Blood Administration: Pre-procedure (Nursing)

00:04 Welcome to the topic of transfusion of blood products.

00:07 One thing to note is depending on where you reside, your regulatory agency may state that only a registered nurse or an RN, can either initiate and transfuse blood products.

00:21 So just make sure that you check your agency's policy and your state's practice act.

00:25 Now, there's a lot of important points to consider before we even start the transfusion of blood.

00:32 Now, one of those is some individuals have religious preferences that do not allow them to receive blood products.

00:40 And as you can imagine, this is a really important point to note, if the patient's going in for a major surgery and may need blood, we need to know this information in before they go in.

00:52 Also note that it's really important that we get blood samples taken for compatibility.

00:58 What we talk about about blood samples is a type and cross, or a type and screen.

01:04 What this does is tell us the patient's specific blood type so we know exactly what kind of blood that we can give.

01:11 Now this is only good for about three days depending on your agency's policy.

01:16 We do this for safety reasons to make sure, if the patient's got a long hospital stay, over three days, then, again, we're rescreening, taking new samples to make sure each and every time they're getting the right blood.

01:32 Also note that a physician or a healthcare provider must consent the client, not the nurse.

01:38 They have to give them the full scope of the risks and the benefits of transfusion of blood products.

01:45 Now once you're ready to transfuse the blood, do your best to not let the blood product set for more than 30 minutes before beginning administration.

01:57 One big helpful hand is if you get everything ready, your equipment, your vital machine, prep the patient, before you go to the blood bank and bring the blood back to your unit to infuse.

02:09 Now, once you're ready to infuse, note that that blood must be completely infused within four hours.

02:16 One thing that you may come across when you're transfusing blood products, is make sure you check your physician's orders.

02:24 Many times, there's going to be an order to give medications with the transfusion itself or even maybe in between.

02:32 So if we're going to give oral medication such as Benadryl for example, we need to give this about 30 minutes before even starting the transfusion, so again, be diligent in checking physician orders.

02:44 Now many times we may do this to reduce the risk or the chance of a transfusion reaction.

02:51 We may also administer IV medications immediately before starting transfusion.

02:57 Don't forget to check the IV site that you're going to transfuse the blood.

03:03 As you can imagine that if you have a bad IV that's not working, we have to stop, restart an IV, that definitely could delay us in transfusing the blood, so you want to make sure your IV site is patent and the correct size.

03:18 So, ideally, we want at least a 20 or about an 18 gauge, a larger diameter to infuse the blood.

03:26 And never, never infuse any other medications in the same tubing as the blood.

03:33 When we use blood tubing, it is only for blood itself.

03:37 Now let's take a look at some of the special equipment that you're actually going to need when we transfuse blood products.

03:44 So this first image that you see here, this administration set, this is very important, guys, that you are using a blood administration tubing.

03:55 Not IV tubing, blood administration tubing.

03:59 This is specially designed for the transfusion of blood.

04:03 Now, as you notice here you see two roller clamps and two ports.

04:07 One of those is going to be for blood and the other one is going to be for this other piece of equipment that you see here which is your normal saline bag.

04:16 So you're going to have blood on one side and the saline on the other.

04:20 Don't forget about your 10 mL saline syringes.

04:23 Alcohol pads to clean your site, and of course, a vital sign machine for monitoring.

04:29 Now, before that we transfuse the blood products themselves, we want to makes sure we verify the order to transfuse the blood.

04:38 Then we want to makes sure that that consent has been signed.

04:43 Now, if you recall, a physician or an advance practice provider, must provide education on this particular action.

04:51 But as the nurse, we want to make sure that the consent itself has been signed.

04:57 Now, let's take a moment and take a look at this consent.

05:00 This is a typical one that you way see that the physician or advance practice provider has gone over with the patient, but again, we're making sure that this has been signed.

05:10 You may see demographic information for the patient, also the type of blood such as either red blood cells or platelets for example, and also all of the risk and benefits are usually included here on the consent.

05:25 Now that we've gone over that consent and made sure it's signed, now we can request it from the laboratory.

05:32 You want to go ahead and gather all the necessary supplies before you even get started.

05:39 Perform your hand hygiene and provide privacy for your patient.

05:43 Now, once we've gotten the blood, we want to confirm the client's identity using two-patient identifiers.

05:50 Of course, this is very, very important.

05:53 And, of course, the physician or the advance practice provider has talked about the risk and the benefits of the blood, but as the nurse, we need to let the patient know what they're going to expect, such as how long we're going to monitor and things to watch out for.

06:09 And we're talking about providing that education, and then it's really important in particular, that you talk about signs of a transfusion reaction.

06:20 So, anytime I go to give blood to a patient, before I even start the transfusion, I ensure that I provide this education such as, Hey, Mrs. Jones, for example, you may have trouble breathing, you may have a hard time catching your breath.

06:37 If you ever feel like that you are running a fever or getting hot, if you feel like you're getting chest pain.

06:44 And, sometimes, when we're monitoring with the vital signs, we may see signs of tachycardia such as a high heart rate over 100.

06:53 We may see hypotension which is an abnormally low blood pressure.

06:57 You may have the patient experience things like itching, again, fever, pain.

07:03 If any of these occur, this is immediate warning sign that we must stop the transfusion.

07:10 Now, once we've educated our patient thoroughly about these reactions, now we can raise the patient's bed to an appropriate working height.

07:19 And then assist the client in a comfortable position because unfortunately, once we start the blood, the patient is going to be sitting there for a bit.

07:27 Now we can perform our hand hygiene and don our gloves.

07:31 Now, again, if you recall, make sure that peripheral IV is patent and appropriate gauge.

07:36 And, ideally, you have about an 18 or a 20 gauge IV.