Monitoring during blood transfusion

Dear friends, After knowing, when to give the packed cell and platelet transfusion in preterm babies One should understand that. Any transfusion is a invasive procedure that puts the preterm baby at risk of various complications Hence, we should offer good monitoring on all these babies who receive the transfusion. In this webinar, we will discuss the monitoring of the babies who receive the blood component transfusion
Here we will learn, what monitoring is needed for the babies receiving the transfusion. Before during and after transfusion
Understanding that the monitoring of the neonate is important all through, let us now see what monitoring should be done prior to transfusion, It is very important to document the indication for the transfusion and the levels of Hb or the platelet before the transfusion, As the transfusion is a invasive procedure , talk to the parents about the procedure and take a consent, One should always, recheck and document the details of the lot and the bag. This is mandatory prior to any transfusion, One should legibly and clearly document the rate and volume of the component to be given , and the same should also be communicated to the nursing staff taking care of the baby, The transfusion should be given only through the peripheral intravenous Having knowing these important considerations , one should not forget to take the samples for determining the aetiology prior to transfusion , as the results will be difficult to interpret once the baby is transfused
Now, once we have gone though the checklist to be completed prior to transfusion. let us now see what important monitoring is needed during the transfusion. Every vital is important during the transfusion, hence monitor the baby for variation in, Temperature , Spo2, Heart rate, BP / CFT, Urine output, Respiratory rate every hour , or more frequently in case of sick babies At sometimes , the transfusion volume is administered fast unknowingly , hencealways regularly check the amount of blood component left , and determine if this is appropriate for the time elapsed . Needless to say , always look for the local site complication actively and regularly.
After the transfusion , continue monitoring the baby for another 2 to 4 hrs , as complications may still occur, Restart maintenance fluids if stopped. Inform the parents about the completion of the transfusion. Hb or platelet levels need to be repeated only if : Baby is not improving or in case of severe anaemia or thrombocytopenia . Hence , to conclude Monitoring is a very important part of transfusion in preterm neonates it should include. The preparation before transfusion and documentation is a vital. Monitoring the vitals during transfusion is done frequently and aggressively in sick babies. The monitoring should continue post transfusion for 2 to 4 hrs
  • Introduction...
  • 1. Learning object...
  • 2. Monitoring befo...
  • 3. Monitoring duri...
  • 4. Monitoring afte...
  • 5. Summary...
 

Introduction

DR. ASHISH JAIN
MD, DNB, DM (Neonatology)

Assistant Professor
Department of Neonatology
Maulana Azad Medical College
New Delhi

1. Learning objectives

► Monitoring of the babies receiving transfusion

      ♦ Before transfusion
      ♦ During transfusion
      ♦ After transfusion

2. Monitoring before blood transfusion

► Document:
      ♦ Indication
      ♦ Pre-transfusion haemoglobin and platelet counts

► Identify the baby and take consent from parents

► Check and label the bag

► Prescribe the correct volume/ rate in the treatment
    chart of the baby

► Transfuse only through peripheral intravenous or
    central venous line, no other line should be used

► Do sampling for the cause of anaemia, if any

3. Monitoring during blood transfusion

► Adherence of strict asepsis

► Monitoring of vital signs should be more frequent during
    initial few minutes of transfusion
      ♦ Temperature
      ♦ SpO2
      ♦ Heart rate
      ♦ BP/ CFT
      ♦ Urine output
      ♦ Respiratory rate

► Rate of the administration, judge by volume left and
    time passed

► Local site complications

4. Monitoring after blood transfusion

► Continue monitoring for 2 to 4 hours

 

► Restart feeding/ maintenance fluids, if stopped

 

 

► Inform the parents about the completion of the transfusion

 

 

► Haemoglobin or platelet levels need to be repeated only, if
      ♦ baby is not improving
      ♦ in case of severe anaemia or thrombocytopenia

 

5. Summary

► Monitoring is very important part of transfusion in
    preterm neonates it should include


      ♦ The preparation before transfusion and documentation
          is a vital


      ♦ Monitoring the vitals during transfusion is
         done frequently and aggressively in sick babies


      ♦ The monitoring should continue post transfusion
         for 2 to 4 hours