|The Clinical Use of Blood - Handbook (WHO - OMS, 2002, 222 p.)|
|Clinical transfusion procedures|
It is essential to take baseline observations and to ensure that the patient is being monitored during and after the transfusion in order to detect any adverse event as early as possible. This will ensure that potentially lifesaving action can be taken quickly.
Before commencing the transfusion, it is essential to:
· Encourage the patient to notify a nurse or doctor immediately if he or she becomes aware of any reactions such as shivering, flushing, pain or shortness of breath or begins to feel anxious
· Ensure that the patient is in a setting where he or she can be directly observed.
MONITORING THE TRANSFUSED PATIENT
1 For each unit of blood transfused, monitor the patient:
· Before starting the transfusion
2 At each of these stages, record the following information on the patients chart:
· Patients general appearance
- Oral and IV fluid intake
· Time the transfusion is started
Severe reactions most commonly present during the first 15 minutes of a transfusion. All patients and, in particular, unconscious patients should be monitored during this period and for the first 15 minutes of each subsequent unit.
The transfusion of each unit of the blood or blood component should be completed within four hours of the pack being punctured. If a unit is not completed within four hours, discontinue its use and dispose of the remainder through the clinical waste system.
Acute transfusion reactions
If the patient appears to be experiencing an adverse reaction, stop the transfusion and seek urgent medical assistance. Record vital signs regularly until the medical officer has assessed the patient.
See pp. 62-65 for the clinical features and management of acute transfusion reactions.
In the case of a suspected transfusion reaction, do not discard the blood pack and infusion set, but return them to the blood bank for investigation.
Record the clinical details and actions taken in the patients case-notes.