Page 107 - ATP-P 11th Ed

Although identification tags for ABO/Rh verification is authorized it should
be utilized as a last resort only. Accurate identification and verification of the
26
donor’s blood and the intended recipient may be the single most important step
in ensuring transfusion safety. SECTION 1
c. Active warming loss prevention should be used to prevent casualty hypothermia.
Transfusions
1. Ideally blood products should be warmed to approximately 98.6° F (37° C) prior to trans-
fusion. Do not exceed 102° F (39° C) as this may cause an inflammatory reaction and
lyse some of the red cells.
Do not use warmers directly against the fluid bag because of the risk of hemolysis
or damage to the blood or blood product. Blood or blood components should not be
warmed in a microwave, unless it is specifically designed for that purpose.
2. Blood and blood components may be pressure infused using a pressure infuser that en-
cases the entire blood collection bag. Do not use a BP cuff for pressure infusion as they
deliver uneven pressure.
Do not exceed 300mmHg with the pressure infusion device.
3. The largest bore IV catheter should be used. An IO device may be used. Ensure that a
strong flush is done and good flow is obtained prior to using an IO infusion.
4. When performing any administration of blood or blood components the patient should
be continuously monitored for signs and symptoms of an immunologic blood transfu-
sion reaction. The first 10–15 minutes of any transfusion are the most critical.
a. Anaphylactic Reaction
i. Shock
ii. Hypotension
iii. Angioedema
iv. Respiratory distress
b. Acute Hemolytic Transfusion Reaction
i. Acute hemolytic reaction usually has onset within 1 hour
ii. Evidence of disseminated intravascular coagulopathy (DIC) – oozing from
blood draw, IV sites.
iii. Flushing, especially in the face
iv. Fever and increase in core temperature of more than 2° F (1° C)
v. Shaking, chills (rigor)
vi. Flank pain or the acute onset of pain in the chest (retrosternal), abdomen and
thighs
vii. Wheezing, dyspnea
viii. Anxiety, feeling of impending doom
ix. Nausea and vomiting

96 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 97