Pharm Basics, part 9: Blood Transfusions

I am Cathy with Level Up RN. In this video, we are going to talk about blood transfusions. So I highly recommend that you review the different blood types and for each blood type, who they can give to and who they can receive from. So that information is contained in our pharmacology basic stack. And I was personally tested on that type of information on the NCLEX, so definitely worth a review. Let's talk about the different types of blood products that we may need to give our patient, and the infusion time associated with each of those blood products. So for packed red blood cells, we would infuse those over two to four hours, so a maximum of four hours. With fresh frozen plasma, we infuse those much faster. So those will be infused between 15 and 30 minutes, and they need to be administered within two hours of thawing. Then we have platelets, and those are also infused between 15 and 30 minutes. So whenever we're going to do a blood transfusion on a patient, we want to confirm the patient's ID, their blood compatibility, and the expiration date of the blood product with another RN. We're going to want to make sure the patient has a 20-gauge or larger IV catheter, so ideally, they would have an 18-gauge, but a 20-gauge will likely work as well. And you always want to check the patency of that IV and make sure it's working properly before you call and have that blood product sent up, because that can definitely happen where you're like, "Yeah. I'm ready for it. Send it up." And then you go and set it all up, and you realize, "Oh. That IV has infiltrated, or not working properly." So definitely check the IV first.

You want to prime the blood transfusion administration set with normal saline only. So 0.9% NaCl. So we're not priming the line with any other type of fluid other than that normal saline. And then, you never want to administer medications through the line that is getting blood. So just like with TPN, when a patient is getting TPN, that line is just for TPN. When a patient is getting blood, that line is just for blood. If the blood is not administered within 30 minutes of you receiving it, it needs to be sent back to the blood bank. And, like I mentioned before, we definitely need to administer packed red blood cells within four hours. And then, we're going to take the patient's vital signs before administration of the blood, and we're going to stay with the patient for the first 15 minutes of administration to make sure they don't have a reaction. And if they are doing fine after 15 minutes, we're going to take all those vital signs again to make sure everything looks okay.

Now, let's talk about blood transfusion reactions. If your patient has a serious reaction to their blood transfusion, you're going to want to stop the infusion. You're going to want to administer 0.9% NaCl through a separate line. So why don't we administer the saline that we used to set up the blood transfusion, through that blood transfusion administration set? Well, you have tubing there that's going into the patient that is full of blood. So if your patient's having a reaction, and you're like, "Okay. I'm going to clamp the blood, and I'm going to open up the NaCl," all that blood still has to get into the patient before they're going to get that normal saline, and we don't want any more blood going into the patient, so that is why we want to administer 0.9% NaCl through a separate line.

Okay, now that you understand the general steps that we would take in the case of a blood transfusion reaction, let's talk about specific reactions and what symptoms you may see, and what medications you may need to give in response to those reactions. So first of all, we have a mild allergic reaction. And symptoms of this reaction can include itching, flushing, and urticaria. In response to a mild allergic reaction, we may be able to give the patient diphenhydramine which is Benadryl to help mitigate those symptoms. In the case of an anaphylactic reaction, which of course is very serious, the patient may have symptoms such as wheezing, dyspnea, hypotension, and decreased oxygenation, so their SpO2 will be decreased. In response to this type of reaction, we will likely be giving epinephrine and corticosteroids as ordered by the provider. If the patient has a cerebral reaction, they may have symptoms such as fever, chills, hypotension, tachycardia, and tachypnea, and you would anticipate giving antipyretics as ordered for this type of reaction. With a septic reaction, your patient may have symptoms such as fever, chills, and abdominal pain. In response to that, you may need to collect cultures and administer antibiotics as ordered. If your patient is having an acute hemolytic reaction, that's going to cause low back pain as well as fever and chills, tachycardia, tachypnea, and hypotension, so you may need to collect labs and specimens and give them IV fluids as ordered by the provider.

And then finally with a circulatory overload reaction to the blood transfusion, your patient may have signs such as dyspnea, tachycardia, tachypnea, crackles, hypertension, and distended jugular veins, so all the signs of fluid volume excess. This is the one type of reaction where, in all likelihood, we can keep giving them the blood transfusion, but we need to decrease the infusion rate. So if your patient is having circulatory overload-type symptoms, you want to raise the head of the bed, slow that infusion rate, although you still need to give it within four hours, like we talked about before. You're also going to monitor their oxygenation and their vital signs. And then the provider may order diuretics for you to provide the patient as well.

Are you guys ready for a quiz? I have three questions to test your knowledge on the information I just covered. So first question, what do you use to prime the blood transfusion administration set? If you said 0.9% NaCl you are correct. Number two, low back pain, fever, tachycardia, and tachypnea are signs of what blood transfusion reaction? The answer is an acute hemolytic reaction. Question number three, a blood transfusion needs to be completed within "blank" hours. The answer is four. So I hope you did well on that. This concludes our pharmacology basics video playlist. I hope it was super helpful for you guys. Good luck with studying, and take care.