The line must be primed to remove air before attaching it to the patient.

It is unnecessary to
prime with anything other than the blood component, however 0.9% Sodium Chloride may be
used for this purpose. Dextrose should never be used in a giving set before or after blood, as it
can cause haemolysis.
There are a variety of blood administration sets available. Manufacturers instructions for priming
the
line should always be followed.

Changing the administration set

If multiple units are being transfused, the administration set should be changed at least every 12
hours to prevent bacterial growth.
Some administration sets may be supplied with different instructions, or your hospital policy may
vary. In these cases you should follow the manufacturer s instructions or your hospital policy, as
appropriate.

On completion of the transfusion

Flushing through the remainder of the blood in the line with 0.9% Sodium Chloride is
unnecessary and is not recommended because it may result in particles being flushed through
the filter. If another IV infusion is to take place after the blood transfusion, it is good practice to
use a new administration set to reduce the risk of incompatible fluids or drugs causing
haemolysis of any residual red cells which may be left in the administration set.

Drugs
Drugs must not be added to any blood component pack. It is generally advised that an infusion
line that is being used for blood should not be used to administer any other drugs. Dextrose
solution (5%) can cause haemolysis and must not be mixed with blood components. Calcium-
containing solutions may cause clotting of citrated blood. The topics of compatible IV fluids and
co-administration of drugs and blood components are currently under review by BCSH
transfusion task force. (The Handbook
of Transfusion Medicine 4th edition 2007)

NHSBT Transfusion Liaison Team December 2009

BLOOD TRANSFUSION
PROCEDURES
November 2016
Review date: September 2018
Issue number: 6
Issued by: Hospital Transfusion Committee
NHS SHETLAND
Notes:
1. 0.9% Sodium Chloride is the only solution that should be infused through the
administration set immediately before or after blood.
2. Electronic infusion pumps can be used to transfuse red cells, but they must have been
verified as safe to use for this purpose and used according to the manufacturer's
instructions. Blood administration sets specific for these devices must be used.
3. When required, Red blood cells should only be warmed using a specifically designed
commercial device and following the manufacturer's instructions.
4. Drugs must not be added to blood.
5. Red cells should be collected from the blood refrigerator immediately prior to transfusion.
Commence the transfusion within 30 minutes and complete within 4 hours of removal
from the controlled temperature storage facility. If the infusion is not commenced within
30 minutes, the pack must be returned to the laboratory and labelled as described in section
16.
6. A new administration set should be used if the patient has multiple transfusions over
more than 12 hours to prevent bacterial growth. Administration set should also be changed
between different types of blood component, and if ABO group of blood being transfused is
changed

Notes:
1 The first 15 minutes of each unit is the most critical for the patient.
2 Visual observation of the patient is often the best way of assessing the patient during the
transfusion. Patients must be transfused in an area where they can be readily observed and
they should have a call button to obtain assistance.
3 Acute transfusion reactions can occur up to six hours post transfusion.
4 Unconscious patients are more difficult to monitor for signs of transfusion reactions.
5 Transfusion reactions should be considered when assessing a change or deterioration in
a patient's condition, particularly during the first 15 minutes following the start of a unit of
blood. Hypotension, fever, loin pain, uncontrolled bleeding due to Disseminated
Intravascular Coagulation (DIC), haemoglobinuria or oliguria may be the first indications of
an acute haemolytic transfusion reaction in these patients.
6 Second and subsequent units of blood being administered will have a delay in reaching
the patient due to the time taken to travel through the administration set.