Administering Blood Products

Red Blood Cells or Whole Blood
  1. After proper procedure identification of patient and blood product, initiate administration of RBCs as soon as possible. Consider administration via warmer if rapid infusion is indicated. 
  2. Invert the RBCs gently several times to suspend them. 
  3. Spike the RBCs with one tail of the Y blood set. Make sure the upper drip chamber is half full to prevent damage to the RBCs. 
  4. Close the roller clamp on the normal saline tail, and open the roller clamp on the RBCs. A gentle squeeze on the filter helps start the flow of blood. 
  5. Infuse slowly (if clinically appropriate) for the first 15 to 30 minutes at a rate no greater than 5 ml per minute while observing the patient for reactions. 
  6. After 15 minutes, reassess the vital signs and adjust the flow rate to the desired speed. 
  7. Continue the assessments of the patient (always include the vital signs). Monitor fluid balance carefully in patients at risk for fluid overload. 
  8. Check that the proper solution is being used (5% or 25%). Albumin does not have to be ABO compatible. 2.  The 25% solution is usually delivered concurrently with crystalloid solution, whether it is administered directly or inserted in piggyback fashion into another line. 
  9. Infuse the 5% solution as fast as it can be tolerated. The 25% solution should be administered over 20 to 60 minutes. 
  10. Monitor respiratory status.
Platelets
  1. Check the unit for clumps or aggregates.
  2. Prime the blood administration set with normal saline, and place a three-way stopcock at the distal end of the tubing (just in front of the IV catheter). Platelets must be transfused through a filter.
  3. Check the platelet blood type versus the patient's blood type per institutional policy.
  4. Hang the platelet bag on one tail of the Y set.
  5. Close the normal saline-solution line roller clamp, and open the platelet line.
  6. Run the infusion slowly for the first 15 minutes. After this, the infusion rate can be moved up to 4 to 8 ml/kg per hour according to the patient's tolerance.
  7. If platelets do not run at a sufficient speed, attach the syringe to the 3-way stopcock Turn off the stopcock to the patient and withdraw the platelets into the syringe. Close the stopcock to the IV line, open it to the patient, and inject the platelets at 5 to 10 ml/min.
  8. When the platelet pack is empty, close its roller clamp, open the normal saline solution, and flush the line to infuse all the platelets.
Fresh Frozen Plasma
  1. Identify the patient and the blood type.
  2. Inspect the bag for leaks and the color of the infusion.
  3. Spike the plasma with the other tail of the Y set.
  4. Close the roller clamp on the normal saline solution, open up the plasma, and regulate the drip rate.
  5. Run the infusion slowly for the first 15 minutes, as with other blood products, and watch closely for any transfusion reactions. After this, the infusion rate can be moved up to 4 to 8 ml/kg per hour according to the patient's tolerance.

Cryoprecipitate

  1. Initiate an IV line with a normal saline solution and Y blood set at a keep-vein open (KVO) rate. Cryoprecipitate must be given through a filter. Infuse only at room temperature.
  2. Inspect the bag for leaks and examine the solution. It is normal for the solution to be cloudy.
  3. Hang the cryoprecipitate on the other tail of the Y blood set.
  4. Infuse slowly for the first 15 minutes and watch for a transfusion reaction. Then, adjust the drip rate to infuse at a rate of 4 to 8 ml/kg per hour.
  5. If necessary, the three-way stopcock and syringe may be used to infuse the cyroprecipitate faster. Use only a plastic syringe, because factor VIII may bind to the surface of a glass syringe.
  6. Flush the IV line with a normal saline solution after the cryoprecipitate is finished.
 
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