Management of needle clotting
Stopping blood flow due to a thrombus forming in the needle lumen is a frequent technical issue. In this situation, a strict rule applies: it is strictly forbidden to try to clear the needle lumen using a stylet. It is also unacceptable to try to push the formed clot into the venous bed by creating excessive pressure with the solution or the blood itself in the administration set.
If blood flow has stopped, the surgeon or nurse must follow this algorithm:
- Immediately clamp the infusion set using the roller clamp.
- Carefully disconnect the set from the venous access.
- Remove the clotted needle from the patient's vein and apply a pressure aseptic bandage to the puncture site.
- To continue the procedure, take another sterile needle and puncture another vein.
Mixing media and completing the transfusion
During the transfusion, donor blood may be mixed with sterile blood volume expanders, but this is only permitted in hermetically sealed factory packaging while observing all aseptic rules.
The procedure is not carried out until the bottle or polymer bag is completely empty. The transfusion must be stopped at the moment when about 20 ml of blood remains in the container. After that, the needle is removed from the vein, and a secure aseptic bandage is applied to the puncture site.
Rules for storing blood residues
The remaining 20 ml of blood in the container is not discarded immediately. The container with the remaining transfusion medium, without breaking its tightness and asepsis, is placed in a refrigerator.
Storage conditions: temperature 4°C, duration — 48 hours.
Clinical significance: this sample is a crucial material for retrospective analysis in the event of post-transfusion complications in the patient. The preserved volume is used to determine the causes of the reaction:
- Performing bacteriological testing of the medium for contamination.
- Re-checking blood group and Rh factor (Rh).
- Performing a repeat individual cross-match between donor and recipient blood.
Recording blood transfusions
Legal and medical documentation of blood transfusion is a mandatory step. The record of the performed procedure is entered into two main documents: the patient's inpatient medical record and a special blood transfusion registration log.
To ensure safety and control, the records must include the following data:
- The exact dose of transfused blood or its components.
- Batch and passport data of the used transfusion medium (number, date of collection, blood service facility).
- Results of all cross-match tests performed before the transfusion.
- Information on the presence or complete absence of any reactions and complications in the patient during and after the procedure.
Briefly: answers to topical questions
What individual cross-match tests between donor and recipient blood must be performed before starting the transfusion?
- Group and Rh compatibility tests — if true agglutination is detected, individual blood selection at the blood transfusion center is required, and a compatibility test is performed with blood from each container.
- Indirect Coombs test — mandatory compatibility testing in the laboratory for "at-risk recipient" groups with suspected Rh sensitization.
How is the biological test correctly performed directly during the blood transfusion?
- Rapid bolus injection — blood is administered rapidly in a volume of the first 15–20 ml.
- Pause and condition assessment — stop the transfusion for 3 minutes and during the pause assess the patient's condition (behavior, skin color, pulse, respiration).
- Triple check — repeat the test twice more (a total of three checks), maintaining a slow drip infusion between the rapid bolus injections to prevent needle clotting.
What criteria are used for macroscopic assessment of blood quality before transfusion?
- Packaging integrity — checking the tightness of the bottle or bag.
- Expiration date — assessing compliance with the allowable storage periods of the transfusion medium.
- Storage conditions — absence of signs of potential freezing or overheating.
- Visual appearance after settling — normally, blood separates into three layers: the lower red layer of erythrocytes, a thin middle layer of leukocytes, and the upper transparent, slightly yellowish plasma.
- Signs of unsuitability — presence of hemolysis (red or yellow-pink plasma discoloration), contamination (flakes, turbidity, film on the surface), and clotting (presence of clots).
What types of post-transfusion reactions and complications can develop in a patient?
- Incompatibility reactions — manifest as tachycardia, shortness of breath, respiratory distress, facial flushing, and a drop in blood pressure.
- Transfusion shock — develops during transfusion of incompatible blood according to the ABO system and Rh factor with rapidly ensuing intravascular hemolysis; it is classified by degrees of systolic blood pressure drop and proceeds with periods of oliguria and anuria.
- Sensitization and immune conflict — development of a reaction up to shock in sensitized individuals upon repeated blood administration.
Clotting algorithm: STOP. Stop the set — Treat (disconnect) — Out (remove needle) — Puncture another vein.
Class and exam questions
Can a clogged needle be flushed with saline under pressure?
No, this is strictly prohibited. Any pressure or use of a stylet can push the thrombus into the vein.
How much blood needs to be left in the vial at the end of a transfusion?
The transfusion is stopped when about 20 ml of blood remains in the bag or bottle.
Why keep the empty bag after a transfusion?
The 20 ml residue is stored at 4°C for 48 hours for laboratory tests (culture, blood group and compatibility check) if the patient develops complications.
What else to study on this topic
- Methodology for performing individual compatibility tests
- Classification and types of post-transfusion complications
- Transfusion medium passport: decoding the labeling
- Groups of blood volume expanders
- Peripheral vein puncture technique
Master the entire topic in the "General Surgery" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Blood Transfusion Technique" and 3,335 more subject pages
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 70 video lessons on the subject
Other topics in the section "CHAPTER 6. BLOOD TRANSFUSION"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.