[0:00]And I am going to demonstrate blood administration. So, what we're going to first do is come in and make sure I come into the patient's room and I'm going to do hand hygiene. and introduce myself to the patient and I'm going to make sure that I'm verifying that we have an order to administer blood. So, I've gotten my order from the physician, I have verified that we have a type and cross done, and I'm also going to verify the patient's blood type. So, I have done all of that and then I'm going to talk with the patient and educate them about blood administration. So, we want to verify and make sure that we have consent from the patient and that they're okay with that. Um, and then we're also going to be, um, reviewing and going over the signs and symptoms of a blood reaction before we administer the blood to the patient.Okay? So, next thing that I want to do is, I want to also just verify that my IV site is in a good location and a good place for blood administration. Is it a large enough IV, um, is it in a vein that's large enough that can handle that amount of infusion and, um, it looks like it's a good place and a good condition and good size. I'm going to go ahead and put my gloves on and I want to clean. I'm just going to take an alcohol pad and I am going to clean our clay. And I want to do that for 15 seconds. And then we're just going to flush this and make sure that everything is good with this IV line. I'm going to make sure that I unclamped my tubing. And I'm going to go ahead and give that a good flush.It looks like it's flushing well.There's no problems with the IV. Okay, I'm going to flush that with three to five mils of NS or saline. Okay, next thing that I'm going to do is I'm actually going to leave this connected to the clay, the NS flush and it's going to keep this clay clean. So, I'm not going to be contaminating that. Okay, next thing that I'm going to do is, I'm going to take my tubing. So, we've got blood tubing and another name for it you may hear is called Y tubing. So, I've got that and what I do is, I've got two spikes on it and one is going to be for the saline, one is going to be for the blood. Okay, right now, as soon as I take it out of the package, I just want to make sure that I am closing all of my clamps. Okay, so I'm closing all of my roller clamps and I am going to flush this line first with normal saline. We only use normal saline to hang with blood.That's the only thing that's compatible. Okay, so I'm going to take my cap off. And as I do that, I want to be really careful that I'm not touching it.Same with this.Once I take my cap off of my tubing, I want to verify that I am not contaminating anything. Okay, I'm going to spike my bag. Okay, and then I am going to go ahead and I'm going to hang my bag of saline up here on the pull. Okay, so I've got all of my clamps closed. Next thing that I want to do is I am going to open up the clamp for the NS. When I am priming this, I just want to make sure that I am squeezing the saline and that the saline is going up over this filter. So, as the blood product comes down, it's hitting the saline instead of this filter and it's not lysing that, um, red blood cell. Okay, so the next thing that I'm going to do is, so I've got it up above my filter is, I am now going to take my roller clamp on my tubing. And I'm going to open it up and I am going to prime the rest of my tubing and I'm just going to do it over the sink or the garbage can. And once I've primed that, I'm going to now close my roller clamp and I can either connect this now into the patient, or I can wait and hook my blood up and prime the blood all the way to the end and then connect it to the patient.Either way is just fine. Okay, so the next thing is, um, I now want to check a set of vitals. So, we always want to check a set of vitals within 15 minutes of us giving that blood to give us a baseline so we know how that patient is doing to make sure that, um, we can kind of look at the consecutive vital signs to compare to it. Okay, I've gotten my blood product from the blood bank and as soon as I get that, I want to inspect it and I want to look at it. And I want to look, are there any particulates, are there any clotting, any discoloration, and this all looks good. Okay, next thing that I want to do is, I want to do a double check. So, I'm going to take a second RN and I am going to do a double check with him to make sure it's the right blood for the right patient. And we have the blood product and we have this requisition form that will be with the blood. Okay, so the very first thing that I'm going to do is, one person is going to be looking at the armband. So, I'll do that and the second person is going to be looking at the blood requisition form. Okay, so I'm going to check the name, Jessica Hart, and I'm going to say that out loud and the second person is going to verify that and repeat that back to me. Okay, the second part is, is I'm going to then look at the date of birth. So, I'm going to say the date of birth, that second person is going to repeat back the date of birth. Okay, third part is, is I'm going to say the MR number. Okay, that's the medical record number and I'm going to verify that off of the patient's armband and the person with the, the blood requisition form is going to verify that and repeat that back and repeat it off of the blood bag. So, the next thing that I'm going to do is, I'm now going to take my blood bag and we're going to spike it and put it onto our blood tubing.
[6:55]So, as I do that, I make sure that my tubing is clamped, which it is. And then I'm going to take my spike off, my cap off of my spike, being really careful that I don't touch that. Okay, we're going to stick that into our blood tubing and I'm also going to hang my blood up here. Okay, next thing I'm going to do is I am going to close my clamp for my saline. Okay, and I can actually back prime this blood also. Um, I'll open this saline back up and I can back prime it. There's only a little bit of air here and there's enough saline in here, it should be okay, but I'm going to go ahead and open my saline roller clamp. I'm going to go ahead and open up my blood one and I'm just going to back prime that so I get saline up into that line. Okay, so I've done that and now I'm going to close my roller clamp on my saline. And I'm going to open up my blood and I am going to let this run all the way through. I'm also going to open up this roller clamp down here and I'm going to let that blood run all the way through the tubing. So, as I can see, I've got the blood coming through and if it doesn't run, take your little end cap off. Okay, I've got that done and I've got blood all the way to the end. I just want to be really careful when I take that cap off that I'm keeping that end clean. Okay, so I have clamped my tubing and I've got it primed, so it's primed with saline and now I've shut my saline off and then I've primed it with blood and now I'm ready to connect it to the patient. Okay, we have already, uh, cleaned this.We've already flushed this, so I can go ahead and take that off. Okay, I have got my blood connected. Now, the next thing that I want to do is, I want to make sure that I am running this at a slower rate for the first 15 minutes. So, we did our previous set of vitals.I'm going to go ahead and I am going to adjust this, um, and it would be on a pump or it can be free hanging depending. So, we'll do 50 to 60 mils an hour and I want to do that because I want it for that first 15 minutes to go in slow to verify that there is no reaction. Okay, so we have adjusted it.It's infusing for that 50 to 60 mils for the first 15 minutes. I am going to go ahead and I am going to take another set of vitals. So, we do a full set of vitals and if everything looks good and there's no reaction, I'm going to go ahead and I am going to increase that infusion. Depending on what the patient can tolerate, uh, what's going on with them. If they're actively bleeding, uh, if their hematocrit's really low, we might need to get that blood in a little bit faster. If they've got heart failure or or elderly and maybe can't tolerate a lot of fluid at once, then we may keep going at maybe a rate of 100, but we might be able to bump it up to 150, 175. I want to make sure that that blood is all given within four hours of, um, it coming from the blood bank. Okay, and we want to make sure that we're starting this blood as soon as we get it from the blood bank as soon as we possibly can. If there was any sort of signs or symptoms of a reaction, I am going to immediately stop the blood, flush this line with a saline. And I can disconnect this and I would call the provider and let them know.Okay, check another set of vitals. Okay, so everything is looking good.I have gone ahead and I have increased my rate.Patient's doing well. Once the blood is all done and has infused, there's always going to be some blood that is left here in the line and we want to get that all to the patient as much as we possibly can. So, the next step is, I'm going to take my tubing and I am going to close my blood and I'm going to clamp that so the patient's no longer getting that because it's empty. And I'm going to open my saline all the way up and I'm going to continue to let this infuse at the rate that I was running my blood at and finish flushing that all the way through. Once we're done with all of that, I can then take my line right here and I've got my clamp, my tubing all clamped. And I'm going to take a flush. And I'm going to flush the tubing. Okay, and I want to do that with three to five mils. Even though we flushed saline through here, there may be some residual blood, so I just want to verify and make sure that we've gotten all of that flushed through. Okay, I have flushed it with three to five mils. And I am going to clamp my tubing and then I am going to take all of this. I'm going to take all of my tubing and the blood and I am going to put it into a biohazard bag right here and then go and dispose of it, uh, properly. The other thing that I also want to make sure that we also do is, we want to make sure once we're all done with everything that we document another set of vital signs. So, we do it right before we start, we do it within 15 minutes of starting that blood and then we want to do it when we are all the way done. And I also want to make sure that I am documenting those vitals.I am documenting my start and my stop time and I also want to document the amount and then if there was any sort of a reaction. So, we want to make sure that those are all the things that we would be documenting.
