be increased gradually. Vital signs need to be measured after 15 minutes, 30 minutes, two hours and after the completion of the blood transfusion. Blood should be transfused within four hours from starting time of the transfusion and the completion of transfusion should be recorded in the patient’s chart.
 In contrary, if a patient shows any adverse reaction, then the transfusion of the blood need to be stopped immediately and the physician should be notified. The tubing and remaining blood within the blood container should be sent to the Blood Bank for the investigation. The amount of blood that is already administered and the patient reaction should be recorded in the patient chart. Patient’s vital signs and physical symptoms should be monitored carefully even after the blood transfusion. The registered nurse should be able to distinguish the sign of hemolytic and allergic reactions during and until 24 hours after the blood transfusion has completed, which can result in destruction of the patient immune system (U.S. National Library of Medicine, 2012). The symptoms may include back pain, bloody urine, chills, fainting or dizziness, fever, flank pain and flushing of the skin.
National Institute of Health. (2012). What is blood transfusion? National Heart Lung and Blood Institute. Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/bt/
U.S. National Library of Medicine. (2012). Transfusion reaction-hemolytic: MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/001303.htm

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