Platelets are tiny, disc-shaped blood cells necessary for hemostasis, the process that stops bleeding. They aggregate at the site of a blood vessel injury to form a temporary plug, initiating blood clot formation. Platelets are administered to patients with thrombocytopenia (low platelet count) or functionally impaired platelets. Transfusions treat active bleeding, prevent spontaneous hemorrhage in high-risk patients, or serve as a prophylactic measure before invasive procedures. Nurses manage this administration, requiring careful checks, precise execution, and diligent monitoring.
Verification and Pre-Transfusion Patient Preparation
The process begins with safety checks to ensure the correct product is given to the correct patient. Two-person verification is a mandatory measure adhering to institutional protocols. This involves two qualified staff members cross-checking the physician’s order against the blood product tag and the patient’s identity band. Key details, including the patient’s full name, date of birth, medical record number, unit identification number, blood group, and expiration time, must match exactly.
Before the product is spiked, the patient’s baseline physiological status must be established using a complete set of vital signs (temperature, heart rate, blood pressure, and respiratory rate). This baseline helps detect subtle changes indicating an adverse reaction during the infusion. The nurse must also confirm that the patient has provided informed consent, a required step for any blood product administration.
Adequate intravenous access is required for a safe and effective infusion. While a large bore catheter (e.g., 20-gauge) is preferred for blood products, platelets can be infused through smaller gauges if the flow is adequate. The nurse must confirm the line’s patency and ensure the access site is free of infiltration or phlebitis.
Initiating the Platelet Infusion Procedure
Platelets require specialized handling and equipment for administration. The product is stored at room temperature with continuous agitation until use, as refrigeration damages platelet function. Due to the storage temperature, the transfusion must be initiated as soon as possible after retrieval from the blood bank, typically within 30 minutes, to minimize bacterial proliferation risk.
A new, standard blood administration set with a 170 to 260-micron in-line filter must be used for every platelet unit. This filter traps small clots or debris formed during storage without compromising the platelets. Platelets must be infused alone and never mixed with medications or other intravenous solutions.
The only compatible solution for flushing the intravenous line before and after the infusion is 0.9% Sodium Chloride (Normal Saline). Other solutions, particularly hypotonic ones like Dextrose 5% in water (D5W), can cause hemolysis or platelet aggregation, destroying the product. The infusion rate is often rapid, with a typical adult unit administered over 30 to 60 minutes, though this duration may be extended for patients at risk of fluid overload.
The initial 15 minutes of the infusion are considered a high-risk period, requiring the nurse to remain at the bedside for close observation. Infusing slowly during this period (e.g., at 0.25 mL/kg) allows for prompt detection and management of an acute transfusion reaction. If the patient shows no signs of a reaction after this observation period, the rate can be increased to complete the transfusion within the prescribed time frame.
Recognizing and Managing Transfusion Reactions
Patient monitoring is mandated continuously throughout the entire platelet transfusion. Vital signs must be assessed at baseline, after the first 15 minutes of the infusion, and upon completion. The nurse is responsible for recognizing the subtle signs and symptoms of an adverse event, which can range from mild allergic reactions to severe acute hemolytic reactions.
A mild allergic reaction often presents with flushing, hives, or itching, caused by sensitivity to plasma proteins in the donor product. A febrile non-hemolytic transfusion reaction, a common complication, is indicated by a sudden fever of at least 1°C (1.8°F) above baseline, often accompanied by chills. More severe reactions, such as acute hemolytic or septic reactions, may manifest with back pain, hypotension, high fever, or shortness of breath.
If a transfusion reaction is suspected, the nurse must immediately stop the infusion. Intravenous access must be maintained, but the existing tubing should be disconnected from the catheter. A new line primed with Normal Saline should be attached immediately to keep the vein open. The provider and the blood bank must be notified, and emergency medications like antihistamines or antipyretics should be administered as ordered.
Immediate documentation and specimen collection are necessary to investigate the reaction. The nurse must re-verify the patient and product information. The remaining platelet bag, administration set, and required post-reaction blood and urine samples must be sent back to the blood bank. Post-procedure documentation must include the start and stop times, total volume infused, the patient’s complete response, and any treatments administered. Efficacy is often checked by drawing a post-transfusion platelet count one hour after the infusion is complete.