A nurse is planning care for a client who is scheduled to receive a transfusion of packed RBCs.
Which of the following actions should the nurse plan to take?
A.
Store the unit of blood at room temperature for 1 hr prior to the infusion.
B.
Ensure that the transfusion is completed within 6 hr.
C.
Obtain venous access using a 22-gauge needle.
D.
Use a solution of 0.9% sodium chloride to flush the transfusion tubing.
The Correct Answer and Explanation is:
The correct answer is D. Use a solution of 0.9% sodium chloride to flush the transfusion tubing.
Explanation:
When planning care for a client scheduled to receive a transfusion of packed red blood cells (RBCs), several key considerations must be addressed to ensure the procedure is performed safely and effectively:
- Use of 0.9% Sodium Chloride Solution (Answer D): The primary purpose of using 0.9% sodium chloride (normal saline) during a blood transfusion is to maintain venous access and to dilute and flush the blood transfusion line before and after the infusion. This saline solution is isotonic and helps prevent hemolysis of the red blood cells that can occur if a hypertonic or hypotonic solution is used. It also helps to clear any residual blood from the transfusion tubing, reducing the risk of transfusion reactions and ensuring the full volume of blood is administered to the patient.
- Storing the Blood Unit (Answer A): Blood should not be stored at room temperature for any period before transfusion. Blood units are stored in refrigerators at 1-6°C (34-43°F) to maintain their viability. Once the blood is removed from the refrigerator, it should be transfused promptly, ideally within 30 minutes. Keeping the blood unit at room temperature for 1 hour before infusion can increase the risk of bacterial growth and decrease the safety of the transfusion.
- Transfusion Duration (Answer B): The transfusion of packed RBCs should typically be completed within 4 hours. The 6-hour time frame is longer than recommended and could increase the risk of bacterial contamination and transfusion-related reactions. Blood transfusions must be monitored closely, and the infusion rate should be adjusted to ensure completion within the 4-hour limit.
- Venous Access (Answer C): For RBC transfusions, it is recommended to use a large-bore needle, typically 18-20 gauge, to facilitate the rapid infusion of blood and reduce the risk of hemolysis. A 22-gauge needle may be too small for effective transfusion and could increase the risk of complications such as hemolysis or transfusion reaction.
In summary, using 0.9% sodium chloride to flush the transfusion tubing (Option D) is the correct action for safe and effective transfusion of packed RBCs, while other options either introduce safety risks or do not align with best practices for blood transfusions.