Recently there has been some discussion between nursing and the transfusion service about the frequency of vital signs taken during a transfusion. Our current policy is to have the transfusionist take the patient's vitals at the start of the transfusion, 15 minute mark, 30 minute mark and every 30 minutes thereafter until the completion of the transfusion.

I am requesting feedback from the members as to what their hospital policies are.

Hi Tom_L

If you click on the Refrences tab at the top of the BBT page, then document library, United Kingdom, BCSH Guidelines. The very first document are Guidelines on the Administration of Blood components. I accept that these are UK guidelines but they may help.

Regards

Steve

:)

Edited January 27, 201015 yr by Steven Jeff
spelling

Our policy is for nursing to take the patient's vital signs pre-transfusion, 15 minutes after the transfusion is started, and post-transfusion.

We do the same, but add a one hour post transfusion if an additonal unit has not been hung.

If you are in the US you might want to have the nurses check with the state regulators. Some states have developed regulations that address this at a minimum level. The other thing for the nurses to do is to research their national guidelines. Bottom line, in my world this was a nursing issue, I helped but it was up to them to come up with the standards they wanted/needed to follow.

:rolleyes:

I agree with John, check the state regs. Ours say before the start, at 15 minutes, every hour during, and at completion.

Thank you all for the responses. Our state pretty much follows AABB recommendations so they are minimalistic.

We are also having this discussion with Nursing. They would like to drop to vitals at only pre-, 15 minutes, and post.-transfusion. I understand that many facilities do this, but the only references I can find add that there must be 'regular observation throughout the transfusion.'

(See the British Guideline mentioned and the AABB Primer on Blood Administration, Chap.5)

So if you are not taking vitals during the transfusion, are you just looking at the patient to make sure they are not having a reaction?

Are there any references out there in journals that describe the best practices?

Thanks,

Linda Frederick

There was a survey done in the UK a couple of years or so ago, which raised some horror stories about observations during transfusion.

One that stuck in my mind in particular was of a neonate being transfused in a side room, with no observations being done (and, of course, the poor little thing couldn't shout if he or she was feeling unwell).

I know babies don't have their own antibodies usually (although some are born with their own ABO antibodies), but that does not mean that they have not got unrecognised maternal antibodies in their circulation, or that they cannot become over-loaded, etc, etc.

:eek::eek:

I have to agree with Malcolm. Every patient who is being transfused should remain under observation, but particularly the ones who cannot speak for themselves (whether neonates or unconscious adults). Sometimes I think you have to require vital signs just to get the observation to happen. Also, how else will the transfusionist know if something bad is happening to the voiceless?

I wonder if it would be posible to place a patient being transfused on an automated bedside monitoring system during transfusion something similar to a telemetry monitor where there could be some alarm if something is going wrong. This way we could obtain a regular and objective monitor which would free up the nursing staff to the extent that they would not have to make regular and somewhat less objective trips depending on how busy they were. Does anyone know if such a practice is already in use?

I wonder if it would be posible to place a patient being transfused on an automated bedside monitoring system during transfusion something similar to a telemetry monitor where there could be some alarm if something is going wrong. This way we could obtain a regular and objective monitor which would free up the nursing staff to the extent that they would not have to make regular and somewhat less objective trips depending on how busy they were. Does anyone know if such a practice is already in use?

This is an excellent idea on the face of it, but I think that it would be hugely expensive.

:confused: