The protocol for blood transfusions is tightly regulated by state and federal law. If one piece of information is missing or one step skipped, the process must begin again from the point of taking a blood sample from the patient to send to the blood bank for testing and matching a unit of blood to the patient's specific blood type. Although the protocol may seem tedious, it is designed to protect the patient's well-being.
Preliminary Steps
After receiving the order to type and cross the patient's blood sample and transfuse units of blood, a nurse talks to the patient about the blood transfusion. She explains the reasons and risks and asks the patient if he has any questions. She then obtains a signed consent from the patient or his representative to accept the transfusion, according to the California Blood Bank Society. The nurse draws a blood sample from the patient and labels the vial of blood with the patient's first and last name, date of birth, patient identification number, current date and time, and the nurse's name. Before leaving the room, the nurse places a blood bank identification band on the patient's wrist with the same information. This band has an identification number that is also written on the vial of blood. The vial is then sent to the blood bank for determination of the blood type and Rh factor, either positive or negative.
Blood Bank
When the blood bank informs the nurse that the blood is ready for pick-up, the nurse or her representative will check the blood against the paperwork for the transfusion with one person reading off several series of numbers, plus the name and birth date of the patient. If all numbers match, the blood is signed out and transported to the patient care floor.
Patient's Bedside
At the patient's bedside, two nurses check the unit of blood once more against the paperwork, the patient's wristband and the doctor's order. The nurse sets up an IV pump with special blood transfusion tubing. Before initiating the transfusion, the nurse takes the patient's vital signs to obtain baseline readings. The nurse begins a slow rate of infusion and checks the patient's vital signs again after 15 minutes have passed. If the patient's vital signs remain stable and the patient is tolerating the infusion well, the nurse will increase the drip rate and take the patient's vital signs again in one hour and every hour until the transfusion is completed. The nurse asks the patient to please call for help if he experiences difficulty breathing or develops hives, nausea or a fever. When the unit of blood is finished, the nurse takes the patient's vital signs again and flushes the IV with saline, according to the National Heart, Lung and Blood Institute. One hour later, she takes another set. The tubing and the empty unit of blood is saved in case of a delayed reaction to the transfusion.
