Evaluating the Frequency of Vital Sign Monitoring During Blood Transfusion: An Evidence-Based Practice Initiative

Abstract

Patients with cancer are often dependent on blood transfusions during treatment. Frequent vital sign monitoring during transfusions may interrupt sleep and the patient's ability to ambulate or participate in unit activities. Relying heavily on vital sign findings may also overshadow unmeasurable symptoms of transfusion reaction. The aim of this evidence-based practice initiative was to examine the evidence regarding the optimum frequency of vital sign monitoring for patients undergoing stem cell transplantation receiving blood products and to amend policy and practice to be consistent with the literature. AT A GLANCE : Patients with cancer frequently require transfusion support during treatment.Inconsistencies exist in recommendations for the frequency of vital sign monitoring during transfusion.Examining best practice guidelines suggests that less frequent vital sign monitoring may be appropriate if coupled with thoughtful physiologic assessment.

Detecting blood transfusion reactions: What are vital signs anyway?

“…Systolic blood pressure, heart rate, and temperature were the only components included in all “vital signs” across manuscripts. Respiratory rate was not included in vital signs to identify transfusion reaction, including The Joint Commission standards stating respiratory rate should only be recorded if “significant” changes from baseline are noted 6–8,12 . Reviewers questioned how a clinician would know if any significant changes occurred from baseline without monitoring respiratory rate or knowing what change from baseline would be deemed “significant.”…”

“…Further, advances in technology have allowed for the routine addition of pulse oximetry; however, this important metric is not yet included among standard vital sign components as reported in the literature 1–5 . When viewed through the lens of the scientific literature, what is taught as a comprehensive approach to the assessment of vital signs as a standard of practice is not consistently applied 6–12 . Incomplete and inconsistent reporting of vital sign assessment (especially respiratory rate, pain, and pulse oximetry) limit identification of situational best practices for this vital component of physical examination 13,14 …”

“…No clinical practice guidelines were identified. Evidence‐based guidance on vital sign composition and definition of what is considered out of range of normal vital signs were lacking in the reviewed literature 7–9,11 . If vital sign composition has been taught to nurses in a standardized way for decades, 2,5 with pain incorporated in the 1990s, 1–4 then why does the scientific literature not report best practice guidance on variation in the standard of care around vital signs? 6–12 Vital sign component variation, applied to the detection of blood product transfusion reaction, represents a creative controversy (Figure 1).…”

Proposta de um procedimento operacional padrão para a mitigação das reações transfusionais imediatas em um hospital universitário

“…A falha na verificação dos sinais vitais (Santos, Santana, & Oliveira, 2021). As fases essenciais são: antes da transfusão, dentro de 15 minutos do início da transfusão e na conclusão da transfusão para que haja eficácia no reconhecimento das RT (Sullivan, Vu, Richardson, Castillo, & Martinez, 2015)-sobretudo nos primeiros 15 min (Gurgel et al, 2019). Ressalta-se que na fase de pré administração de HC, os sinais vitais servem de marcador essencial nos eventos adversos relacionados à transfusão (Negi et al, 2015).…”

Efforts Toward Elimination of Infectious Agents in Blood Products

“…The Joint Commission recommends that vital signs be measured pretransfusion, within 15 minutes of initiation, and within 1 hour of transfusion end. 57 Hospital policies are based on these guidelines but may differ with respect to each other. In addition to vital signs, it is important to also assess the patient for skin changes (eg, rash, hives), discomfort, or pain.…”