frequency of vitals monitoring during transfusion

[umeshkumar]

What are the AABB guidelines on frequency of vital signs monitoring during transfusion?

Many hospitals are following the protocol of monitoring every 5 minutes for the first 15 minutes, and thereafter hourly once till end of transfusion (3-4 hours)

Is this acceptable? what are the views of the AABB and FDA on this issue? What is being practised by most north american hospitals?

thanks

[goodchild]

We have been documenting pre-transfusion, 15minute, hourly and post-transfusion vitals for years. The nurse is also required to document a nursing note for each blood transfusion.

[David Saikin]

AABB standards require pre, after 15 minutes and at the end. We do pre, 15 minutes, hourly and at the end.

[tbostock]

We do them pre, 15 min, hourly, then 1 hour post.

[Mabel Adams]

Same as goodchild.

I think the AABB Blood Administration Primer recommends a 1 hr post but that is not the standard in the Nursing manual our Nursing dept uses for a reference so we don't do it at this time.

[goodchild]

Our procedure gives a fairly vague "monitor post transfusion for signs/symptoms of transfusion reaction" because our medical director is interested in seeing any fevers occurring during or within 4 hours of transfusion, but it's not very rigorous.

[Deny Morlino]

Same here as Terri

[MAGNUM]

We do pre, 15 min, 30 min, and hourly thereafter.

[ABIDer]

I realize this is an old thread but we are currently evaluating our post transfusion patient observation time at our hospital. We check vitals at one hour post transfusion for all of our patients. We are being asked, by nursing, to disregard this post check for out-patient transfusions at our infusion site. We would like to know what others are doing for all transfusion recipients and whether any distiction is made between in-patients and out-patients at your institutions.

[Auntie-D]

Forgetting allogenic transfusion reactions, 1 hour seems like far too long to be leaving a patient. An allergic or anaphylactic transfusion reaction can happen anything from a few seconds to a few minutes and up to an hour post transfusion so even just for this monitoring should be close.

 

We do 5 minutes for the first 15, then every 15 minutes until the end of the transfusion.

[ABIDer]

The question is whether to continue to monitor the patient once the transfusion has ended or just let them go with a list of "reactions" to watch out for. We also follow the patients closely throughout the transfusion but we also like to check again, one hour post transfusion. Do you check vitals any time after the transfusion has ended?

[Sophie1210]

We do pre, 15 min, and post vitals on everyone. For outpatients, it depends on if they're a recurring patient or new. Patients who haven't received transfusions before, they'll keep a little longer and go over what to look out for in more detail with them. Our cancer patients who have transfusions weekly, they'll let them go right away because they know what to look for and how they react to transfusions already.

[tbostock]

We do vitals one hour post, but there is no regulatory requirement to do so. We're also thinking about dropping that and changing it to "at completion" instead. I would encourage that if you drop it, you do so for inpatients and outpatients. Inspectors sometimes will pick up on it if they think you have a different standard of care for certain patients.

We also give our outpatients discharge instructions including what symptoms to look out for and that they should call their physician right away for any reaction once they get home.

[Auntie-D]

Tbistock - what happens if you have a patient with a dormant anti-E and it their first presentation with you? Antibody screen comes up neg, units come up neg and are issued in good faith but the patient has a transfusion reaction... How would this be picked up if there are no checks in place?

[Malcolm Needs ☆]

Tbistock - what happens if you have a patient with a dormant anti-E and it their first presentation with you? Antibody screen comes up neg, units come up neg and are issued in good faith but the patient has a transfusion reaction... How would this be picked up if there are no checks in place?

I can see from where you are coming Auntie-D, but a clinically significant anamnestic response involving a dormant anti-E is highly unlikely. I, for one, have never seen such a scenario in the literature (although, of course, I have not read ALL of the literature!). Of course, such a thing can, and does, happen with anti-Jka, but that is different.

That notwithstanding, I would still recommend E-, e+ units for transfusion, except in the case of a fulminant auto-anti-e.

[tbostock]

 

Tbistock - what happens if you have a patient with a dormant anti-E and it their first presentation with you? Antibody screen comes up neg, units come up neg and are issued in good faith but the patient has a transfusion reaction... How would this be picked up if there are no checks in place?

 

I never said I don't have checks in place. We do vitals at 15 minutes, every hour thereafter, and 1 hour post-transfusion. So we would either pick it up during the transfusion or later if it was a delayed hemolytic reaction.

[Auntie-D]

 

 

I never said I don't have checks in place. We do vitals at 15 minutes, every hour thereafter, and 1 hour post-transfusion. So we would either pick it up during the transfusion or later if it was a delayed hemolytic reaction.

 

Ah right it just said that you do 1h post and people were wanting to forget that too...

[cthherbal ☆]

We do pre, 15 min and completion vitals. All patients get discharge instructions- both inpatients and outpatients. Some inpatients are transfused day of discharge so we recently decided to include both groups to increase awareness of delayed TRs especially since they make up 20% of all our reactions.

[bbbirder]

We do vitals pre, 15 min and hourly AND then 1 hour post.

The Outpatients (who are usually return customers) are encouraged to stay and given written instructions on what to watch for when they leave.  Many of these outpatients do not stay (I doubt the nurse really twists their arms), if they leave prior to the one hour check, the nurse documents that the patient declined to stay.

[aafrin]

We do vitals pre, 15 min, 30 min and then hourly until completion of transfusion.

The day care and dialysis patients who come as out-patients are requested to stay for an hour after completion of transfusion, but many do not opt to stay. The nurse takes their signature on the chart that they have declined to stay. All patients are given written instructions on what symptoms to watch for & to contact their caregiver physician immediately if they feel they might be experiencing a trxn reaction.

[Eagle Eye]

How do you monitor for TRALI?