AIIMS Delhi NO-2016: A patient felt chills and fever following a blood transfusion. After stopping the transfusion, what is the ne…

AIIMS Delhi NO-2016

Medical & Surgical Nursing

Medium

Appeared in: AIIMS Delhi NO-2016

Explanation

After stopping the transfusion, the immediate priority is to maintain a patent intravenous (IV) line for potential emergency interventions.
This is correctly achieved by disconnecting the blood tubing and starting an infusion of 0.9% Sodium Chloride (Normal Saline) with a new administration set.
This action keeps the vein open (KVO) for administering emergency drugs and supportive fluids, and crucially, prevents the remaining blood in the old tubing from being infused into the patient.
This step is a critical part of the standard protocol for managing any suspected transfusion reaction.

Option B: Sending the catheter tip for culture and sensitivity (C/S) is the procedure for diagnosing a suspected catheter-related bloodstream infection (CRBSI), which would present with signs of local infection at the IV site (redness, pus, tenderness) or systemic signs of sepsis without another clear source.
Option C: Removing the cannula is a dangerous action because it eliminates the patient's intravenous access. This access is vital for administering emergency medications (like epinephrine, corticosteroids, or vasopressors) and fluids if the patient develops a severe reaction, such as anaphylactic shock or severe hypotension.
Option D: Administering antipyretics is a secondary intervention that requires a healthcare provider's order. It is not the immediate, priority nursing action. Furthermore, giving an antipyretic can mask the fever pattern, which is an important clinical sign used to assess the severity and progression of the reaction.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Management of Acute Transfusion Reaction in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Prompt recognition and correct sequencing of actions during a transfusion reaction are critical nursing responsibilities that can prevent life-threatening complications like shock, renal failure, and death.
The rule is to always stop the transfusion first, then maintain the line with saline using new tubing. Never flush the existing line, as this will administer more of the offending blood product to the patient.
What if? If the patient developed shortness of breath, wheezing, and hypotension in addition to chills and fever, this would suggest a more severe anaphylactic or acute hemolytic reaction. In this scenario, the patent IV line maintained with saline becomes even more critical for the immediate administration of life-saving epinephrine, corticosteroids, and vasopressors.

How to Approach the Question

First, identify the question type. This is a clinical process question asking for the 'next' or priority action in a specific sequence.
Recognize the clinical scenario: a patient showing signs of a transfusion reaction (chills and fever).
Recall the standard protocol for managing a suspected transfusion reaction. The steps are sequential and prioritized for safety.
The first step is always to STOP the transfusion. The question asks for the action after stopping.
Evaluate the options based on priority. The next priority is to maintain circulatory access (a 'C' in ABCs) for potential emergencies without causing more harm.
Analyze the options: Administering NaCl with new tubing maintains access safely. Removing the cannula loses access. Sending the catheter tip is for a different problem. Administering medication is a later, dependent action.

Concept Tested & Keywords

Concept Tested: Management of Acute Transfusion Reaction
Stem keywords: blood transfusion, chills and fever, stopping the transfusion, nursing action
Lead-in keywords: next
Clinical cues: Patient symptoms of chills and fever are classic signs of a febrile non-hemolytic transfusion reaction, the most common type of reaction.
Negative lead-in flag: false