Page 121 - ATP-P 11th Ed

(d) If after the first 15min no adverse reaction is suspected and the vital signs
are stable, open the main roller clamp or set at the desired flow rate. You
may bolus or pressure infuse the blood or PRBCs at this time.
f. Monitor and evaluate the patient throughout the procedure. SECTION 1
i. Monitor vital signs every 15 minutes.
ii. Compare the vital signs with previous and baseline vital signs.
iii. Observe the casualty for changes that indicate an adverse reaction to the blood
or PRBCs.
iv. If a reaction is suspected, stop the blood or PRBCs, infuse LR through a sepa-
rate IV line, and identify and treat the reaction.
When a transfusion reaction occurs or is suspected, no more fluid should
be infused through the IV line or catheter. The unused blood or PRBCs and
recipient tubing should be sent along with the patient for testing.
g. Discontinue the infusion of blood or PRBCs when the patient’s vital signs have
stabilized or the transfusion is finished.
i. Close the clamp to the blood or PRBCs and open the clamp to the NS.
ii. Flush the tubing and filter with approximately 50mL of NS to deliver the re-
sidual blood or PRBCs.
iii. After the residual blood or PRBCs have been delivered, run the NS at a TKO
rate or hang another solution, as needed.
iv. Take and record the vital signs at the completion of the transfusion and continue
to monitor until evacuation.
h. Document the procedure. Ensure you document the infusion of any blood or blood
component, to include the number, component type, and blood type of units infused
on the casualty card (DA FORM 7656) and send this with the patient to the MTF.

Disposition
Urgent evacuation is indicated for any casualty requiring the administration of
blood or blood components.
Urgent evacuation is indicated in any patient who has an acute hemolytic reaction
while undergoing a blood transfusion.

References
1. Lorenzo M, Davis JW, Negin S, et al. (1998). Can Ringer’s lactate be used safely
with blood transfusions? Am J Surg. 175: 308–310.
2. Levac B, Parlow JL, et al. (2010). Ringer’s lactate is compatible with saline-
adenine-glucose-mannitol preserved packed red blood cells for rapid transfusion. Can J
Anaesth. Dec;57(12):1071–1077.

110 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 111