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b. Discard it in a container for contaminated waste.
- Document the procedure and significant observations on the appropriate forms IAW local SOP.
What Not To Do:
Do not transfuse blood products when ANY doubt exists as to the crossmatching, or type of blood.
Transfusion reactions can convert a critical situation into a “fatal” situation if safe medical procedures are
not followed.
Do not withhold blood products in a patient that is hypotension, tachycardic and actively bleeding, with a
normal hematocrit. Remember, the hematocrit will take several hours to fall in a bleeding patient, so that a
normal percentage is not unusual in acute trauma.
Procedure: Field Transfusion
COL Richard Tenglin, MC, USAIntroduction: Transfusion of red blood cells in a hospital is a complicated, risky procedure. Obtaining fresh
whole blood from one individual and transfusing it to another under austere field conditions is even more
risky, so there is no reason to transfuse red cells to a patient if bleeding can be stopped. Bleeding from
an extremity can be stopped with a tourniquet. Continuous bleeding from neck, chest or abdomen requires
surgical intervention and blood transfusion can only support a patient for a short time while accessing
resuscitative surgery. Aggressive transfusion can increase blood loss by increasing intravascular pressure
and diluting coagulation factors. Within these very significant limitations, field transfusion can be done as
follows.
What You Need: An established large bore IV in the patient that will receive the transfusion, a suitable
blood donor, a blood collection system, clamps, alcohol prep pads, and a blood pressure cuff
What To Do:
- The donor and recipient must be males, or females who have never been pregnant (pregnancy can induce
transfusion-significant antibodies) of known ABO and Rh compatibility (donor: same ABO and Rh type as
recipient, or Type O positive for RH positive recipient, or Type O negative). The medic should document
blood types for all team members prior to deployment–attempts to type and cross in the field in an emergency
only adds to the already considerable risk of field transfusion. - Any sterile, closed blood collection system may be used, but the current system used to collect donated
blood in the US should be considered the standard. Clamp or tie off all tubes from the collection bag
except two–one that will be used to collect the blood from the donor and one that will be used to infuse
the blood into the recipient. - Draw blood from the donor first. Position a blood pressure cup on the donor’s arm above the elbow.
Inflate the blood pressure cuff so that it is between systolic and diastolic pressure. Find the antecubital vein,
prep the area with alcohol and puncture it with the needle. Collected blood into the largest of the collection
bags, (the one with the anticoagulant), mixing it frequently and gently. - When the collection bag is full, deflate the BP cuff, clamp the collecting tube and remove the needle
from the donor. - Immediately infuse the blood into the recipient through the remaining line. It is best to piggyback this
through an established large bore IV.