Clinical Skills - Blood Transfusion

ELLIS: Hi. I'm Ellis with Level Up RN. And in this video, I'll be demonstrating how to administer a blood transfusion. I'll be following the steps that we've included in our clinical nursing skills deck. So if you have the deck, go ahead and grab these cards. And that's cards because there's a couple of them that talk about blood transfusion. If you don't have this deck, then you can check it out at LevelUpRN.com. Because blood transfusions require two registered nurses to complete, I bet you'll recognize a very special guest that assists me with this video.

ELLIS: Okay. Today, with Mr. Smith, we're going to go ahead and be giving him a unit of packed red blood cells. So before we get started, we're going to ask him about his history with blood transfusion reactions. We're going to make sure he has a patent IV site, and we're going to double-check that his chart has a signed informed consent. And then before we worry about going to get the blood or worrying about the blood bank, we're going to hang our blood tubing. So we'll need a blood administration set, which is a Y tubing. And then we only ever prime this tubing with normal saline. So we'll also need normal saline. So we'll get our tubing out of the container. We'll go ahead and roller clamp both Y ports. Now, our blood tubing is usually indicated with these red ports. So I'm going to take the cap off of my spike, take the plunger out of my bag, and just carefully twist and spike my normal saline. I'm going to hang it on my pump. All right. Double-checking that this one is closed, I can now open this port, and I'm going to prime the drip chamber, filling it until the saline is over the filter that's inside. We're using a type of pump today that does have a stopper on the system cassette. So you may or may not need to do the system stopper. But I'm going to go ahead and remove the end of my tubing, open my stopper, and prime my tubing over a trash can, making sure I prime my full cassette until it exits my tubing. Then I can connect this to my patient.

CATHY: So we would wipe the hub with the alcohol swab and connect this.

ELLIS: And go ahead and put in my pump. So all of this is ready for us when we come back with our blood. So we'll go on down to the blood bank and retrieve our blood. Once we return, we want to make sure that we've already visually inspected the blood, that it looks like blood. The--

CATHY: Not discolored.

ELLIS: Right, the color, the consistency, the bag is intact, all of those things. And then we have to have a second RN with us, so I've asked my RN friend Cathy to join me to double-check and make sure that we are giving the correct blood to the correct patient.

CATHY: So I'm going to be looking at his blood bank bracelet here.

ELLIS: And I'll be looking at the blood transfusion request slip and the bag of blood itself. So today, we have our patient, Mr. Smith.

CATHY: We have Mr. Smith.

ELLIS: His account number is 20090.

CATHY: 20090.

ELLIS: His MR number is 200422.

CATHY: 200422.

ELLIS: Date of birth is April 6, '91.

CATHY: April 6, '91, date of birth.

ELLIS: All right. And we'll look. We've got AB positive blood.

CATHY: Yep, AB positive.

ELLIS: His unit number is 069364.

CATHY: Unit number 069364.

ELLIS: He has been electronically cross-matched. And that's going to be on here.

CATHY: Okay.

ELLIS: And once we verify that all of that information is correct, I'm going to sign and initial. I'm going to have Cathy sign and initial, making sure that we've both acknowledged this is the correct blood going to the correct patient. Now I'm going to go ahead and set up my blood. And during this time, Cathy can get that initial set of vital signs for me that we'll also need to put on our documentation.

CATHY: All right.

ELLIS: So to set up my blood, I do similarly in that I open the port on my blood tubing. I open the spike on the tubing itself. I carefully insert with a slight twist. And I hang the blood on the pole.

CATHY: Need help?

ELLIS: Yeah, go ahead and get that for me. Now, a really important step that can be missed here is that because this is that Y tubing, you have two clamps with the two roller clamps. If you leave the saline clamp open and unclamp the blood as well, the blood will actually get sucked down into here and backflow up into the saline and will never reach your patient. So when I unclamp my blood, I'm going to clamp my saline and make sure that that's clamped. When I start to administer my blood-- you can do this one of a few different ways. We're going to use the pump to prime the line. So this is filled with saline right now. So I can go ahead and start my pump and set it at a fairly quick rate so that I can prime all of that saline out because when I receive my blood from the lab, I only have 30 minutes in which to start it, which is why we do all that prep work. And I only have four hours to administer it. So I need to be very careful about the timing and when it starts. And blood only starts, officially, on paper, when this touches the patient. So right now, my blood's not started. I haven't started the blood. My timing doesn't count yet. So I'm going to flush his line through as long as that's safe for him and watch this blood here. And until this red stuff, right, until the red color reached the patient, it doesn't count yet.

CATHY: All right.

ELLIS: And once it's reached the patient, I can set the rate to whatever's appropriate for him.

CATHY: Okay. So once this is all primed, this whole tubing will be filled with blood, and Ellis or I will be hanging out with the patient for the first 15 minutes to make sure they don't have any transfusion reaction. If we notice that they are having some reaction, we're going to want to immediately turn off the blood infusion. And we're going to want to administer normal saline through a separate line. And the reason why we do that is this whole line will be filled with blood. If we open the saline and close off the blood, all this blood in this tubing is still going to go in the patient, and we don't want that because they're having a reaction. So we don't want any more blood inside of them. So hopefully, that will not happen with our patient, [laughter] but we're going to stick around--

ELLIS: It's pretty rare with the electronic cross-matches. But if it happens, we stop it, and then we actually disconnect. We package everything back up and send it back to the lab.

CATHY: Right, to get analyzed.

ELLIS: So don't throw anything away. I mean, tubing and everything, we want everything to get sent back to the lab, and they'll figure out what went wrong. Why did he have a reaction?

CATHY: Right. And so we're here for 15 minutes. After 15 minutes, if everything looks good — they're not having any kind of reaction — we'll take a second set of vitals. So we took our first set before we started administering the blood, and then we'll take our second set at 15 minutes to make sure that our patient isn't having a fever or any other alterations in vital signs.