A physician or a qualified and trained nurse should administer blood and blood products

1. For each unit of blood transfused,monitor the patient at the following stages:

• Before starting the transfusion
• As soon as the transfusion is started.
• For 15 minutes after starting transfusion
• At least every hour during transfusion.
• On completion of the transfusion.
• 4 hours after the transfusion.

2. At each of these stages,record the following information:

• Patient's general appearance.
• Temperature
• Blood pressure
• Respiratory rate
• Sign of any adverse reaction-these signs are fever with back pain(acute hemolytic transfusion reaction),anyaphylaxis,hives or puritis(urticarial reaction).Congestive heart failure(Volume overload) and fever alone(febrile non-hemolytic transfusion reaction).

3. Monitor the patient carefully during the first 15 minutes of the transfusion to detect any early signs and symptoms of adverse effects.The adverse effects of transfusion are usually dose-realted,therefore,every slow transfusion rates are used at the start,15 to 50 ml are given during the 15 minutes. Once the transfusion is progressing satisfactorily,the infusion rate can be increased so that the product is transfused within a reasonable time depending on the clinical condition of the patient.

4. Only isotonic(0.9 percent)saline or 5% albumin should be used to dilute blood components or can be infused with the transfusion set used for blood products transfusion,because other I.V.solutions like dextrose solutions such as 5%destrose in distilled water may damage the red cells and cause hemolysis or calcium containing solutions such as lactated Ringer's solution initiate coagulation in the infusion set.In addition,many drugs will cause hemolysis if injected through blood infusion set.