Vein-to-Vein Transfusion Safety: Nursing, Laboratory, and Blood Bank Practices to Prevent Transfusion Errors: A Systematic Review

Abstract

Background: Blood transfusion is among the most frequently performed hospital procedures, yet preventable errors still occur at every step between collection of the pretransfusion sample and administration of blood at the bedside. Most serious incidents arise from human error rather than from the blood component itself, and responsibility for prevention is shared by nursing, clinical laboratory, and blood bank staff. This review synthesized the evidence on error patterns and preventive practices across the hospital vein-to-vein transfusion chain.

Methods: Following the PRISMA 2020 statement, PubMed/MEDLINE, Embase, CINAHL, Scopus, and the Cochrane Library were searched from January 1990 to August 2026 for studies reporting the frequency, nature, or prevention of transfusion errors at any stage of the chain. Two reviewers independently screened records, extracted data, and appraised quality with Joanna Briggs Institute tools. Heterogeneity of designs and outcomes precluded meta-analysis, so findings were synthesized narratively.

Results: Thirty-four studies were included: hemovigilance and fatality analyses, multicenter audits, observational studies, interventional and technology-implementation studies, and staff surveys. Errors cluster at the two human interfaces of the chain, sample collection and bedside administration. Wrong blood in tube occurs in roughly 1 per 2,000 samples, and failures of patient identification are the leading proximate cause of ABO-incompatible transfusion. Practices with consistent evidence of benefit include zero-tolerance sample-labeling and acceptance policies, a two-specimen ABO verification rule, electronic positive patient identification with barcode support (about fivefold fewer wrong-blood-in-tube errors), electronic remote blood issue, structured bedside checklists, competency-based education, and participation in hemovigilance and near-miss reporting.

Conclusions: No single discipline can secure the transfusion chain alone. Layering nursing, laboratory, and blood bank barriers - standardized identification and sampling procedures, rigorous laboratory verification, electronic systems, education, and reporting - offers the most reliable protection against transfusion error.