Step-by-Step Master’s Guide to Blood Transfusions

Learn the procedures, risks, and requirements of blood transfusions.

Whether a patient has lost blood during surgery or injury or an illness is preventing the proper production of blood, a blood transfusion can correct the situation. A transfusion introduces donated blood into the patient’s circulatory system.

Blood transfusions are safe and rarely involve complications. As a result, these potentially life-saving procedures are an essential skill in a nurse’s repertoire. (Read more to learn about the common duties performed by a registered nurse.

Let’s get into the details of blood transfusions and how nurses and other health professionals perform them.

What is a Blood Transfusion?

In a blood transfusion, donated blood or components (such as plasma) are given to a patient through an intravenous (IV) line. This new blood replaces lost blood or blood components or upgrades blood of inferior quality or makeup that the patient’s body is producing.

The nurse gains access to a vein through a small needle. Blood then flows from an elevated bag, through rubber tubing, into the needle, and into the patient’s vein. The nurse (or another health professional) periodically monitors the patient’s vital signs as the blood transfuses.

Why are Blood Transfusions Performed?

According to the American Red Cross, over 21 million blood transfusions or component transfusions are performed yearly in the U.S. The most likely reason a person would need a blood transfusion would be due to the loss of blood during surgery or due to a traumatic injury. Those instances generally transfuse whole blood.

But in some cases, the patient’s blood can be impacted by certain medical conditions. These include anemia, leukemia, kidney disease, hemophilia, sickle cell disease, and others. In many of these instances, the transfusion can provide specific blood components rather than “whole blood.”

What Are the Different Blood Components that May Be Transfused?

In addition to whole blood, a transfusion can provide specific blood components. These include:

• Plasma. Plasma carries nutrients needed by the body.
• Cryoprecipitate. This helps the blood clot.
• Platelets. These also help the blood clot.
• Red blood cells. These cells carry oxygen throughout the body.

How Long Does a Blood Transfusion Take?

The time needed for a nurse to perform a blood transfusion depends on how much blood the patient needs, along with other factors. However, most transfusions take between one and three hours.

Who Performs Blood Transfusions?

Various members of the healthcare team can perform blood transfusions. But transfusions are most often performed by nurses (registered nurses, RNs; licensed vocational nurses, LVNs; or licensed practical nurses, LPNs).

(Read more if you’re interested in making a career change to nursing.)

Where Does Blood for a Transfusion Come From?

Blood banks are the usual source of blood transfusions. In a blood bank, anonymous donors volunteer to donate blood. This blood is stored in the blood bank until it is needed.

Some patients “bank” their own blood if they foresee an upcoming need. Also, friends or family members may donate blood directly to benefit the patient.

What Are the Training Requirements to Perform a Blood Transfusion?

Learning the techniques of blood transfusions is a part of all nurses’ training. This training covers these areas:

• Identifying the patients and the unique needs — This section involves the prescription needed to perform the transfusion, identifying the blood type needed, ensuring the blood bank supply matches that type, and obtaining consent.
• Checking for access — This involves access to the vein, checking the vein’s integrity, and selecting the correct gauge needle.
• Documentation — Providing the necessary documentation of the administered blood or blood components.
• Administration and monitoring — This training covers the procedure and the necessary steps to monitor the patient’s situation.

The knowledge of blood transfusions is one of the components of the national nursing licensure exam, the NCLEX-RN exam. This exam verifies that potential nurses have the necessary understanding of the procedure and blood and blood products. Here’s a link to what is covered in the blood and blood products section of the NCLEX-RN exam.

(Go here to learn more about how to pass the NCLEX-RN exam)

What Materials Do You Need for a Blood Transfusion?

These are the typical materials needed, although they can vary depending on which blood components are involved.

• IV access — This is the needle to provide entry into the vein. For routine adult transfusions, the standard gauge size is 20-22. For rapid transfusions, this changes to larger 16-18 gauges. Pediatric gauges range from 22-25.
• Administration sets — These vary depending on the blood components administered. For example, filters that remove coagulated proteins, clots, and cellular debris vary with the component.
• Infusion devices — Some transfusions will involve devices, such as infusion pumps.
• Blood warmers — Blood supplies are kept refrigerated. To avoid hypothermia during rapid transfusions, a blood warmer will be necessary.
• Rubber tubing — This will connect the blood supply to the IV needle.

How is a Blood Transfusion Done?

A Step-by-Step Guide

The process of performing a blood transfusion is not complicated. Still, the preparation before the procedure is important to ensure the blood or blood product given will be well tolerated by the patient.

Blood Transfusion Prep

1. The physician will assess the patient’s clinical need for blood and the timing necessary. The physician will then prescribe the blood.
2. Educate the patient and relatives about the need for this procedure, and record this in the patient’s notes. Then, obtain consent from the patient for the transfusion.
3. Discuss the patient’s health history and any allergies.
4. Record the indications for the transfusion in the patient’s notes.
5. Take a blood sample and send this to the blood bank. Ensure the sample is accurately labeled with the time and date, as it will last no more than 72 hours. This sample will be used for initial blood type examination and subsequent compatibility testing with the blood products.
6. Request the blood product and quantity required. Include the reason for the transfusion so the blood bank can select the most suitable product to test for compatibility.
7. Create access, usually with an 18G bore IV needle.
8. Create a second access point, as well. This will be the access point if the patient requires additional IV medication, such as antibiotics.
9. Assemble supplies:
   • Special Y tubing with an in-line filter
   • Blood warmer
   • Normal saline solution

10. Take patient’s vital signs:
    • Heart rate, blood pressure, temperature, pulse oximeter, and respiratory rate
    • Check lung sounds
    • Check urine output
    • If the temperature is above 100 degrees F, notify the doctor

11. Once blood is verified compatible, prepare for delivery.

Blood Transfusion Steps

12. Double-check/verify the blood product
    • Check the physician’s order with the blood bank documentation
    • Check the patient’s name, DOB, and medical record number
    • Check the patient’s blood type versus the donor’s blood type and Rh-factor compatibility
    • Verify the blood has not passed its expiration date

13. Administer the blood product:
    • Prepare the Y tubing using only saline solution
    • Have the blood ready in an infusion pump
    • Initially, the blood should flow slowly for the first 15 minutes (2 ml/min)
    • Increase the flow rate after the first 15 minutes once it appears a reaction is not going to occur
    • Stay with the patient for the first 15 minutes to be on the alert for reactions
    • After 15 minutes, take and document vital signs
    • Repeat vital sign measurements hourly and after the transfusion

14. Record the completion of the transfusion in the patient’s notes.

What Kinds of Reactions Can Occur During a Blood Transfusion?

Blood transfusions are safe, but any medical procedure carries the potential for a reaction. To the patient, these reactions can feel like allergic reactions. These are reactions that people may experience.

• Trouble breathing
• Fever, chills, rashes
• Hemolytic transfusion reaction (the patient’s immune system tries to destroy the transfused red blood cells)

If you notice or suspect a reaction, these are the next steps to take:

• Immediately stop the transfusion
• Disconnect the blood tubing
• Notify the doctor and/or blood bank
• Stay with the patient and continue to monitor and assess their status
• Document all of this in the patient’s record

What Is the Recovery Time After a Blood Transfusion?

In most cases, the patient will need to rest and not perform any strenuous activity for one to two days. As you would assume, the patient may have some soreness at the access points.

What are the Potential Risks or Complications with Transfusions?

Blood transfusions are very safe, standard procedures. They are life-saving procedures in cases such as blood loss from trauma. The standards used for ensuring blood purity are rigid, and only those who pass stringent standards are allowed to donate blood. View the blood safety basics reported by the Centers for Disease Control and Prevention to learn more.

Possible risks and complications include:

• Allergic reaction — Of all the reactions reported, the CDC says allergic reactions make up about one-half of them. Antihistamine medications can usually stop these reactions.
• Fever — This is not a severe problem, but it can happen.
• Hemolytic reaction — If the blood transfused is not compatible with the patient’s inherent blood type, the immune system will attack the new blood cells. This serious reaction should not occur when following the proper verification methods.
• Transmission of infections — Patients fear diseases passed through the donated blood, but these are rare thanks to rigid testing and stringent requirements. For instance, the CDC maintains that the risk of acquiring hepatitis C from transfused blood in the United States is less than 1 case per 2 million units transfused.

Pro Tips for Blood Transfusions

Following best practices helps to ensure the success of a blood transfusion.

• Pay attention to expiration dates — Blood samples can only be used for up to 72 hours. Once initiated in transfusion, blood must be fully transfused within a four-hour window.
• Check and double-check — Check the patient’s blood type against the delivered blood supply. Ensure they are a match, as confirmed by testing for compatibility in the blood bank. Double-check the names, blood types, and documentation.
• Ensure a correct filter size — All blood components must be transfused through a filter designed to remove clots and aggregates. Sizes can vary with the component, so ensure you use the correct filter to match.
• Different access points for medications — Medications cannot be added to the blood or infused through the same tubing simultaneously with the blood or blood components.
• Slow for the first 15 — If any serious reactions occur, they will usually happen within the first 15 minutes. For that reason, this initial transfusion period should use a reduced flow rate.
• Warming required — Remember that in large transfusions, the blood must be warmed before delivery. Otherwise, the patient may suffer hypothermia.

Are You Ready to Make the Move Into a Nursing Career?

Transfusions are a standard — often life-saving — procedure, and a nurse usually performs them. Blood transfusion education is a standard part of all nurse training.

Are you interested in working with people and making a difference in their lives? A career in nursing not only satisfies that goal, but the projections for employment are excellent: there aren’t enough nurses to fill the available jobs.

Brookline College has nursing program options to help you move into nursing. From accelerated programs to various tuition assistance options, we want to help talented people like you to become nurses.