Transfusing the Patient

Commencing a transfusion
Observing the patient
Documentation

---

Commencing a transfusion
An intravenous infusion may only be changed to a blood or blood component transfusion by a registered nurse or a medical doctor on the written instruction and responsibility of a medical doctor after

• Proper verification of all unit-related and patient identifiers by two registered health care professionals was completed;
• ensuring the correct administration set for the specific component is used;
• checking the physician’s prescription on rate of infusion, additional medication or special instructions;
• baseline observations were done and recorded in the patient’s file; and
• ensuring that informed consent has been obtained and documented.

Remember to communicate with your patient for early recognition of symptoms of a transfusion reaction and prompt reporting.

Observing the patient
Baseline observations must be done prior to the transfusion. During a transfusion, patients should be observed

• every 15 minutes for the first half-hour of each unit (severe transfusion reactions are more likely to occur during the first 30 minutes of a unit),
• then half hourly or according to hospital policy. Observations include:
• visual observation and verbal enquiry regarding the patient’s wellbeing.
• blood pressure, pulse, respiration, temperature, urine output.
• CVP reading (if applicable).

The unconscious patient warrants extra observations. Often, a drop in blood pressure and oozing from wound or venous access sites are the only signs of a haemolytic reaction.

Documentation
All documents pertaining to a transfusion are kept in a patient’s file indefinitely. The following information must be documented:

• date of transfusion
• type of product transfused
• unit number
• start and finish time of each unit
• name of persons starting, discontinuing and checking each unit
• units that was not transfused to the patient
• any reactions that occurred during or after the transfusion