Which sequence correctly represents the steps a nurse would take before administering a blood transfusion?

• A. Check primary health care provider's prescription; Obtain vital signs and history of transfusions; Ascertain that intravenous catheter size is 18 or 20 gauge; Change main line solution to normal saline; Check client identification before hanging unit of blood.
• B. Check primary health care provider's prescription; Obtain vital signs and history of transfusions; Determine typing and crossmatching of blood; Use a Y-type infusion set to initiate 0.9% normal saline.
• C. Obtain vital signs and history of transfusions; Check prescription; Ascertain intravenous catheter size; Change main line solution to normal saline; Check client identification before hanging unit of blood.
• D. Check prescription; Prepare the patient; Validate the blood type with the kit; Hang the bag without saline.

Answer: (A)

Before giving a blood transfusion, the nurse follows a safety checklist that starts with confirming the physician’s order and then assessing the patient’s current status and transfusion history. Establishing adequate IV access (typically an 18- or 20-gauge catheter) is essential to ensure the unit can be infused smoothly and safely. The line should be primed with 0.9% normal saline, not with other solutions, to prevent any incompatibilities or reactions with the blood product. Finally, the nurse verifies the patient’s identity and checks the intended unit right before hanging the blood to prevent transfusing the wrong product to the wrong person. This order of steps helps guard against common transfusion errors and ensures the patient is prepared and safe for the procedure. Typing and crossmatching are crucial steps performed with the blood bank before administration, but the immediate preinfusion sequence focuses on verifying the order, assessing the patient, securing proper IV access, and confirming identity for a safe start.