What are the key steps in performing a blood transfusion. How long does a typical blood transfusion take. Who is qualified to administer blood transfusions. What are the main reasons patients require blood transfusions. How can healthcare professionals ensure safe and effective blood transfusions.

Understanding Blood Transfusions: Definition and Purpose

Blood transfusions are a critical medical procedure that involves transferring blood or blood components into a patient’s circulatory system. This life-saving intervention is commonly performed in hospitals and outpatient settings to address various medical conditions and emergencies.

The primary purposes of blood transfusions include:

• Replacing blood lost during surgery or traumatic injuries
• Treating severe anemia and other blood disorders
• Supporting patients undergoing chemotherapy
• Providing essential blood components to those with chronic illnesses

In the United States alone, approximately 21 million blood components are transfused annually, highlighting the procedure’s significance in modern healthcare.

Types of Blood Transfusions

Different types of blood transfusions are performed based on the patient’s specific needs:

1. Red blood cell transfusions: Boost hemoglobin and iron levels, improving oxygen delivery throughout the body
2. Platelet transfusions: Commonly given to cancer patients or those with low platelet counts
3. Plasma transfusions: Provide vital proteins and substances crucial for overall health, often administered to patients with liver failure, severe infections, or serious burns

The Blood Transfusion Process: A Step-by-Step Guide

Performing a blood transfusion requires precision, attention to detail, and adherence to strict protocols. Here’s a comprehensive breakdown of the process:

1. Patient Assessment and Preparation

Before initiating the transfusion, healthcare professionals must:

• Verify the patient’s identity and medical history
• Obtain informed consent
• Assess vital signs and overall condition
• Ensure proper blood type matching

2. Intravenous (IV) Line Placement

An IV line is inserted into a vein, typically in the patient’s arm or hand. This serves as the entry point for the blood or blood components.

3. Blood Product Verification

Healthcare providers must double-check that the blood product matches the patient’s needs and has been properly stored and handled.

4. Initiation of Transfusion

The blood is connected to the IV line and allowed to flow into the patient’s circulatory system at a controlled rate.

5. Monitoring

Throughout the transfusion, nurses closely monitor the patient’s vital signs, watching for any signs of adverse reactions or complications.

6. Completion and Documentation

Once the transfusion is complete, the IV line is removed, and all relevant information is documented in the patient’s medical record.

Duration and Timing of Blood Transfusions

How long does a typical blood transfusion take? The duration can vary depending on several factors, including the volume of blood being transfused and the patient’s condition. Generally, a simple blood transfusion can last anywhere from 1 to 4 hours.

Factors influencing transfusion duration include:

• The type of blood component being transfused
• The patient’s body weight and blood volume
• Any underlying medical conditions
• The urgency of the transfusion (e.g., in emergency situations)

Qualified Professionals for Blood Transfusion Administration

Who can perform blood transfusions? Various healthcare professionals are trained and authorized to administer blood transfusions, including:

• Registered Nurses (RNs)
• Licensed Vocational Nurses (LVNs) or Licensed Practical Nurses (LPNs)
• Physicians
• Certified medical technologists

These professionals typically work under the direction of a physician’s order and must adhere to strict protocols and guidelines set by their healthcare facility and regulatory bodies.

Training and Education for Blood Transfusion Competency

Mastering the art and science of blood transfusions requires comprehensive training and education. Healthcare professionals involved in this procedure must demonstrate proficiency in several key areas:

Educational Requirements

Blood transfusion training is a crucial component of nursing education programs and is extensively covered in licensing exams such as the NCLEX-RN. Key areas of study include:

• Blood typing and compatibility
• Proper handling and storage of blood products
• Transfusion reactions and management
• Patient assessment and monitoring techniques
• Documentation and record-keeping procedures

Ongoing Professional Development

To maintain competency in blood transfusion procedures, healthcare professionals often engage in:

• Regular in-service training sessions
• Simulated practice scenarios
• Continuing education courses focused on transfusion medicine
• Participation in quality improvement initiatives

Common Indications for Blood Transfusions

Understanding when blood transfusions are necessary is crucial for healthcare providers. Some of the most common reasons for administering blood transfusions include:

Surgical Procedures

Many major surgeries result in significant blood loss, necessitating transfusions to maintain adequate blood volume and oxygen-carrying capacity.

Traumatic Injuries

Patients who have experienced severe trauma, such as car accidents or natural disasters, often require blood transfusions to replace lost blood and stabilize their condition.

Chronic Medical Conditions

Certain ongoing health issues may necessitate regular blood transfusions, including:

• Severe anemia
• Sickle cell disease
• Thalassemia
• Leukemia and other cancers
• Kidney disease

Acute Blood Loss

Conditions such as gastrointestinal bleeding, severe nosebleeds, or postpartum hemorrhage may require urgent blood transfusions to prevent life-threatening complications.

Ensuring Safe and Effective Blood Transfusions

How can healthcare professionals maximize the safety and efficacy of blood transfusions? Several key strategies and best practices should be employed:

Strict Adherence to Protocols

Following established guidelines for patient identification, blood product verification, and administration procedures is crucial to prevent errors and ensure patient safety.

Vigilant Monitoring

Close observation of patients throughout the transfusion process allows for early detection and management of any adverse reactions.

Proper Documentation

Accurate and thorough record-keeping is essential for continuity of care and quality assurance purposes.

Effective Communication

Clear communication among healthcare team members, as well as with patients and their families, helps prevent misunderstandings and ensures informed decision-making.

Ongoing Education

Staying up-to-date with the latest developments in transfusion medicine and participating in regular training sessions helps maintain high standards of care.

Potential Risks and Complications of Blood Transfusions

While blood transfusions are generally safe, healthcare professionals must be aware of potential risks and complications that may arise. These can include:

Allergic Reactions

Some patients may experience mild to severe allergic responses to transfused blood products, ranging from itching and hives to anaphylaxis in rare cases.

Febrile Reactions

Fever and chills can occur during or shortly after a transfusion, often due to the recipient’s immune response to white blood cells in the donated blood.

Transfusion-Related Acute Lung Injury (TRALI)

This rare but serious complication can cause sudden breathing difficulties and requires immediate medical intervention.

Infection Transmission

Although extremely rare due to rigorous screening processes, there is a minimal risk of transmitting infectious diseases through blood transfusions.

Iron Overload

Patients receiving frequent transfusions may accumulate excess iron in their bodies, potentially leading to organ damage over time.

Healthcare professionals must be vigilant in monitoring for these potential complications and be prepared to respond swiftly if they occur.

Advancing Technologies in Blood Transfusion Medicine

The field of transfusion medicine continues to evolve, with new technologies and techniques emerging to enhance safety and efficacy. Some notable advancements include:

Pathogen Reduction Technologies

These methods aim to further reduce the risk of transfusion-transmitted infections by inactivating potentially harmful pathogens in blood products.

Automated Blood Component Separators

Advanced machines can now separate whole blood into its components more efficiently, allowing for more precise and targeted transfusions.

Point-of-Care Testing

Rapid, bedside testing for blood type and compatibility can expedite the transfusion process in emergency situations.

Artificial Blood Substitutes

Ongoing research into artificial oxygen carriers and blood substitutes may provide alternatives to traditional blood transfusions in the future.

Electronic Crossmatching

Computerized systems can streamline the process of matching blood products to recipients, reducing the potential for human error.

As these technologies continue to develop, healthcare professionals must stay informed about their applications and potential benefits in clinical practice.

Patient Education and Informed Consent in Blood Transfusions

Effective communication with patients and their families is a crucial aspect of the blood transfusion process. Healthcare providers play a vital role in educating patients about the procedure, its benefits, and potential risks.

Key Elements of Patient Education

When discussing blood transfusions with patients, healthcare professionals should cover the following topics:

• The reason for the transfusion and expected benefits
• The procedure itself and what to expect during and after
• Potential risks and side effects
• Alternatives to transfusion, if applicable
• The patient’s right to refuse the procedure

Obtaining Informed Consent

Proper informed consent is essential for blood transfusions. This process typically involves:

1. Providing clear, understandable information about the procedure
2. Answering any questions or concerns the patient may have
3. Ensuring the patient understands the information provided
4. Obtaining written consent from the patient or their legal representative

By prioritizing patient education and informed consent, healthcare professionals can promote trust, reduce anxiety, and ensure that patients are active participants in their care.

Blood Conservation Strategies and Alternatives to Transfusion

While blood transfusions remain a crucial medical intervention, there is growing interest in blood conservation strategies and alternatives to traditional transfusions. These approaches aim to minimize the need for allogeneic (donor) blood and reduce associated risks.

Blood Conservation Techniques

Several methods can help conserve a patient’s own blood and reduce the need for transfusions:

• Preoperative autologous blood donation
• Intraoperative cell salvage and reinfusion
• Minimally invasive surgical techniques
• Use of hemostatic agents to control bleeding
• Optimizing the patient’s hemoglobin levels before surgery

Pharmacological Alternatives

In some cases, medications can be used as alternatives to blood transfusions or to reduce transfusion requirements:

• Erythropoiesis-stimulating agents to boost red blood cell production
• Iron supplementation to treat anemia
• Antifibrinolytic agents to reduce bleeding

Bloodless Medicine Programs

Some healthcare facilities offer specialized bloodless medicine programs that cater to patients who refuse blood transfusions for religious or personal reasons. These programs employ a range of blood conservation techniques and alternative treatments to provide care without the use of donor blood.

As healthcare professionals, it’s important to be aware of these alternatives and consider their appropriateness for individual patients when developing treatment plans.

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

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

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.

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)

2. 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

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

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

Unitek College offers several nursing programs for aspiring nurses, including our BSN program and Vocational Nursing school.

Contact us today to learn more about our programs and tuition assistance options. Take the first step toward a rewarding future in healthcare!

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.

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Stages of blood use – Blood Center

June 22 Blood Center, Estonia Boulevard 1 open from 8:00 to 16:00; Donor Center in Ülemiste – from 10:00 to 16:00. June 23 Blood centers are closed.

New opening hours at the Ülemiste Donor Center from May 2: Tue and Thu 10 am – 6 pm,
and Mon, Cp and Fri, as usual, 9 am – 5 pm .

IMPORTANT! Vaccination against Covid-19 is not a contraindication to donation!

And the staff at the Blood Center is always so friendly and nice. (Kalle Kask, paramedic and donor)

Patient

1. Donor blood centrifugation

   In order to separate the components of blood from each other, centrifugal force is used, under the influence of which particles with different weights are deposited in layers on top of each other.

   A donated dose of whole blood is placed in a large centrifuge and centrifuged for a pre-programmed time (usually approximately 15 minutes) at a given speed.

   Under the influence of centrifugal force, erythrocytes settle to the bottom of the bag; on top of them are platelets and leukocytes, and at the very top is plasma

2. Separation

   A device called a separator separates the blood components from each other. Under optical control, plasma (in the picture on the left) and erythrocytes (on the right of the machine, on the scales) are collected in separate bags. A layer of platelets and leukocytes remains in the primary sac. The separation of the components takes two to three minutes.

   Nutrient solution is added to red blood cells during processing to keep the cells alive during storage. The result obtained is called a suspension of erythrocytes; it is most often transfused in hospitals. From one dose of whole blood from one donor, one therapeutic dose of erythrocyte suspension is obtained for an adult patient or several smaller therapeutic doses for children.

   Red blood cells in nutrient solution

   Plasma after its separation is placed in a quick freezer, where it is cooled to a temperature of -30 degrees for several hours. Rapid (shock) freezing preserves the blood clotting substances in the plasma from decomposition, and when the frozen plasma is thawed again for transfusion, these substances are again activated.

   Plasma is placed in a quick freezer

   Platelets and leukocytes remaining in the original bag are subjected to an additional procedure. Platelets and leukocytes from three or four donors with the same blood type are merged together, then the resulting product is again passed through a centrifuge. A layer of leukocytes and platelets is formed. Leukocytes cannot be used for blood transfusion, they are separated. The end result is a concentrate of platelets (platelets).

   Platelet concentrate in storage cabinet with movable shelves

3. Storage of blood components

   Blood components are stored under various conditions:

   • red blood cells are stored in an appropriate solution at +2…+6 °C for up to 35 days,
   • platelets can be stored in a cabinet with special shaking shelves at +22°C for five to seven days.
   • plasma is stored at -25°C or lower for up to three years.
4. Use of donated blood

   Red blood cells are transfused to compensate for large blood losses associated with operations or childbirth, to perform blood replacement for newborns and for anemia (anemia).

   Erythrocytes are transfused more often than other blood components, because their deficiency is very difficult to tolerate by the body.

   Platelets are transfused in patients whose blood levels are deficient or not functioning properly; for example, those suffering from leukemia while undergoing intensive chemotherapy. In addition, platelet concentrates are transfused with blood and liver diseases, cancer, burns and large blood loss.

   Plasma is transfused for bleeding disorders and to compensate for massive blood loss.

   By purifying, concentrating and isolating the constituents of plasma (fractionation), more than 20 different effective drugs for medical use can be obtained. They are used in the treatment of many diseases – such as immune deficiency, neurological, infectious and autoimmune diseases, heart failure, asthma, multiple abortions, bleeding and hemophilia.

Testing

1. Blood typing

   For each donated blood dose, its group is determined according to the AB0 and RhD systems.

   The primary donor receives information about his blood type according to the AB0 system already at the first visit to the Blood Center. The blood type is determined using a rapid test before blood sampling. The blood group is then rechecked in the laboratory.

   The Rh factor is determined only in the laboratory, and the donor can recognize it during the second visit to the Blood Center. The blood of primary and secondary donors is also examined using the less known Kell system and the presence of antibodies to erythrocyte antigens in the plasma is determined. In donors who donated blood for the second and third time, the Rh phenotype is determined.

   Microplate blood typing in a large analyzer

   To ensure maximum blood safety, all donors are retested for blood typing and viral diseases at each return visit.

2. Tests for viral infections

   Donated blood is tested for HIV, hepatitis B, C and syphilis. The following tests are performed at each blood draw:

   1. Hepatitis B surface antigen (HBsAg)
   2. Hepatitis B DNA (HBV DNA)
   3. Anti-Hepatitis C Virus (Anti-HCV)
   4. Hepatitis C virus RNA (HCV RNA)
   5. Anti-HIV antibodies (Anti-HIV-1,2) and HIV antigen (HIV p24)
   6. For the presence of HIV virus RNA (HIV RNA)
   7. For the presence of the causative agent of syphilis

   In 2007, another very important step was taken in the testing of donated blood for infectious agents – instead of determining the HIV antigen, a molecular biological test for HIV is now being carried out, which is currently the most sensitive and high-tech method of viral diagnostics.

   When determining the HIV RNA, the window period before the manifestation of the virus is only 8-12 days, therefore, the safety of donated blood in terms of the risk of infection is ensured at the maximum level.

   All tests of donated blood for viruses are automated and performed according to a single internationally recognized testing system

   All test results are entered into the Estonian Blood Service Information System (Eesti Vereteenistuse Infosüsteem (EVI)) directly from the analyzer. The Blood Center does not issue blood components that have not been analyzed or whose results have been found to be unsatisfactory.

   If the test results require follow-up verification, the donor is called for a second test. The blood dose in which the infectious agent was found is destroyed.

Jaluse navigatsioon

North Estonian Regional Hospital Blood Center

• Estonia Boulevard 1, 10143 Tallinn
• Registrar: 617 3002
• verekeskus@regionaalhaigla. ee

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• Blood Center , Estonia Boulevard 1
  Mon, Fri 8-16 and Tue-Thu 11-19
• Ülemiste Donor Center
  Valukoya 7, 1st floor
  Mon , Cp, Fri 9-17 and Tue, Thu 10-18

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History of blood donation – Official website of the Kursk Blood Center Kursk Regional Clinical Blood Transfusion Station

REGIONAL BUDGETARY HEALTH INSTITUTION “KURSK REGIONAL CLINICAL BLOOD CENTER”

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The history of blood transfusion begins in antiquity, when people tried to treat with the blood of animals. The writings of the ancient Greek poet Homer say that Odysseus gave blood to the shadows of the underworld to drink in order to restore their speech and consciousness. Hippocrates recommended that patients suffering from mental disorders drink the blood of healthy people. There are indications of such blood treatment in the writings of Pliny and Celsus, who reported on epileptic patients who drank the blood of dying gladiators. Blood was credited with a rejuvenating effect. So, in Rome, the decrepit Pope Innocent VIII was treated with the blood of young people. The blood of animals was drunk for medicinal purposes during wars. Egyptian troops were followed by herds of sheep, the blood of which was used to treat the wounded. In ancient monuments, there are notes about the use of blood for baths. So, the ancient Greek king Constantine, who suffered from leprosy, had blood baths. It was believed that blood is a miraculous liquid: once it is used, life can be extended for many years. If a person drinks the blood, then it will replace the one that was lost.

In 1628, the English scientist W. Harvey discovered the law of blood circulation. He established the principle of blood movement in a living organism and thereby opened up wide possibilities for developing a method of blood transfusion. The first successful experiments on blood transfusion from one dog to another were made in 1666 by the English anatomist R. Lower, and on June 12, 1667 in France, the court physician of Louis XIV, Jean-Baptiste Denis, performed the first blood transfusion from animals to humans. A 15-year-old boy suffering from severe mental disorders and exhausted by numerous bloodlettings was injected with 250 milliliters of blood directly from the carotid artery of a lamb into a vein. The patient recovered, but, despite this, none of the patients dared to transfuse blood for themselves. Then the scientist announced that the recipient of the blood transfusion would receive a significant payment. The worker of a poor quarter of Paris was the first to lend himself to the experience of blood transfusion. After the transfusion, the recipient felt great and offered his own blood for transfusion. He became the first conscious donor in the history of mankind. But not all transfusions of Jean-Baptiste Denis were successful. Complications began, deaths appeared, and transfusions were banned in France. The reason for these failures was the incompatibility of human and animal blood. The blood of animals transfused into the human body is destroyed. However, the idea of ​​saving a dying person by infusing the blood of a healthy person did not leave doctors. In 1832, the St. Petersburg obstetrician G. Wolf made the first human-to-human blood transfusion in Russia. It was a woman in labor who had lost a large amount of blood. The transfusion was successful and the woman was saved. The first theoretical substantiation of blood transfusion belongs to the professor of the Medico-Surgical Academy S.F. Khotovitsky, who wrote in 1830: “In severe bleeding, when all the signs of impending death are already present . .. there is no other means of salvation than blood transfusion.”

The development of donation was accompanied by numerous ups and downs – from the deification of this method to the state ban on its use. The first documented intravenous injections refer to the beginning of the world’s first academy of sciences – the Royal Society of London, founded in the 60s of the 17th century. It was not easy to make an intravenous infusion of blood to a person in those days – before the invention of a hollow injection needle and a modern syringe, there were still two centuries left. Christopher Wren in 1656 used a bird’s feather as an injection needle, and bladders of fish and animals instead of a syringe. Despite the fact that the first attempts gave good results, the method of blood transfusion was not widely used. It was a technically rather complicated operation, and in a number of patients the transfused blood caused serious complications. The reason for them was then completely incomprehensible.

1628 – English physician William Harvey makes a discovery about blood circulation in the human body. Almost immediately after this, the first attempt at a blood transfusion was made.

1667 – Jean-Baptiste Denis (Fr. Jean-Baptiste Denis) in France and Richard Lower in England independently record successful blood transfusions from sheep to man. But over the next ten years, transfusions from animals to humans were banned by law due to severe adverse reactions.

1795 – In the US, the American physician Philip Syng Physick conducts the first person-to-person blood transfusion, although he does not publish information about this anywhere.

1882 – James Blundell, a British obstetrician, performs the first successful transfusion of human blood on a patient with postpartum hemorrhage. Using the patient’s husband as a donor, Blundell took nearly four ounces of blood from his arm and injected it into the woman with a syringe.

From 1825 to 1830, Blundell performed 10 transfusions, five of which helped patients. Blundell published his results and also invented the first handy instruments for taking and transfusing blood.

1832 – St. Petersburg obstetrician Andrey Martynovich Wolf for the first time in Russia successfully transfused the blood of her husband to a woman in labor with obstetric bleeding and thereby saved her life. Wolf used for transfusion the apparatus and technique he received from the pioneer of world transfusiology, James Blundell.

1840 – The first successful blood transfusion for the treatment of hemophilia is carried out at St George’s College in London under the direction of Blundell.

1867 – English surgeon Joseph Lister first uses antiseptics to prevent infection during blood transfusions.

1873 – 1880 – American transfusionists are trying to use milk for transfusions – cow, goat and human.

1884 – Salt solutions replace milk in transfusions, because there are too many rejection reactions to milk.

1900 – Karl Landsteiner (German: Karl Landsteiner), an Austrian doctor, discovers the first three blood types – A, B and C. Group C will then be replaced by O. Landsteiner received the Nobel Prize in 1930 for his discoveries.

1902 – Landsteiner’s colleagues Alfred de Castello (Italian Alfred Decastello) and Adriano Sturli (Italian Adriano Sturli) add a fourth to the list of blood types – AB.

1907 — Hektoen suggests that the safety of transfusions can be improved if donor and recipient blood is matched to avoid complications. Reuben Ottenberg in New York performs the first blood transfusion using the cross-matching method. Ottenberg also noted that the blood group is inherited according to Mendel’s principle and noted the “universal” suitability of the blood of the first group.

1908 – French surgeon Alexis Carrel developed a method to prevent clotting by sewing the recipient’s vein directly onto the donor’s artery. This method, known as the direct method or anastomosis, is still practiced by some transplant physicians, including J.B. Murphy in Chicago and George Crile in Cleveland. This procedure showed its unsuitability for blood transfusions, but developed as a method of organ transplantation, and it was for it that Carrel received the Nobel Prize in 1912

1908 Moreschi describes the antiglobulin reaction. Usually, when an antigen-antibody reaction occurs, it cannot be seen. Antiglobulin is a direct way to visualize an antigen-antibody reaction. The antigen and antibody react with each other, then, after removing the antibodies that did not participate in the reaction, an antiglobulin reagent is added and attached between the antibodies that are attached to the antigen. The formed chemical complex becomes large enough to be seen.

1914 —Roger Lee, physician at the Massachusetts Community Hospital, introduces the so-called “Lee-White clotting time” into laboratory tests. Another important discovery is made by Lee, who experimentally proves that blood of the first type can be transfused to patients with any group, and any other blood type is suitable for patients with the fourth blood type. Thus, the concepts of “universal donor” and “universal recipient” are introduced.

1914 – Long-term anticoagulants were invented and introduced, which made it possible to preserve donated blood, among them sodium citrate.

1915 – At a hospital in New York, Richard Levison uses citrate for the first time to replace direct blood transfusion with indirect. Despite the importance of this invention, citrate was introduced into mass use only after 10 years. 1916 – Francis Roos and D. R. Turner first use a solution of sodium citrate and glucose to store blood for several days after donation. Blood begins to be stored in closed containers. During the First World War, Great Britain uses a mobile blood transfusion station (Oswald Robertson is considered the creator).

History of blood donation in Russia

Since the mid-1930s, the official version of the history of blood transfusion began to be created in the USSR. It was written by those who were direct participants in the widespread introduction of this technology in medicine, its creators.

In 1935, S.I. Spasokukotsky presented a brief historical review, covering a number of textbook episodes: Medea transfuses blood to the elder Pelias in Ovid’s Metamorphoses, an unsuccessful transfusion to Pope Innocent VIII (1492 years), Harvey’s discovery of the law of blood circulation (1628), Denis’s experiments in France with the transfusion of lamb’s blood to a person (1667), the return of the Englishman Blendel to the experiments of transfusion from person to person (1820), the introduction of the practice of infusion of saline into surgery ( 1875), Landsteiner’s discovery of the law of isohemoagglutination (1901), Carrel’s development of the vascular suture technique (1907), the first mass transfusions in the clinic of the American Crile (1909), Ggosten’s use of sodium citrate to combat blood clotting (1914).

At the same time, he singled out the history of blood transfusion in pre-Soviet Russia: Wolf transfusion of blood to a dying woman in labor (1832), Sokolov’s transfusion of blood serum to a patient with cholera (1847), publication of Filomafitsky’s “Treatise on Blood Transfusion” (1848), individual successes in blood transfusion at the end of the XIX century. Finally, an introduction to the modern history of blood transfusion followed: “Since 1926, since the establishment of the Central Institute of Blood Transfusion in Moscow, on the initiative of A.A. Bogdanov began a broad scientific development and systematic implementation of the method throughout the Union.

In the same year, in the next volume of the first edition of the Great Medical Encyclopedia, one of the leading Leningrad transfusiologists, E.R. Hesse, in an article on blood transfusion, outlined an almost similar version of the history of transfusion – from the case of Innocent VIII to the creation of the Bogdan Institute. In 1938, articles devoted to the history of blood transfusion appeared on the pages of the periodical. First B.S. Bessmertny presented a report on the history of blood transfusion from antiquity to the creation of the Bogdan Institute in Moscow, then the director of the TsIPK (since 1931 to 1961) A.A. Bagdasarov gave an overview of the history of transfusion since 1926.

In 1940, the Guide to Blood Transfusion was published, written by V.N. Shamov and A.N. Filatov with the participation of a group of leading specialists in transfusiology. Its entire second chapter (author – Associate Professor I.S. Lindenbaum) was devoted to the history of blood transfusion, and three stages were distinguished in it: from Hippocrates to Harvey, from Harvey to Landsteiner’s immunological doctrine of blood groups, from Landsteiner to the present. Numerous publications appeared, addressed both to narrow specialists and to a wider audience, which significantly expanded the understanding of the development of transfusiology, its significance for the interests of the state and society.

In Russia, the first fundamental work on blood transfusion was the book by A.M. Filomafitsky “A treatise on blood transfusion as the only means in many cases to save a fading life, compiled in historical, physiological and surgical terms …” (1848). In 1865 V.V. Sutugin in his doctoral dissertation “On blood transfusion” came to important conclusions: the transfused blood must be deprived of the ability to clot; only human blood is suitable for a person; it is best to transfuse slowly to avoid negative reactions. It was the first time that the idea of ​​preserving blood was expressed. In 1887, from the clinic N.V. Sklifosovsky published the work of Dr. Tabure “On blood transfusion”, which substantiated the huge role of blood transfusion in military field surgery.

In the 60s – 80s. In the 19th century, three important discoveries in the field of blood transfusion were made in Russia: S.P. Kolomnin introduced the method of intra-arterial transfusion, V.V. Sutugin – a method of preservation and V. Rautenberg – a method of chemical stabilization of blood. N.I. Pirogov emphasized the benefits of blood transfusion for some wounds in the field. At the end of the XIX century. A. Schmidt conducted experiments to study the mechanism of blood coagulation, and P. Ehrlich, J.I. Mechnikov, E.S. London, L.A. Tarasovich observed hemolysis of erythrocytes when mixed with the blood serum of various animals. The use of blood as a remedy has long attracted the attention of researchers. The thought of a person worked on how to compensate for the loss of blood in the body during injuries and heavy bleeding, how to improve the composition and quality of blood that worsened during diseases.

The discovery of blood groups played a very important role, as a result of which the causes of some post-transfusion complications were revealed, which made it possible to prevent them. It turned out that complications in the transfusion of blood from animals to humans occur because human blood serum sticks together (agglutinates) and destroys the blood cells of animals. The intensive development of blood donation, the development of methods and the introduction of blood transfusion into widespread clinical practice in our country began only after the Great October Socialist Revolution.

The first science-based blood transfusion in the Soviet Union, taking into account its group affiliation, was performed on June 20, 1919 by VN Shamov, a surgeon who stood for the fastest use of the most advanced methods in practice. In 1914, he visited Crile’s clinic in Cleveland, USA, and got acquainted with the transfusion work there. In 1919, in Petrograd, he independently isolated standard sera and performed the first transfusion taking into account blood group factors.