West Midlands Regional Training Package for Safe Blood Transfusion Practice

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West Midlands Regional Training Package for Safe
Blood Transfusion Practice
MODULE 10 Blood Transfusion Patient Monitoring /
Patient Observations

• The West Midlands Regional Transfusion Committee

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Module 10 Blood Transfusion Patient Monitoring /
Patient Observations

• Contents
• Minimum patient observations required before,
  during and after a blood / blood component
  transfusion
• Possible signs and symptoms of a transfusion
  reaction
• Immediate actions to take if you suspect a
  transfusion reaction

Aim Increase staff awareness and knowledge and
thus improve patient safety

• Objectives
• To list the minimum requirements relating to
  patient monitoring / observations
• To identify signs and symptoms of possible
  transfusion reactions
• To list the immediate actions to take if a
  transfusion reaction is suspected

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Observing / Monitoring the Patient During a Blood
/ Blood Component Transfusion
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations
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Possible signs and symptoms of a blood / blood
component transfusion reaction
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations
Include
Any of these signs or symptoms could indicate a
transfusion reaction
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Possible signs and symptoms of a blood / blood
component transfusion reaction
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations
It can sometimes be difficult to determine the
exact cause of any signs or symptoms, especially
if the patient is already generally unwell.
Many of the transfusion reactions that can
occur have the same or similar signs / symptoms
(refer to Module 12 Transfusion Reactions and
Adverse Events). It is therefore very important
that if there are any changes in a patients
condition, the nurse / doctor in charge of the
patient should be informed immediately so that an
assessment can be made.
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The following observations must be performed and
recorded (minimum observations) - please also
refer to local hospital policy
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations
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Immediate Action to Take if you Suspect a Serious
Transfusion Reaction
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations
A transfusion reaction may be a medical
emergency.
Contd..
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Action - continued
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations
Contd..
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Action - continued
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations
If the doctor requests that the transfusion is
discontinued due to the transfusion reaction /
adverse event, remove the entire blood giving set
as well - the unit of blood / blood component
should be sealed as per hospital policy and sent
to the hospital Blood Bank for further
investigation.
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Module 10 Blood Transfusion Patient Monitoring /
Patient Observations
Highlight Case from SHOT 2003 Wrong blood
administered and a delay in recognising an acute
reaction The patient, who was being treated in
an intensive care unit for oesophageal
carcinoma, received an ABO incompatible blood
transfusion resulting in major morbidity but he
survivedthe patient developed fever, chest pain
and haemoglobinuria but observations were not
recorded at appropriate intervals and the
transfusion reaction was not recognised until
almost a whole unit had been transfused.
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Key Points
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations

• Patients receiving a blood / blood component
  transfusion should be nursed in an area where
  they are visible and can be observed.
• Patients should be informed and aware of any
  possible transfusion reactions, and what signs
  and symptoms they may experience should this
  happen.
• Record patients observations (minimum
  requirements) pre-transfusion, 15 minutes after
  commencing each unit and post-transfusion.
• If you suspect a transfusion reaction, stop the
  transfusion and inform the doctor / nurse in
  charge of the patient immediately.

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Module 10 - Quiz
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations

• Question 1 of 4
• Patients receiving a blood transfusion should be
  nursed
• in an area where they are visible and can be
  observed.
• True / False

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Module 10 - Quiz
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations

• Question 2 of 4
• Observations must be performed and recorded
  (minimum requirements)
• A. Pre and post transfusion
• B. Pre transfusion and 30 minutes after
  commencement
• C. Pre transfusion, 15 minutes after commencement
  and post transfusion
• D. Only if a reaction is suspected

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Module 10 - Quiz
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations

• Question 3 of 4
• Possible signs and symptoms of a possible
  transfusion reaction include (more than one
  correct answer)
• A. Nausea / Vomiting
• B. Breathlessness
• C. Agitation / Confusion
• D. Diarrhoea
• E. Haemaglobinuria
• F. Pyrexia
• G. Change in Blood Pressure
• H. Urticaria (itchy rash)
• I. Abdominal Pain

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Module 10 - Quiz
Module 10 Blood Transfusion Patient Monitoring /
Patient Observations

• Question 4 of 4
• An acute transfusion reaction is a medical
  emergency the doctor or nurse in charge of the
  patient must be informed immediately.
• True / False

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Module 10 quiz answers

• Question 1 True
• Question 2 C
• Question 3 All are correct
• Question 4 True