Mary Marsden & Carmel Parker. Transfusion Practitioners.

Ext 68041 bleep 2010 or 8041

Blood Transfusion Administration

Trust Blood Transfusion Policy

Two National Fatal errors 2007

Case 1 Lack of care and accuracy in paediatric prescribing results in overtransfusion; Case 2 Faulty blood sampling technique and a wrong decision to transfuse

Very sick preterm infant, platelets

48 Platelets 15 ml/kg prescribed Transfused 50 ml/kg, (300 ml over 30 mins) Infant suffered cardiorespiratory arrest and died

80 year old woman, fractured neck

of femur Post-op Hb 3.9g/dL, diluted by IV infusion Pre-op Hb was 9.5g/dL, little intraop bld loss 6 units red cells given over 16 hrs, post-tx Hb 18.2 Death from cardiac failure

Patients understanding of Transfusion Why do I need a transfusion?

Decision to Transfuse

Communicate with patient

Patient information leaflet

Document in patient notes

Documentation

What would you consider to be good transfusion documentation in the patients notes?

Good Documentation

Minimum Transfusion Dataset: the following should be documented in the notes Reason for transfusion Current blood results Component type and amount to be prescribed Anticipated outcome Any reported transfusion adverse events/reactions Review following the transfusion including how much blood has been transfused

Communication

MAKE A PHONE CALL (You should be a doctor or senior nurse who has full knowledge of the situation) to the Hospital Blood Bank (Ext 4400 or 4887 or Out-of-hours bleep 2525)

*In extreme emergency only, if no reply or line is engaged, dial 0161 273 2968 (emergency outside line)

State clearly: Reason (diagnosis, extent of bleeding) Patient Details First name Surname Date of birth Gender Hospital/A&E number What blood component is required, how much and how soon.

Trust Blood Transfusion Policy

Frequently asked questions Cannulae size does it matter? Can you warm blood, if so why? Duration of transfusion minimum & maximum Can other drugs be added to blood? Use of diuretics Type of infusion sets Where can you store RBC, Platelets, FFP?

I V Canulae For Transfusion

There are no special requirements and selection would be dependant on the desired infusion rate

Warming blood

WHY WARM BLOOD ?

Warming blood 1 Patients undergoing surgery will already be losing body heat due to wound or cavity exposure. 2 Large volumes of cold blood may induce hypothermia or cardiac arrhythmia

3 Exchange transfusion
4 If requested by the laboratory. i.e.. The patient has cold agglutinins Never warm blood by any other method

Blood Prescription

Who can administer blood?

Refer to the Trust Blood Transfusion Policy Blood administration must take place at the patient bedside not in remote locations such as the ward clinic

Monitoring patients on Blood Transfusions

Base line observations Temperature, pulse and blood pressure Further observations (as above) at 15 minutes A set of observations at the end of transfusion More frequently if the patient is unwell, unobservable, unconscious or a child.

Administration procedure

Step 2: Check the patients

First name Surname Date of birth Hospital number

on the compatibility/ traceability label against the patients ID wristband

Unique Donor Number

Administration Procedure
Step 3: Check the compatibility/traceability label with the
blood bag label

Transfusion Paperwork

Signs and Symptoms of Reaction

Mild Reaction Fever Rash Pruritis Urticaria Severe Reaction Pyrexia/Rigors Hypotension Loin/Back Pain Increasing Anxiety Pain at the infusion site Respiratory Distress Dark urine Severe Tachycardia Unexpected bleeding (DIC)

Reporting transfusion reactions/incidents Stop the Transfusion and seek Medical Input and inform the Transfusion Laboratory staff Check the Blood component matches the patient details Replace the unit and giving set with Normal Saline 0.9% Send the discontinued unit with giving set attached back to transfusion capped off at the end with a white venflon cap and any previous transfused bags sealed with the blue plugs all in biohazard bags Documentation (complete the checklist) Complete a Trust Incident form

A patient receiving a red cell transfusion complained of severe back pain, and then developed rigors. The deputy Sister attended the patient, noticed it was the wrong blood, took it down and bleeped the HO. The ward then phoned Blood Bank requesting a further unit of blood for another patient as the first had been 'wasted'. Only when the BB manager asked for the bag was it revealed that the unit had erroneously been given to the wrong patient. BB Mgr contacted a consultant haematologist who went to see patient immediately. The sticky label from the blood bag tag had been removed from the medical notes, and the name had been crossed out on the blood bag label. The bag of blood had been thrown into the sharps bin, this was retrieved by consultant haematologist. The nurse who put up the blood admitted she had not performed any bedside checks.

Follow guidelines and Policies Be Safe