Final bedside checking procedure

All patients who require the administration of any blood component MUST have a legible wrist band in situ which includes minimum of the three key identifiers, full name, date of birth and unique patient identifier number.

If two patients are to be transfused on the same ward, the transfusions must be staggered. Once the first unit is started, the blood for the second patient can be sent for. This ensures that two units will not be required at the same time.

Before the transfusion is commenced, the staff member setting up the transfusion must make a final identity check, in conjunction with another registered nurse or doctor.

At the patient’s bedside both individuals must first check the name, unit number and date of birth against the patients care pathway document. Then the details on the donor unit compatibility/traceability tag are checked. Check for any special instructions on the compatibility/traceability tag i.e. ‘complete by’

Check and confirm the Bag number (G092 310…) are the same on both the compatibility/traceability tag and the pack label. Then check the expiry date on the unit.

Where possible, ask the patient to verbally confirm their name and date of birth. FINALLY, check and confirm the patient’s identification (name, unit number and DOB) against the patient’s wrist band and the Blood bag tag

 

Blood Component administration

Please note; traceability labels are attached to every blood component/product issued by Blood Bank. Dept. staff are responsible for there completion and return at the first convenient opportunity.

RED BLOOD CELLS (RBC’s)

  • Depending on the administration rate can be documented on either the standard or rapid / emergency care pathways
  • The transfusion should be started within 30 minutes from removal from Blood Bank fridge (controlled temperature of 4°) or returned.
  • Transfused via a standard gravity feed blood transfusion giving set.
  • The giving set line should be primed with normal saline prior to first unit.
  • Each unit should be administered over maximum of 4 hours from the time the unit was removed from Blood Bank fridge. Patients requiring blood to be transfused urgently due to their clinical condition can be transfused STAT.
  • RBC’s can be stored in an un-opened cool box for a maximum of 3 hours, but once opened the 30-minute rule re-applies. However, if blood arrives in the clinical area in a cool box and is not going to be used imminently it must be returned to the Blood Bank and not stored in a cool box.

PLATELETS

  • Documented on a rapid / emergency blood transfusion care pathway.
  • Should be commenced as soon as possible once removed from the agitator (If delayed must be used or discarded after 2 hours from issue)
  • Never stored in a cool box
  • Transfused via a platelet giving set (170-200μm ‘screen’ filter) however if not available a standard blood giving set can be used but NOT if it is has already been used for RBC
  • Each unit is administered over around 30 minutes.

Fresh Frozen Plasma (FFP)

  • Documented on a rapid / emergency blood transfusion care pathway.
  • Average adult therapeutic dose is calculated by body weight (usually dose 3-4 units – to be prescribed individually)
  • Once thawed FFP must be transfused as quickly as possible as prolonged post-thaw storage will result in a decline of labile coagulation factors (maximum storage time 24 hours in the controlled blood bank fridge)
  • Administer via a standard blood transfusion giving set. (No need to prime the line prior to transfusion)
  • Each unit administered over 20 – 30 minutes

Cryoprecipitate (CRYO)

  • Documented on a rapid / emergency blood transfusion care pathway
  • Average adult therapeutic does is 10units (each pack contains 5units)
  • Once thawed must not be re-frozen or stored in a fridge and should be transfused as soon as possible. If delay is unavoidable the unit must be transfused or discarded within 4hours.
  • Administer via a standard blood transfusion giving set. (No need to prime the line prior to transfusion)
  • Each unit can be transfused in around 15-20 minutes

 

ALBUMIN

  • Recorded as administered on the patient’s prescription chart only
  • Administered via a standard intravenous fluid giving set
  • Each bottle should be infused over 1 to 2 hours
  • Albumin must be administered with caution as a too rapid infusion can lead to circulatory overload or interstitial dehydration
  • Once the bottle has been ‘spiked’ the contents must be used or discarded after 4 hours.

 

Paediatric administration

The principles are the same as for adult administration. Blood administrations sets containing 170-200microm filters should be used. Paediatric blood administration sets appropriate for small volume transfusions are available from NNU / Ward 38

It is vital for the medical team to specify both the volumes in mls and the time over which the transfusion should take place when prescribing for young children and infants.

 

NURSING ALERT

No drugs or other intravenous fluid to be added to OR administered via the same cannula during the transfusion of any blood component.

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, a new IV fluid administration set must be used to reduce the risk of incompatible fluids or drugs causing haemolysis of any residual red cells which may be left in the administration set.

If multiple units of RBC’s are being transfused, the administration set should be changed at least every 12 hours to prevent bacterial growth. Additionally, in cases of massive haemorrhage, where different components are to be given in rapid succession is best practice to use a new set for each component

N.B For further guidance, all clinical staff should refer to the Trust individual blood component guidelines located on the TAD website or Blood Products sharepoint website.