Transfusion Monitoring and Reactions: Flow Sheet, Stop Rules and Traceability

Key takeaways

• Every transfusion needs continuous clinical attention — not “set and forget.”
• Use a dedicated monitoring sheet with timed vitals.
• Stop for acute reaction signs, then treat the physiology in front of you.
• Log product identity for look-back years later if needed.
• TRACS consensus statements (AVHTM, 2021) define reaction categories and management frameworks.

Minimum monitoring cadence

1. Baseline: TPR, MM colour, CRT, mentation, demeanour, catheter site, optional BP.
2. First 15–30 min (slow phase): every 5–15 minutes.
3. Thereafter: at least every 30–60 minutes and at end of unit.
4. Post: recheck clinical status and PCV/TS as indicated.

Stop criteria (examples)

• Sudden fever rise, rigors
• Vomiting, restlessness, angioedema/urticaria
• Tachypnoea/tachycardia out of proportion, hypotension, collapse
• Haemoglobinuria/haemolysis signs, unexpected pain at catheter
• Respiratory distress suggesting overload (TACO) or acute lung injury patterns

Immediate actions: stop product, keep IV access, check patient ABC, disconnect set from catheter (do not flush remaining line contents into patient), treat reaction type, save unit/set for investigation, document everything.

Traceability log fields

• Product type, unit ID, expiry
• Volume planned/given, start/stop times, rates
• Staff involved
• Reaction details and treatments
• Patient identifiers and date

External reference: AVHTM transfusion guidelines / TRACS.