A colleague in Virginia wonders how other hospitals address how often vital signs need to be checked during a blood transfusion. Her hospital requires that vital signs be taken pretransfusion, during transfusion (at 15 minutes, 1 hour, 2 hours, and 3 hours if the transfusion goes that long) and within 20 minutes post-transfusion. The vital signs must be documented on a blood slip, a copy of which is sent to the blood bank after the transfusion is completed. Their Department of Nursing feels that this practice is excessive and takes up too much time. She wants to know what others are doing regarding monitoring vital signs during a transfusion.

The following comments have been received.

ADDENDA May 13, 2004

1. The Editor suggests that the information at the following links is germane to this discussion:

• Guidance on the length of time a patient must be observed during the start of a transfusion
• Shulman IA et al. Assessing Blood Administering Practices. Archives of Pathology and Laboratory Medicine 1999;123:595-598.

2. A Blood Bank/Hematology Coordinator at a Health Center in Texas reports that her reading of the AABB Standards (21st Edition) is that pre and post transfusion vital signs should be recorded and that the patient should be observed during and "for an appropriate time after" the transfusion." Because it is the Texan's hospital policy to have a transfusion run slowly for the first 15 minutes, her hospital requires a pre-transfusion set of vital signs, and vital signs during the transfusion at 15 minutes, and post transfusion. They require the vital signs 15 minutes after starting the transfusion so that the patient is observed at least once during that first critical 15 minutes of the transfusion. She agrees with nurses who complain that taking vital signs at 1, 2 and 3 hours during a transfusion is labor intensive and (in her opinion) unnecessary. Interestingly, the outpatients at this Texas Health Center come in for a transfusion and after the transfusion is completed stay for 20 minutes, during which they are observed for a reaction. The Texan says that this is what they currently interpret as "an appropriate time" after the transfusion for observation of a reaction.

ADDENDA Mar. 27, 2007

3. The nurses at a facility in Texas recently proposed changing the frequency of taking vital signs during transfusion. They propose that vital signs should be taken before beginning the transfusion (as a base line), 15 minutes after the beginning of the transfusion and post transfusion. These 'timed' measurements would be complimented with hourly "assessments" of the patient, which would generally consist of asking the patient how they feel. The inquiring Texan would like to know how other facilities schedule the timing of vital signs during transfusion, and if anyone is using the aforementioned approach. If so, have any transfusion reactions been missed or their detection delayed as a consequence?

4. Editors' NOTE: The article by Novis DA, et al entitled Audit of Transfusion Procedures in 660 Hospitals A College of American Pathologists Q-Probes Study of Patient Identification and Vital Sign Monitoring Frequencies in 16494 Transfusions (Arch Pathol Lab Med. 2003 May;127(5):541-8) seems to be germane to this discussion.

ADDENDA June 11, 2007

5. A colleague at a Medical Center in El Paso, Texas reports that their nurses take vitals before transfusion, 15 minutes into transfusion and 1hr post transfusion. They report not having 'missed' any transfusion reactions, based the review of the Issue/Transfusion forms that are completed and one copy returned to the blood bank.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator