Editing Nursing Skills and Procedures (section)

=== Blood administration ===
Verify a signed consent and a patent large-gauge access, prime only with 0.9 percent sodium chloride using Y-tubing with a filter, and complete a two-person verification of the patient identifiers, blood type, unit number, and expiration. Obtain baseline vital signs, begin slowly, and remain with the patient for the first 15 minutes because most severe reactions occur early. Recheck vital signs per policy and complete the unit within four hours.

If a transfusion reaction is suspected, stop the transfusion immediately, disconnect the blood tubing and maintain the line with normal saline using new tubing, assess the patient and take vital signs, notify the provider and blood bank, and return the unit and tubing with a post-transfusion blood and urine specimen. Acute hemolytic reaction presents with fever, chills, flank or back pain, hypotension, and dark urine. Febrile nonhemolytic reaction produces fever and chills. Allergic reaction produces urticaria and itching, and anaphylaxis produces bronchospasm and hypotension. Transfusion-associated circulatory overload produces dyspnea and crackles, while transfusion-related acute lung injury produces hypoxemia and bilateral infiltrates without volume overload.