i. Nursing Care.
(1) Proper nursing care is important for patients receiving transfusions of all
blood components, including platelets, plasma products, cryoprecipitate, and albumin,
as well as RBCs.
(2) Base line values for temperature, pulse, respirations, and blood pressure
should be obtained before beginning transfusion. During the first 15 minutes, the rate of
infusion of RBCs should be very slow, approximately 100 ml per hour. This will
minimize the volume of RBCs infused if the patient experiences an immediate reaction.
The nurse should observe the patient during at least the first 5 minutes of transfusion,
and then return after 15 minutes to ensure that the transfusion is proceeding
uneventfully. If so the rate of infusion can then be increased, to that ordered by the
(3) At the termination of the transfusion, the nurse should record whether an
adverse reaction has occurred and discontinue the intravenous infusion. All adverse
reactions should be reported to the blood bank as soon as practically possible. If other
intravenous therapy is ordered after the blood transfusion, the infusion set should be
rinsed with normal saline before starting these drugs or solutions.
j. Warming of Blood.
(1) It is not necessary to warm blood before transfusion except in unusual
circumstances, such as (1) massive transfusions or when the infusion rate is greater
than 50 mI/per minute, (2) occasionally in exchange transfusion of the newborn, or (3)
patients with potent cold agglutinins.
(2) If blood must be warmed prior to transfusion, this should be performed
by passing the blood through coils immersed in a water bath or dry incubator where the
temperature is maintained at approximately 35C, but always less than 38C.
Hemolysis may occur when blood is subjected to temperatures greater than 40C.
Blood should never be warmed by placing it near a radiator, heater, or stove.
Microwave instruments are available for warming blood, but these instruments have
malfunctioned, causing hemolysis of the RBCs being warmed. If any warming device is
utilized, it should undergo careful and continuing quality assurance procedures and the
staff should be thoroughly trained in its operation. A blood-warming device that is not of
the in-Iine type should be located in or under the control of the blood bank. Once blood
has been warmed, it cannot be returned to the blood bank for future transfusion. It is
desirable to indicate on the transfusion that the blood component has been warmed.