Infusion and Monitoring

Monitoring the Patient

Each hospital must set policy for the frequency of monitoring and recording of vital signs.

For example, the patient's temperature should be recorded after 15 minutes and then every 30-60 minutes until one hour after the completion of the transfusion.

The Registered Nurse initiating the transfusion should remain with the patient for the first 15 minutes and then monitor the patient closely for the duration of the transfusion. Ambulatory patients should not be allowed to leave the patient care area during transfusion.

Infusion of all blood products should begin within 30 minutes from the time the component is removed from the monitored blood storage refrigerator. If any delays that exceed this length of time are expected, the components must be returned to the monitored blood storage refrigerator. Prior to initiation, record the pre-transfusion vital signs and time.

Rate of Infusion

Blood components should be transfused over the period of time prescribed by the treating physician. The rate of infusion depends upon the clinical condition of the patient and the product being transfused (consult product inserts of fractionated products).

Unless otherwise indicated by the patient's clinical condition, the rate of infusion of red blood cells should be no greater than 5 mL/min for the first fifteen minutes of the transfusion. The patient should be observed during this period, as some life-threatening reactions could occur after the infusion of only a small volume of blood.

A unit of red blood cells (RBC) can be infused in 45-90 minutes in most patients. The transfusion should not take longer than four hours because of the risk of bacterial proliferation at room temperature.

Pediatric infusion rate is usually 2-5 mL/kg/hour. Units are sometimes aliquoted by the hospital transfusion service (depending on hospital services and policies) into several bags or syringes containing small volumes. Contact the hospital transfusion service if this is indicated.

Similarly, blood that is not hung within thirty minutes of removal from the hospital transfusion service department or temperature controlled blood product storage device should be returned until needed.

Air should never be introduced into the blood component container or into the administration set, because of risk of air embolism.

Administration of blood under pressure to speed infusion may contribute to hemolysis and should always be supervised by a nurse or physician.

Circulatory overload, leading to pulmonary edema, can occur after transfusion of excessive volumes or at excessively rapid rates. This is a particular risk in the elderly and in patients with chronic severe anemia in whom low red cell mass is associated with high plasma volume. Except for the replacement of acute, massive blood loss, infusion rates should, ordinarily, be no greater than 2-4 mL per kg body weight per hour, and for patients at known risk of hypervolemia, a rate of no faster than 1 mL/kg/hr is advisable.

After platelets are transfused, it is preferred (but optional) to rinse the entrapped platelets from the filter by flowing 50-100 mL of 0.9% Saline Solution (USP) through it.

Additional information on infusion may be found in the Circular of Information for the Use of Human Blood and Blood Components (Sections A.4 #11 Rate of infusion and A.5 #7b Circulatory overload reactions).