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(For Quick Reference see flippin’ blood
The Transfusion Administration Checklist is a useful tool to ensure the correct steps are followed when administering blood products. Patient Preparation Prior to Collection of Blood Product Equipment Collecting the Blood Product Pretransfusion Check Duration of Transfusion Co-Administration of Medication and other fluids Monitoring of Transfused Patients Documentation Disposal of Waste References
Patient Preparation The patient should be ready for transfusion prior to picking up blood from the Transfusion Service e.g.
• • • •
Medical order for transfusion. Informed consent documented. For any non-emergency transfusion the patient / parents should have had the benefits / risks of transfusion discussed and an opportunity to have any questions answered. BloodSafe Consent Quick Reference Guide (PDF) for medical staff who need to obtain informed consent for blood and blood products. Appropriate IV access patent. Check resuscitation equipment, including oxygen and adrenaline are available and in working order.
Questions to Ask Your Doctor.Transfusion Basics: Prescribing Blood 2006 . Blood Who needs it? Consumer Brochure Arabic (1029 KB) Greek (1420 KB) Italian (68 KB) Spanish (71 KB) Turkish (1519 KB) Vietnamese (2027 KB) (51 KB). Ensure informed consent documented in the medical record (non-emergency patients). Also available in: Patient Guide . including possible transfusion reactions. Explain the procedure to the patient/parent. Ensure intravenous access is patent. Take the patient’s TPR and BP Check for any premedication requirements and if ordered administer sufficiently in advance to allow effectiveness. • • • • • • • ▲Top Equipment . Check the patient is wearing an ID band and that the details are correct (check against the patient’s medical record). Always check urgency with the medical officer. Check resuscitation equipment. If there is doubt do not delay the transfusion. including oxygen and adrenaline are available and in working order. In non-urgent/non-bleeding/stable patients red blood cells should NOT be transfused between 2200-0700hrs where ever possible for patient safety. Prior to Collection of Blood Product • Check the medical order for transfusion.a guide for Medical Officers for prescribing blood products.
whichever comes first. The rate and volume administered must be checked at Syringe Pump Medication label IV blood line incorporating a 170-200 micron filter Three way tap x 2 30 mL luer lock syringe Disposable gloves and eye protection glasses Sterile trolley cover Minimum Volume extension tubing (150 cms) . with new IV fluids or on completion. platelets.g. o Baxter IV blood lines contain a 200 micron filter and are therefore appropriate to use when administering blood products • IV pole/hook . The maximum rate at which the manufacturer has tested the pump for safe administration of blood products must not be exceeded.For red cells. Staff using the pump must be competent with its use. In neonates and small paediatric patients the blood product is used to prime the line to prevent unnecessary fluid volume being administered to the patient. fresh frozen plasma (FFP) and cryoprecipitate: • Always use IV blood line incorporating a 170-200 micron filter to remove clots and clumps of debris. o IV blood lines must be changed every 8 hours. does not damage the red cells or platelets). • Disposable gloves and eye protection glasses • Alcohol Swab • Tape to secure IV line as required Neonates • • • • • • • • Pumps • • • • • Pumps may be used only if the manufacture has documented evidence of safety of blood product administration (e. The pump line must incorporate a 170-200 micron filter to remove clots and clumps of debris. FFP and Cryoprecipitate contain very few cells and can be given safely via any pump.never share an IV pole with 2 patients • Normal saline to prime line if required.
if clinically indicated. Carefully label the syringe with correct patient details. When blood is being administered by syringe. Blood should be warmed using a specifically designed commercial blood warming device. Both staff checking the right patient identification and right blood product must sign the syringe label verifying correct patient/pack detail Blood Warmers • • • Blood components may be warmed during or just prior to transfusion. .least hourly and with any rate change. • Examples of manufactures that have stated their pumps can be used for blood product administration include: Baxter Colleague Red cells – maximum rate 1200 mL/hr Platelets – maximum rate 300 mL/hr Gemini Series Red cells – maximum rate 999 mL/hr Platelets – maximum rate 150 mL/hr Syringe Drivers • • • • Syringe divers are safe for blood administration in neonates and small infants. Always maintain aseptic technique. These must be operated strictly according to the manufacturer's instructions and require a 12 monthly maintenance and validation program. the blood must be drawn into the syringe via a new IV blood line incorporating a 170-200 micron filter.
Consider warming red blood cells in the following circumstances: • Patients receiving massive transfusion • Hypothermic patient requiring transfusion • Intrauterine and Exchange transfusion ▲Top Collecting the Blood Product • Blood products should only be picked up when the transfusion is ready to commence in order to ensure appropriate storage and maintain safe and viable products. • Note: that Fresh Frozen Plasma and Cryoprecipitate are thawed (in a temperature monitored water bath) by Transfusion Service prior to issue. Strict documentation of blood unit movement – in and out of these fridges is required by Transfusion Service – staff must complete the Remote Blood Fridge Register. • There are remote Blood Fridges in the Haematology/Oncology Clinic and Rogerson Theatres. When staff remove blood products from a Remote Blood Fridge. sign and date form and indicate which product is to be collected. Attach patient identification label. Telephone Transfusion Service when these products are required and allow 30 minutes for thawing.• NEVER warm blood in a microwave. Collecting the Blood Pack . The Remote Blood Fridge Register is completed when blood is entered and removed from the fridge. immersion in water or by placing on heat generating machinery. • If the transfusion cannot commence within 30 minutes. • Blood products must not be stored in ward areas or domestic fridges and should not be placed on heat-generating machinery. The release order can be completed by all clinical staff (nursing/midwifery and medical). Blood/Product Authorisation Form • • • A Blood/Blood Product Authorisation Form is required for all products to be picked up from the Transfusion Service. • If a blood product is not used it should be returned to Transfusion Service for updating of the laboratory database so the product is not recorded as transfused to a particular patient. the product must be returned to the Transfusion Service immediately for appropriate storage and to prevent wastage of the product. they need to take paperwork with the patient details to the fridge to check they have collected the correct unit.
If there is any discrepancy. The person collecting the product must: o o o • • Check they have the correct blood product with a Transfusion Service staff member. Sign and print their name. First Name(s). clots or abnormal colour. The patient must be wearing an ID band detailing the patient’s Surname. The pretransfusion check must be completed before commencing the transfusion by two clinical staff (registered nurse/midwife. anaesthetic nurse or medical officer) one of whom must then spike and connect the product. The following checks are carried out at the patient’s side to ensure the right patient receives the right blood product. first name and date of birth (wherever possible) and make sure that these details are the same on the patient’s ID band. This is vital to ensure the right blood is given to the right patient. this must be resolved before leaving the Transfusion Service. . theatre orderly. The blood must then be taken to the ward/unit without delay or deviation to another area. Pretransfusion Check Safe transfusion requires a final identity check at the patient’s side before blood administration. Compare the patient details on the Blood/Product Authorisation Form with those on the Blood/Product Transfusion Report and those on the blood pack labels with a Transfusion Service staff member. Alternative methods of patient identification such as photo ID (Boyland Ward) or unknown patient unique identifier may be used as . plus record the date and time of collection on the white copy of the Blood/Product Transfusion Report (this copy is retained by the Transfusion Service). Special care should be taken for those patients who cannot state their name for whatever reason. Upon arrival to the ward/unit the blood must be handed to a responsible clinical staff member – not left unattended on a bench/desk. Check the blood product for signs of leaks. nurse/midwife or medical staff may collect a unit of blood from Transfusion Service. Verification of patient identity should be checked with the parent/carer/spouse if the patient is unable to state his/her name and the carer is present. Date of Birth. UR Number and Gender. The staff members signing for the blood transfusion are verifying that the check has been correctly completed prior to the transfusion.• • A PSA. Patient Identification: • • • • Ask the patient to state/spell their surname. and that no discrepancies were identified.
two identification bands labeled as stated above will be placed inside the cot facing outwards. Blood Component Label and Patient Compatibility Label for the following and ensure they are correct: Product Special requirements if required – leucodepletion. CMV negative. RIGHT BLOOD PRODUCT Check the Medical Order. Blood Product Transfusion Report. Blood Product Transfusion Report. Follow NICU patient identification guidelines e. • Very low birth weight neonates in NICU nursed in an enclosed isolette are an exception. HLA matched or washed .per hospital guidelines. The checking process involves both staff verbally confirming the following details: • RIGHT PATIENT Check the Medical Order.g. Patient Identification Band and Patient Compatibility Label for the following and ensure they are identical/correct: • Patient’s Surname • Patient’s First Name(s) • • Date of Birth and/or Medical Record Number (or unknown patient unique identifier). irradiated.
Blood Component Label and Patient Compatibility Label for the following and ensure they are identical/compatible: • Blood Group of Patient and Donor • Blood Donation/Batch Number • Expiry Date and Time The colour coding on the images below outlines the details to be checked on the Medical Order.• RIGHT PACK Check the Medical Order. Patient ID Band and Blood Transfusion Report Form. Blood Product Transfusion Report. Medical Order . Blood Pack.
Blood Pack .
Blood Product Transfusion Report .
C. Contact Transfusion Service immediately if there are any concerns or doubts with the blood product . Check the rate of the infusion. • • • Commence transfusion. and check infusion has been set up correctly. expel air Turn 3 way tap off to blood pack Close roller clamp Disconnect syringe from 3 way tap (At the completion of the transfusion this set up is returned to Transfusion Department). Prime the tubing and 3 way tap Label the syringe with the medication label Place the syringe in the pump and set the required rate. • Second checking person connects infusion set to the blood pack. Check 3 way tap is on to neonate and syringe. Attach to IV cannula or 20g lumen of U. Follow IV management standards.phone 16320 or 17014. • Withdraw the required volume into the syringe (+ 3 mls). o o o o o o Ensure protective eye wear and gloves are used. If using a pump check rate is accurately set. Neonates • Using aseptic technique. syringe and three way tap.If there are any discrepancies detected during the checking process DO NOT PROCEED until they have been rectified and it is safe to do so. Attach syringe to minimum volume extension tubing and second 3 way tap. one of the two people involved in the checking process must spike and connect the pack. Remember to start infusion slowly for the first 15 minutes. Once the checking procedure has been correctly completed without any discrepancies. Both staff must sign and print their name and document date and time of commencement. Use an aseptic technique as per IV management standards. wearing sterile gloves and eye protection connect the transfusion set.V. Ensure all air is removed from the line. Remove the second detachable Patient Compatibility Label and attach it to the Blood and Blood Product Administration Record. Hang the pack on the IV pole and attach the IV blood line to the correctly identified patient. . Commence transfusion. Prime the IV blood line with normal saline or the blood product. Re check the medical order.
increase rate as ordered by the Medical Officer.9%. See flippin' blood for individual product solution compatibilities.60 minutes 30 . This includes glucose 5% with sodium chloride 0. Prolonged contact between red cells and dextrose can result in a loss of water from the red cell with subsequent destruction. If the patient does not have any side effects at this time.4 hours 30 .30 minutes ▲Top Co-Administration of Medication and other fluids • No medications or solutions should be added to or infused through the same tubing as blood products except for sodium chloride 0. FFP and dose of cryoprecipitate is four hours from spiking the pack to completion of transfusion. • Fluids containing dextrose (glucose) are NOT compatible with red blood cells. Hartmann’s solution) should never be added to or administered concurrently with any blood product because they contain calcium. platelets. The transfusion should commence at a slower rate than ordered for the first fifteen minutes.45% (5% and ½). • Medications may interfere with the anticoagulant solution in the pack or cause unpredictable damage to the blood product.120 minutes 10 .▲Top Duration of Transfusion • • • Transfusion should proceed at a rate that is appropriate to the patient’s clinical state as ordered by the medical officer. • Crystalloid or colloid solutions (Haemaccel®. If a medication needs to be given: Either: . Blood products contain citrate as an anticoagulant therefore the addition of any calcium based solutions will result in the reversal of anticoagulant causing clot formation. The maximum infusion time for each pack of red cells. The recommended transfusion times in stable paediatric and adults are: • • • • Red cells Platelets FFP Cryoprecipitate 2 .
9%) has been shown not to adversely affect red blood cells or these medications (incorporate a non-reflux value in the IV lines).• Use of insert another cannula for drug administration Or • • • • • • Stop the transfusion Flush the line with normal saline using the injection port closest to the patient. Flush the line again with normal saline.9%). Administer the medication. pethidine (10mg/mL in sodium chloride 0. Ensure the line is clamped above the injection port. ▲Top Monitoring of Transfused Patients Patient receiving blood products should be monitored for signs and symptoms of potential transfusion reactions / complications. the patient must be observed closely for the first 15 minutes of the transfusion. If this is required the blood product and medication should be delivered via separate IV lines. Extreme Circumstances for Neonates and Small Children It is recognised that intravenous access in neonates/children can be limited and lead to significant problems when multiple intravenous blood products. fluids and medications need to be administered. In extreme circumstances the medical officer may need to consider the risks of co-administration. The blood product line should be connected closest to the patient to minimise mixing of the medication and blood product.9%) and ketamine (1mg/mL in sodium chloride 0. . Ensure this manoeuvre does not result in the transfusion exceeding four hours. platelets and FFP as some life-threatening reactions may occur after the infusion of only a small amount of blood. Observations • • The patient must be observed closely during the first 15 minutes of each pack of red cells. The only exception is the following as it has been shown not to adversely affect red cells. Unclamp the line. • Co-administration of morphine (1mg/mL in sodium chloride 0. A non-reflux valve is required on both the blood and medication line. Restart the infusion. Contact the Transfusion Nurse Consultant for further information Page:4147. For cryoprecipitate only. A cryoprecipitate dose usually includes more than one pack.
respiration and blood pressure prior to commencement of each blood pack or blood product. pulse and respiration hourly during administration. Children and Adults* . ▲Top Documentation The following must be documented in the medical record: • • • Patient observations and outcome of the transfusion including any adverse effects. respiration and blood pressure • • • prior to commencement of each blood pack or blood product. post partum haemorrhage) may require hourly observations (for four hours) after the completion of the transfusion to observe ongoing blood loss. pulse.* Other Considerations • The patient’s clinical status should determine the observations required. Document on the Blood and Blood Product Administration .Temperature. Blood product administration start and finish times. The patient’s condition should be documented at this 15 minute interval. hourly during administration. patients should be informed of potential symptoms of a transfusion reaction and should inform staff immediately if they feel unwell during the transfusion. • Some clinical areas may require more frequent observations particularly in unstable or unconscious patients. pulse. Unique donation/batch numbers of product. • *Obstetric patients (e. Neonates • Temperature. pulse.• • Where possible. respiration and blood pressure on completion of each blood pack or blood product. • Temperature. • More frequent vital signs should be taken if the patient has an unstable underlying condition or if the patient becomes unwell or shows signs of a transfusion reaction.g. on completion of each blood pack or blood product. • Temperature.
Used blood packs must be return to the Transfusion Service. This legal document must be filed in the patients medical record and be available for 20 years. • • Dispose of IV blood Line as per Infection Control Policy. o Remove IV blood line – fold blood bag tab over and tape down. • Place in a brown plastic bag and have a PSA return it to Transfusion Service. ▲Top Disposal of Waste The following instructions are for all areas except NICU and for patients who have had a transfusion reaction. The IV blood line used in NICU is smaller than the IV blood line used elsewhere and is able to fit into a pathology biohazard bag. o Place biohazard bag into a brown plastic bag and have a PSA/theatre orderly return it to Transfusion Service. Names and signature of both persons checking the product (on above mentioned form). o Place used bag in a pathology biohazard bag and seal. Transfusion Reactions • Leave IV blood line attached to bag. Place partially used bag and attached line in a pathology biohazard bag and seal. NICU • • • Leave IV blood line attached to bag. This is done as only a portion of the blood will be used for a neonatal and this will prevent spillage. • Do not leave any sharp ends exposed. Any equipment used such as pumps or blood warmers. Volume and type of product administered.• • • Record. Place biohazard bag into a brown plastic bag and have a PSA return it to Transfusion Service. ▲Top References .
pp 205-208. Bethesda. & Neumeister. 1st Edition. 2001. Extension 16827. ‘Granulocyte Transfusion’. vol. 2001. Trauma & Burns. An extension of blood component labels. The Clinical Use of Blood. Surgery & Anaesthesia. P. Obstetrics. Australian New Zealand Society Blood Transfusion and the Royal College of Nursing Australia 2004. Guidelines for Administration of Blood Components. Hogan. USA. H. 2004.. Anaesthetic Intensive Care. Blood Transfusion Therapy Working Group 1999. www. Canada. Blood Transfusions. Blood Component Information. & Mahoney. Australia. 2003. Australia. Inc. Alaris Medical Systems. Illinois. Council of Europe Publishing. Doherty. 29. A Guide to Transfusion Medicine’ Sunnybrook and Women’s College Health Sciences Center. Cedex. 2003. use and quality assurance of blood components. Transfusion Nurse Consultant BloodSafe. B. ‘bloody easy.H. Strasbourg. G. Baxter Healthcare Corporation Letter date 19 March. Victoria. Houghton. Guide to the preparation.J. Accessed via www. Medicine. Ontario. W. Sydney. Northoff. 12th Edition.. Royal Children’s Hospital. Council of Europe Publishing 2006.org. Paediatrics.au/bloodtrans World Health Organization Blood Transfusion Safety 1998. Ph: 61-8-81617000. A Guide to Blood Component Administration. Administration of Blood Products through the Gemini Infusion Pump. pp 137-140. Australia. C.L. & Pinkerton. Birch. Geneva. Melbourne. Blood Alternatives and Transfusion Reactions. M.pdf ▲Top Further information is available from Trudi Verrall. Australian Red Cross Blood Service 2006. 87.American Association of Blood Banks. Callum. vol.who.rch. Einsele. Vox Sanguinis.int/bloodsafety/clinical_use/en/Manual_EN. Pager: 4147 . ‘Co Administration of Drugs and Blood Products’. Circular of information. C. H. J.
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