Female nurse preparing a patient

Step-by-Step Guide to Blood Transfusions

Learn the procedures, steps, risks, and requirements for performing a blood transfusion.

Female nurse preparing a patient

Blood transfusions are a potentially life-saving procedure that replaces blood lost during surgery or injury. A blood transfusion can also serve as a treatment for patients with illnesses that stifle their ability to naturally produce enough blood cells for their bodies.

This article focuses on the art and science of blood transfusions, one of the most vital procedures for nurses and other medical staff. Healthcare professionals who master this skill can help save lives and contribute to higher rates of patient satisfaction within the medical facilities where they practice.

(Click here to see our full list of the most common nursing duties and responsibilities).

Blood transfusions are an essential step for surgeries and other lifesaving measures. This important skill can be exciting yet daunting for new healthcare professionals. It’s especially important for Registered Nurses (RNs) to learn the proper method for blood transfusions in a healthcare environment.

Blood Transfusion Definition

What is a Blood Transfusion?

Blood transfusions are a routine medical procedure that delivers blood into a patient’s body through a narrow tube that’s connected to a vein in their arm or hand.

To administer a blood transfusion, healthcare professionals place a thin needle into a vein—usually located in the arm or hand—which allows blood to move from a bag, through a rubber tube, and into the patient’s vein through the needle. Nurses must closely monitor their patient’s vital signs throughout this procedure.

Red blood cell transfusions may be given to patients who suffer from an iron deficiency (i.e. anemia). This transfusion would boost a patient’s hemoglobin and iron levels, while also improving oxygen levels in the body.

Platelet transfusions are often administered to patients who suffer from leukemia or other types of cancer. This is because they may have lower platelet counts due to chemotherapy treatments. Other patients may suffer from illnesses that stop the body from creating enough platelets. Because of this, they may receive regular transfusions in order to stay healthy.

Plasma transfusions provide vital proteins and other substances that are crucial to a patient’s overall health. Plasma transfusions are often administered to those with liver failure, severe infections, or serious burns.

What is the Purpose of a Blood Transfusion?

Blood transfusions are a relatively common procedure. In the United States, about 21 million blood components are transfused every year.

Common reasons for a blood transfusion:

  • Many patients who undergo a major surgical procedure will receive a blood transfusion to replace blood lost during surgery.
  • Blood transfusions are typically administered to patients who have suffered serious injuries from car crashes, natural disasters, or other traumatic events.
  • Patients who suffer from illnesses that cause anemia will typically require blood transfusions as part of treatment. These can include illnesses such as leukemia or kidney disease.

How Long Does it Take to Perform a Blood Transfusion?

Depending on the amount of blood a patient requires, a simple blood transfusion can take anywhere from 1 to 4 hours.

The procedure starts when an intravenous (IV) line is placed into the patient’s body. With this IV, the patient can receive new blood.

Who Performs a Blood Transfusion?

Blood transfusions can be performed by various healthcare professionals, such as Registered Nurses (RNs) and Licensed Vocational Nurses (LVNs) or Licensed Practical Nurses (LPNs).

(Click here to learn how to become a Licensed Vocational Nurse).

Nurses will usually perform this task under the direction of a physician’s order.

Training Requirements for a Blood Transfusion

When it comes to blood transfusion requirements, most licensed professionals such as Registered Nurses and Licensed Vocational Nurses will typically learn how to perform blood transfusions through educational programs and medical training.

In fact, blood transfusion training is a significant component of the NCLEX-RN exam. To pass this test and receive your nursing license, you will be expected to demonstrate your knowledge of blood and blood products (i.e. platelets, plasma, etc.).

(Click here to read our tips for passing the NCLEX Exam).

Blood Transfusion Procedure

A Detailed Guide to Blood Transfusions

By reviewing the following steps, you can begin to learn more about the process of blood transfusions. Like any other skill, blood transfusions require a lot of time and practice to master. While in school, try not to feel disheartened if you don’t get it right the first time. And don’t hesitate to ask for help.

Nurse administering a blood transfusion

Blood Transfusion Prep

Blood transfusions are often administered in a hospital, outpatient clinic, or doctor’s office. A nurse or doctor will also check the patient’s blood pressure, pulse, and temperature before starting the procedure.

Blood Transfusion Steps

Here are some of the general guidelines you should follow when performing a blood transfusion in a controlled setting.

Before the Transfusion

  1. Find current type and crossmatch
    • Take a blood sample, which will last up to 72 hours
    • Send your sample to the blood bank
    • Ensure the blood sample has the correct date/timing/labeling
    • Wait for the blood bank to match and prepare needed units based on the sample you sent them
  2. Obtain informed consent and health history
    • Discuss the procedure with your patient
    • Confirm their health history and any allergies
    • Ensure that the supervising doctor has acquired signature consent for administration of blood products from the patient
  3. Obtain large bore IV access
    • This is 18G or larger IV access
    • Each unit will be transfused within 2-4 hours
    • Obtain a second IV access if the patient requires additional IV medication therapy (i.e. antibiotics)
    • Remember: Normal saline is the only solution that can be transfused with blood products
  4. Assemble supplies
    • Special Y tubing with an in-line filter
    • 0.9% NaCl (Normal Saline) solution
    • Blood warmer
  5. Obtain baseline vital signs
    • These include heart rate, blood pressure, temperature, pulse oximeter, and respiratory rate
    • Lung sounds and accurate urine output should also be documented
    • Notify the doctor if their temperature is greater than 100° F
  6. Obtain blood from blood bank
    • Once the blood bank notifies you that the blood is ready, you must schedule its delivery from the blood bank
    • Packed red blood cells (pRBCs) can only be hung ONE UNIT AT A TIME.
    • Remember: Once the blood has been released for your patient, you have 20-30 minutes to start the transfusion and up to 4 hours to complete the transfusion

Initiating the Blood Transfusion

  1. Verify Blood Product
    • Two RNs at the patient’s bedside must verify the below:
      • Physician’s order with patient identification compared to the blood bank’s documentation
      • Patient’s name, date of birth, and medical record number
      • Patient’s blood type versus the donor’s blood type and Rh-factor compatibility
      • Blood expiration date
  2. Educate the patient
    • Relay the signs and symptoms of a transfusion reaction. If these occur, the patient should notify their RN during the transfusion
      • Rash, itching, elevated temperature, chest/back/headache, chills, sweats, increased heart rate, increased respiratory rate, decreased urine output, blood in urine, nausea, or vomiting
  3. Assess and document the patient’s status
    • Baseline vital signs (HR, RR, Temp, SPO2, BP), lung sounds, urine output, and color
  4. Start the blood transfusion
    • Prepare the Y tubing with normal saline and have the blood ready in an infusion pump
    • Run the blood slowly for the first 15 minutes (2mL/min or 120cc/hr)
    • Remain with the patient for the first 15 minutes; this is when most transfusion reactions can occur
    • Increase the rate of transfusion after this period if your patient is stable and doesn’t display signs of a transfusion reaction
    • Document vital signs after 15 minutes, then hourly, and finally, at the completion of the transfusion

During the Transfusion

  1. Look for any of these transfusion reactions
    • Allergic
    • Febrile
    • GVHD (Graft vs. Host Disease)
    • TRALI (Transfusion Related Acute Lung Injury)
  1. If you suspect a reaction, do the following
    • Stop the transfusion IMMEDIATELY
    • Disconnect the blood tubing from the patient
    • Stay with the patient and assess their status
    • Continue to check for status changes every five minutes
    • Notify the doctor and blood bank
    • Prepare for further doctor’s orders
    • Document everything

After the Transfusion

  1. Flush Y tubing with normal saline
  2. Dispose of used Y tubing in a red biohazard bin
  3. Obtain post-transfusion vital signs and document the patient’s status

Blood Transfusion Recovery

After the procedure, patients may experience some soreness near the puncture site, but this side effect should dissipate quickly. In addition, the patient’s doctor might request a checkup after the transfusion.

Necessary Equipment for a Blood Transfusion

Blood bags and other medical supplies

The suggested supplies for a blood transfusion may include the following:

  • IV access. Blood components may be provided through a number of central venous access devices (CVAD) or peripheral intravenous catheters. You might want to consider the below sizes.
    • 20-22 gauge for routine transfusions in adults.
    • 16-18 gauge for rapid transfusions in adults.
    • 22-25 gauge for pediatrics.
  • Administration sets. The requirements for these sets might vary. Check the facility-specific policy first.
  • Sets for blood components. Administering blood components requires the use of a blood filter, which may range in pore size from 170 to 260 microns. It’s intended to remove clots, cellular debris, and coagulated protein.
  • Sets for PPPs. The administration of platelet-poor plasmas (PPPs) may require a number of supplies, which often differ by product and brand. Facilities should refer to the product monograph and local policy to determine what filtration is required.
  • Infusion devices. Infusion devices can be used to transfuse blood components (i.e. infusion pumps, rapid infusers, blood warmers, and pressure devices).
  • Pressure infusion devices. A pressure infusion device may be used for the rapid administration of blood components.
  • Blood warmer devices. A blood warmer device is often used to prevent hypothermia during rapid administration of cold-blood components, such as the operating room or a trauma setting.

Potential Risks or Complications of a Blood Transfusion

While this is typically a low-risk procedure, serious blood transfusion risks or complications can include some of the following conditions:

  • Allergic reactions
  • Fever
  • Acute immune hemolytic reaction
  • Blood-borne infections

However, the most common reaction to a blood transfusion is mild soreness around the IV site.

You can avoid some of these adverse reactions by following the appropriate steps. What they say is true: practice makes perfect.

Continue reading for more professional tips.

Pro Tips for Mastering the Art of Blood Transfusions

Different blood types

Many of our pro blood transfusion tips involve organization, patience, and a detail-oriented nature. Here are a few pro blood transfusion tips from Dr. Siegel that may assist you in the future.

  • Ordering the wrong dose of platelets. There are two different kinds of platelet products, and some hospitals offer both kinds. Because of this, ordering platelets by the unit can create confusion about how much is needed. To avoid this confusion, some clinicians order platelets by the dose.
  • Ordering plasma to correct a high international normalized ratio (INR). The INR of fresh frozen plasma is not 1.0 as one might assume. It is not necessarily 1.1 or 1.2 or 1.3 either. Plasma can have an INR as high as 1.6. You should be careful because if you give plasma to a patient who as an INR of 1.4 or 1.5, that could make the INR worse.
  • Assuming leukoreduction protects immunocompromised patients. Leukoreduction eliminates enough white cells to lessen the incidence of febrile transfusion reactions, HLA antigen sensitization to the patients, and transmission of cytomegalovirus infection. However, cellular blood products can still cause transfusion-associated graft-versus-host disease. This means that immunosuppressed patients may require additional precautions (i.e. the blood may also needs to be irradiated).
  • Being impatient with the blood typing and screening process. If the patient’s blood has a positive antibody screen, the overall process can be much lengthier. Once the antibodies are identified, and blood lacking the corresponding antigens is found, the donor blood will also have to be physically cross-matched with the patient’s sample. The process can take some time for blood-bank staff to complete.

Why Should Nurses Learn How to Perform a Blood Transfusion?

Around the world, millions of patients need blood transfusions to survive. This medical intervention requires knowledge and skill. Many studies have been conducted on the awareness of nurses and physicians about blood transfusion. It has even been noted there’s an increasing demand for blood transfusions in hospitals.

As the nurse carrying out a doctor’s order, you will be responsible for prepping the patient and ensuring appropriate history, lab work, documentation, and supplies are available before the transfusion. These crucial steps can help prevent adverse transfusion reactions.

In the nursing field, you never know when you may encounter life-or-death situations. Reflect on your goals and which specialization is best for you. Ensure that you work in a facility that suits your needs. And, of course, make sure you pick the right school.

Take the Next Step in Your Nursing Career

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