Write the rules of blood transfusion.

A. Equipment:
The suggested equipment required for a blood transfusion includes the following: (Blood components or whole blood could be provided through various central venous access devices or peripheral intravenous catheters. The following sizes should be considered):
1. 20-22 gauge for routine transfusion in adults
2. 16-18 gauge for rapid transfusion in adults
3. 22-25 gauge for pediatrics
4. The requirements for administration sets might vary
5. Blood filters
6. The administration of platelet-poor plasmas requires supplies that often differ by product and brand.
Infusion devices, such as infusion pumps, blood warmers, rapid infusers, and pressure devices, can be used to transfuse blood components.
7. A pressure infusion device may be needed for the rapid transfusion of blood components.
8. A blood warmer device is often needed to prevent hypothermia in the rapid administration of cold-blood components, for instance, in trauma settings or operation theatres.
B) Personnel:
Two providers should verify blood products before administering, and patients should be monitored during transfusion by qualified personnel. Blood transfusions can be carried out by various healthcare providers, such as registered nurses, licensed vocational nurses, or licensed practical nurses. Nurses usually perform this task on the advice of a physician. Regarding blood transfusion training requirements, most professionals, such as registered nurses and licensed vocational nurses, learn how to carry blood transfusions through medical training and educational programs.

C) Preparation:
The following is the list of important steps to follow before proceeding with blood transfusion:

**Find Current Type and Crossmatch:
1. Take a blood sample, which lasts up to 72 hours
2. Send the sample to the blood bank
3. Ensure that the blood sample has the correct labeling with the date and timing
4. Wait for the blood bank to crossmatch and prepare the needed units
5. Obtain Informed Consent and Health History.

**Discuss the procedure with the patient:
1. Confirm the past medical history and any allergies
2. The supervising provider should have obtained signed consent from the patient
3. Obtain Large-bore Intravenous Access

**This is 18 gauge or larger IV access:
1. Each unit should be transfused within 2-4 hours
2. A second IV access should be secured in case the patient needs additional IV medications
3. Normal saline is the only fluid that can be administered with blood products

**Assemble Supplies:
1. Y tubing with an in-line filter
2. 0.9% NaCl solution
3. Blood warmer
4. Obtain Baseline Vital Signs
5. These include heart rate, temperature, blood pressure, pulse oximeter, and respiratory rate
6. Respiratory sounds and urine output should also be documented
7. Notify the provider if the temperature is more than 100 F

**Obtain Blood from the Blood Bank:
1. Once the blood bank notifies that the blood is ready, its delivery from the blood bank should be ensured
2. Packed red blood cells can only be given one unit at a time
3. Once the blood has been released for the patient, there are 20-30 minutes to begin the transfusion and up to four hours to complete it.

D) Technique or Treatment: (Here are some of the general steps providers should follow when carrying out a blood transfusion):

1. Verify Blood Product
2. Relay the features of a transfusion reaction to the patient. The patient should inform the nursing staff during the transfusion if these appear.
3. Baseline vital signs, lung sounds, urine output, and skin color
4. Prepare the Y tubing with 0.9% NaCl and have the blood unit ready in an infusion pump
5. The blood should be run slowly for the first fifteen minutes, for instance, 2 ml/min or 120 ml/hr
6. Staff should be supervising the patient for the first fifteen minutes as this is when most transfusion reactions happen
7. The rate of transfusion can be increased after this period if the patient is stable and does not display any signs of a transfusion reaction
8. Document vital signs after fifteen minutes, then every hour, and finally, at the end of the transfusion
9. During the transfusion, look for any signs of transfusion reactions
10. If a reaction is suspected, stop the transfusion immediately
11. Disconnect the blood tubing from the patient
12. Inform the provider, stay with the patient and assess the status
13. Document everything
14. After the transfusion, flush Y tubing with normal saline and dispose of used Y tubing in the biohazard bin
15. Obtain post-transfusion vital signs
16. After the procedure, some patients could experience soreness at the puncture site, but this should dissipate quickly.