Platelets are small, disc-shaped cellular fragments that circulate in the bloodstream, playing a vital role in the body’s ability to stop bleeding by forming a clot. When a person experiences a significant drop in their platelet count, a condition known as thrombocytopenia, they face an increased risk of spontaneous hemorrhage. A platelet transfusion is a medical procedure that introduces concentrated platelets from a donor directly into a patient’s circulation to restore this clotting function. This therapy is a routine part of supportive care, especially for patients undergoing cancer treatments or those with hematologic disorders that impair platelet production.
Essential Safety Checks Before Administration
Before a platelet unit is brought to the patient’s bedside, a meticulous series of verification steps must be completed to ensure patient safety. The first check involves verifying the product itself, comparing the unit’s unique identification number and component type against the physician’s order and the patient’s medical record. Staff must also confirm the unit’s expiration date, as platelets have a short shelf life and are stored at room temperature with continuous agitation.
Visual inspection of the platelet unit is required, looking for discoloration, loss of swirling, or the presence of visible clumps that might indicate contamination or product degradation. ABO compatibility is always confirmed, as platelets may contain residual red blood cells or plasma that could trigger a reaction. The patient’s identity must be positively verified using at least two independent identifiers, such as their full name and date of birth, matching them against the unit’s paperwork and the patient’s wristband.
Step-by-Step Procedure for Hanging Platelets
The physical setup for a platelet transfusion begins with gathering the necessary supplies, most notably a standard blood administration set that features an integral filter. This specialized tubing set is designed to trap any small clots or cellular debris that may have formed in the stored product. The intravenous access site must be established and patent, usually using a large-bore catheter, before the platelet unit is released.
Once the administration set is secured, the line must be primed using 0.9% normal saline solution. This step is critical because platelets cannot be exposed to hypotonic solutions, such as Dextrose 5% in Water (D5W), or mixed with most medications, as this can cause the cells to rupture. The platelet bag is then spiked aseptically, and the concentrate is allowed to flow slowly through the tubing, displacing the saline and removing all air bubbles before connecting to the patient’s IV catheter.
Managing the Infusion and Monitoring the Patient
Once the platelet unit is connected to the patient’s IV access, the infusion rate is set to ensure the product is delivered efficiently and safely. Platelets are typically infused relatively quickly, with one unit commonly administered over a period ranging from 30 to 60 minutes. This faster rate is often preferred, although patients at risk of fluid overload may require a slower rate.
Patient monitoring starts with obtaining baseline vital signs immediately before the transfusion begins. Vital signs must be checked again 15 minutes after the infusion starts, as this period is the most common time frame for acute transfusion reactions to occur. The nurse remains vigilant for any signs of an adverse reaction, which can manifest as fever, chills, hives, itching, or shortness of breath.
If any reaction is suspected, the infusion must be stopped immediately. The IV line should be maintained with normal saline through a separate port to keep the vein open, and the medical team and blood bank must be notified. A final set of vital signs is taken upon completion of the unit, and all start and stop times, along with the patient’s response, are thoroughly documented.