Detecting blood transfusion reactions: What are vital signs anyway?

Abstract

There is a lack of consistency in the scientific literature regarding what is included in vital signs and considered derangement in findings. We used vital signs during blood product administration as an exemplar to explore this controversy. Vital sign components varied across all studies when reviewed by a cohort of frontline nurses attempting to align institutional policy with current evidence. Only low‐level data linking conventional approaches to vital sign monitoring for transfusion reaction detection were found.

Should adding pain, oxygen saturation and physical assessment to vital signs become the new standard of care for detecting blood transfusion reactions?

“…Across reviewed studies, including more components for blood transfusion reaction detection led to a higher rate of reported transfusion reaction events. These findings suggest comprehensive vital signs with the addition of physical assessment components detect blood assessment [6]. Adding pain to vital sign monitoring for transfusion reaction detection aligns with the recommendation by the U.S.…”

“…‘Abnormal’ was found frequently as a vital sign finding to indicate a transfusion reaction. Still, parameters to denote what vital sign variation should be considered ‘abnormal’ were not found in the literature except for an increased body temperature of 1°C without supporting evidence [1, 6].…”

“…Pain was repeatedly absent from vital sign assessment across manuscripts despite being frequently mentioned as clinically significant to transfusion reaction detection [2–4, 6, 9]. Only one reviewed manuscript supported including pain in vital sign monitoring to detect a blood product transfusion reaction [4].…”

“…Department of Veterans Affairs to add pain as the fifth vital sign in 1999 and The Joint Commission's condition for accreditation to include pain with vital signs in the year 2000 [6,23,24]. Standardizing the inclusion of SaO 2 and pain into vital sign assessments would ensure consistency in monitoring for blood transfusion reactions using the same screening criteria globally.…”

“…With reported blood transfusion reaction rates ranging from 0.14% to 2.1% in reviewed literature [1][2][3][4], nurses require clear guidance on vital sign measurement frequency, vital sign composition and abnormal findings to recognize a patient reacting to a transfusion promptly [5,6]. Incomplete inclusion of vital signs (especially respiratory rate, pain and pulse oximetry), lack of guidelines to interpret the data [5,7], absence of physical assessment (especially lung sounds) and not including family members and patients as partners in detection contribute to adverse events.…”