General Nursing (RGN)
BLOOD TRANSFUSION
Blood transfusion is the controlled administration of a prescribed blood component through a suitable intravenous line. Safe practice requires valid consent, compatible blood verification by two authorized practitioners, baseline observations, close early monitoring, and immediate action for a suspected reaction.
Purpose
- Replace red cells, platelets, plasma, or other components when prescribed
- Improve oxygen-carrying capacity, haemostasis, or circulating volume
- Treat a documented clinical indication while minimizing transfusion risk
Indications
- A documented prescription for a specific blood component
- Symptomatic anaemia or blood loss when transfusion is clinically indicated
- Thrombocytopenia, coagulopathy, or another approved indication
Equipment
- Correct blood component and patient records
- Blood administration set with appropriate filter
- Patent suitable IV access
- Normal saline where compatible and prescribed
- Vital-signs equipment
- PPE, emergency equipment, and reaction report form
- Consent documentation and transfusion record
Preparation
- Check recent laboratory results, transfusion history, antibodies, previous reactions, and the patient’s ability to report symptoms.
- Ensure the blood is released and transported according to blood-bank policy and is not left at the bedside unnecessarily.
Procedure steps
- Confirm the prescription, indication, valid consent, patient identity, blood group and compatibility requirements, allergies, and baseline observations.
- Explain the transfusion and symptoms to report; verify IV access and ensure emergency support is available.
- At the bedside, two authorized staff independently compare the patient’s identifiers, wristband, prescription, compatibility label, component type, donation or unit number, expiry, and appearance.
- Inspect the blood bag for leaks, clots, abnormal colour, or evidence of contamination; do not use a compromised unit.
- Perform hand hygiene, prime the blood administration set according to policy, and commence promptly using only compatible fluid as approved.
- Record baseline observations and remain with or closely observe the patient during the initial period when reactions are most likely.
- Monitor observations and transfusion site according to policy; observe for fever, chills, rash, flushing, pain, dyspnoea, chest or back pain, hypotension, anxiety, or dark urine.
- If a reaction is suspected, stop the transfusion immediately, keep IV access open with compatible normal saline using new tubing as policy directs, assess the patient, and call the prescriber and nurse in charge.
- Recheck all identification and component details, preserve the bag and tubing as required, collect specimens, and complete the reaction report according to policy.
- On completion, record the component, volume, start and finish times, observations, patient response, and disposal or return of the bag.
Precautions
- Never start blood without a valid prescription, consent, compatible access, baseline observations, and two-person bedside verification.
- Do not add medicines to blood or infuse it with incompatible solutions.
- Do not leave a patient unobserved at the start of transfusion or when symptoms occur.
- Follow local maximum hang-time, monitoring, storage, and reaction protocols.
Aftercare
- Continue observation for delayed reactions and provide instructions about reporting fever, rash, dark urine, jaundice, or malaise.
- Assess the IV site and patient response after completion.
Documentation
- Record consent, component details, verification staff, observations, start and finish times, volume, IV site, and response.
- Document and report any reaction immediately with all required forms and specimens.
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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