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Blood transfusion vital sign protocols do not have sufficient evidence to mandate surveillance frequency. The purpose of this study was to examine the relationship of vital sign changes to reaction times in an effort to determine best practice for monitoring patients receiving blood products.
In the acute care hospital setting, professionals administer blood products to improve quality of life. For instance, blood transfusions help patients replenish blood loss from injury and surgery, and manage symptoms of cancer treatment and blood dyscrasias. Blood products for transfusion in clude whole blood, packed red blood cells, platelets, cryoprecipitate, and fresh frozen plasma (Zonozy, 2013).
Even though blood transfusions are very common, they are not without risk. A negative bodily reaction to a blood product is a possible complication of any transfusion. Literature suggests blood transfusion reactions affect less than 1% of patients (Yeh et al., 2011). A reaction can range from a mere annoyance (e.g., urticaria) to a medical emergency or death. However, death is rare and likely occurs due to lack of adequate monitoring (Card et al., 2012). Other examples of transfusion- related complications include circulatory overload, hemolysis, and transfusion-related acute lung injury (Zonozy, 2013). Blood transfusion policies and procedures based on the best available evidence are needed to ensure safe delivery of blood products in any healthcare setting.
The literature consists of predominately clinical review articles providing expert nurse opinions. While many articles stress the importance of monitoring, standardization of monitoring protocols is deferred to individual organizations (Bielefeldt & DeWitt, 2009). It has been suggested that at minimum, vital signs should be monitored before the blood component is administered, 15 minutes after the start of the transfusion, and at the end of the transfusion (Menendez & Edwards, 2016). Delayed reactions to blood transfusions are also a possibility, and nurses are instructed to monitor and assess the patient for 1 hour after the transfusion (Infusion Nurses Society, 2011). Shockingly, some researchers even question the need for vital sign monitoring at all, implying nurses sometimes complete tasks based solely on habit (Rowe & Doughty, 2000).
Crookston, Koenig, and Reyes (2015) acknowledged the nurse's role in protecting the patient: "Understanding the possible complications of transfusion and how to quickly recognize and manage reactions ensures an optimal pa -...