A charge nurse is precepting a newly licensed nurse who is to administer a transfusion of packed red blood cells (PRBC) to a client who has anemia. Which of the following actions by the new nurse should cause the charge nurse to intervene in this client’s care immediately?
A.
The nurse stays with the client for 15 minutes after beginning the transfusion.
B.
The nurse primes the blood tubing with lactated ringers.
C.
The nurse starts the infusion at a slow rate for the first 15 minutes.
D.
The nurse witnesses the client sign the consent form for the blood transfusion.
The correct answer and Explanation is :
The action by the new nurse that should cause the charge nurse to intervene immediately is:
B. The nurse primes the blood tubing with lactated ringers.
Explanation:
When administering a blood transfusion, the proper protocol involves using only normal saline (0.9% sodium chloride) to prime the blood transfusion tubing and to flush the blood transfusion line. Lactated Ringer’s solution is not recommended for use with blood transfusions due to the potential for interactions between the calcium in the Lactated Ringer’s and the anticoagulants present in the blood product. The calcium can cause clotting within the blood transfusion tubing or the blood bag, which can lead to complications for the patient.
Detailed Steps for Blood Transfusion:
- Verify the Order and Consent: Ensure that the physician’s order for the transfusion is accurate and that the client has signed the consent form for the procedure.
- Check Blood Product and Patient Identity: Verify the blood product with the client’s identity by using two identifiers (e.g., name, date of birth) and confirm with another nurse or healthcare professional.
- Prime the Tubing with Normal Saline: Use normal saline to prime the blood transfusion tubing. Normal saline is isotonic and does not interfere with the blood product. It helps to maintain the patency of the intravenous line and ensures the blood transfusion can flow properly.
- Start the Infusion Slowly: Begin the transfusion at a slow rate, usually no more than 2 mL/min for the first 15 minutes, to monitor the client for any adverse reactions.
- Monitor the Client: Stay with the client for the first 15 minutes to observe for any signs of an allergic reaction or transfusion reaction. Monitor vital signs closely.
Conclusion:
Priming blood transfusion tubing with Lactated Ringer’s solution is a critical error that can jeopardize the safety of the patient. Immediate intervention is necessary to correct this mistake and to ensure the transfusion is administered according to established guidelines.