3.4 Checklist: Administer Blood Products

*Disclaimer: Always follow agency policy and manufacturer recommendations

Checklist: Administer Blood Products^[1],[2]

• Verify the provider’s order. Confirm the order and the medical record are labeled with the client’s first and last name and assigned identification number.
• Unless the transfusion is an emergency, confirm the provider has obtained written informed consent before initiating transfusion therapy and the consent is in the client’s medical record.
• Review prescribed medications to be administered before, during, and after the transfusion.
• Ensure that a blood sample was obtained for compatibility testing according to agency policy, typically within the past 72 hours. Obtain a blood sample if needed.
• Ensure the agency’s transfusion services receives a request with the client’s first and last name, an identification number, the prescribed blood component and amount ordered, and the name of the provider.
• Gather the necessary equipment:
  • Blood or blood product administration set (with standard blood filter)
  • IV pole
  • Gloves
  • Blood or blood product
  • Preservative-free normal saline solution
  • 3-mL syringe
  • Antiseptic pad (chlorhexidine-based, povidone-iodine, or alcohol)
  • Disinfectant pad
  • Stethoscope
  • Vital signs monitoring equipment
  • Blood request
  • Premedications (if prescribed), 250 mL of normal saline solution, IV catheter equipment (should include 18G to 24G catheters), electronic infusion device indicated for blood transfusion use, PPE, and pulse oximeter
• Perform hand hygiene and put on gloves.
• Confirm the client’s identity using at least two patient identifiers.
• Ask the client if they have any allergies or any prior transfusion reactions.
• Assess the client’s previous knowledge and understanding of the procedure. Assess the client’s anxiety level and respond therapeutically.
• Ensure that the client has adequate venous access; insert an IV catheter if necessary.
• Remove and discard your gloves.
• Perform hand hygiene.
• Obtain the client’s vital signs within 15 minutes of initiating the transfusion.
• Assess the client’s breath sounds, skin color, and current laboratory tests, such as hemoglobin and hematocrit. Identify any conditions that may increase the risk of a transfusion reaction, such as a fever, heart failure, kidney disease, or the risk of fluid volume excess.
• Question the client about any symptoms that may later be mistaken for a transfusion reaction.
• Assist the client to the bathroom if necessary. Help the client to a comfortable position.
• If the client is in bed, raise the bed to waist level.
• Obtain the blood or blood product from transfusion services, making sure to verify the blood component with a transfusion services representative. Wear gloves or transport the component unit in a container that prevents direct contact with the unit bag. Start blood transfusion within 30 minutes of obtaining it from the blood bank.
• Perform hand hygiene.
• Put on gloves and other personal protective equipment, as needed.
• Use a two-person verification process in the presence of the client to match the blood or blood component to the provider’s order and the patient. Compare the name and identification number on the client’s wristband with those on the blood bag label. Check the blood bag identification number, ABO blood group, Rh compatibility, and interpretation of compatibility testing. Compare the client’s transfusion services identification number with the number on the blood bag.
• Check the expiration date and the integrity of the product; return expired or abnormal blood to transfusion services.
• Prime the administration set. When using a Y-type set, use normal saline solution to prime the tubing.
• Perform a vigorous mechanical scrub of the vascular access device for at least five seconds using an antiseptic pad. Allow it to dry completely.
• Trace the blood administration set from the client to its point of origin before beginning the transfusion. Route the tubing in a standardized direction if the client has other tubing and catheters that have different purposes. Label the tubing at the distal and proximal ends.
• Start the transfusion at a slow rate per agency policy, typically 2 mL/minute (i.e., 120 mL/hour).
• Remain with the client during the first 15 minutes to monitor for signs of transfusion reaction.
• If a reaction occurs, immediately stop the transfusion and notify the provider and transfusion services according to agency policy.
• During the first 15 minutes of the blood transfusion, obtain and analyze vital signs based on agency policy.
• If no evidence of a transfusion reaction occurs, increase the infusion rate to the prescribed rate to ensure administration is complete within a 4-hour time frame.
• Instruct the client to immediately report any unusual symptoms such as chills, itching, hives, shortness of breath, or chest pain and leave the call light within reach.
• Observe the client periodically during the transfusion and assess their respiratory status, skin appearance, and urine output. Monitor vital signs during the transfusion as directed by agency policy and/or the client’s condition.
• Closely monitor the flow rate and inspect the IV insertion site for signs of infiltration. If signs of infiltration are present, stop the transfusion immediately, disconnect the administration set, and aspirate fluid from the catheter using a 3-mL syringe. Remove the catheter and estimate the volume of fluid infiltrated. Notify the provider and insert a new IV catheter in a different location and restart the transfusion.
• Remove and discard gloves and any personal protective equipment.
• Perform hand hygiene.
• After the completion of the blood product administration, assess the IV site and obtain the client’s vital signs and compare them with the baseline measurements.
• If additional units must be administered, repeat the procedure. If additional units aren’t needed, perform hand hygiene, put on gloves, and reconnect the original IV fluid, saline lock the catheter, or discontinue the IV infusion, as prescribed.
• Appropriately discard the used equipment, blood bag, filter, and tubing in a biohazard bag or bin.
• Dispose of used equipment in appropriate receptacles.
• Remove and discard gloves and other personal protective equipment, if worn.
• Perform hand hygiene.
• In an inpatient setting, help the patient into a comfortable position and place personal items, the tray table, and the call light within easy reach. Make sure the patient knows how to use the call light to summon assistance. To ensure the patient’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. Ensure the bed is locked.
• Perform hand hygiene.
• Document the procedure and assessments.
• Continue to assess and monitor the client for 4 to 6 hours after the transfusion.
• Teach the client and family about the signs and symptoms of a delayed reaction.