What is your standard for frequency of vital signs during a blood transfusion? Most references I have looked at state "vital signs according to your institution's policy". Transfusion Services offered no standard in their regulations either. We currently check VS at 15 minutes, then every 30 minutes thereafter. There is some interest in going to 15 minutes after starting, then hourly thereafter.
Thoughts? Thanks!
Hourly? How long do you allow a unit of blood to infuse? I would get baseline vital signs before I go to pick up the unit of blood. Then at 15 minutes after the blood is started, then would prefer to check vitals at least q 30 minutes. I would hesitate to extend this to an hour because a hemolytic reaction could be very advanced in that hour. I checked INS standards and this is not stated there. Have you checked with your blood bank for a copy of the textbook, Technical Manual, from the American Association of Blood Banks. This book and AABB standards are the primary resource for this question. I am not in my office and can't check my book. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Yes, I did run it all by the Transfusion Services director and medical director, and they stated that there is no set recommendation for timing of vitals. They were both ok with changing it to hourly. I did also look at the INS Standards. Lippincott Nursing Procedures and Skills states: follow your institution's policy. I was just curious as to what the practice was "out there".
Wendy Erickson RN
Eau Claire WI
Missed your other question - a unit of blood must be completed within 4 hours max.
Wendy Erickson RN
Eau Claire WI
Yes, can infuse no longer than 4 hours. But this length of time is only necessary for patients with fluid overload or some other issue where fluid is a problem. I have routinely transfused a unit of blood (about 250 mls) over 2 hours. So you are really talking about maybe only 1 hourly vital sign during this transfusion of 1 unit. What about a set at 15 minutes of transfusion, then 1 hour? I would be extremely uncomfortable to start a unit of blood and then not take vitals for a full hour. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Evidence Based recommendations, and the Joint Commission standard, is for vitals signs pre-transfusion, 15 minutes into the transfusion, and within 1 hour after end of the transfusion (no routine vitals are recommended at any set interval during the transfusion). Evidence based recommendations usually also include q hourly visual assessments and better training for recognizing reactions independent of vitals.
Thanks for the information. We are still in the discussion phase here. Many feel as you do, Lynn. But so far we are unable to find any evidence/research/regulations that require more frequent vitals. Thank you, Wade for your input.
Wendy Erickson RN
Eau Claire WI