Blood Administration

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Offline Andy Battaglia

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Blood Administration
« on: October 30, 2008, 05:26:26 AM »
Please Note: I have attached another document about blood administration as a pdf file. To see it, click on the pdf link at the bottom of the post. The original can be seen at http://www.childrensmn.org/Manuals/Lab/TransfusionSvc/012741.pdf


Blood Administration


To help ensure the benefits and safety of a blood transfusion, the appropriate blood component must be ordered and it must be properly infused.

Preparation for Transfusion


The physician initiates the request for blood by a written order in the patient's medical record. If informed consent has not already been obtained, the physician should explain the risks and alternatives of transfusion to the recipient or responsible family member and document this discussion in the medical record.



The written order is forwarded to the Transfusion Service. If needed, a blood specimen is drawn for compatibility testing. It is important to specify the time of transfusion and any special instructions such as the need for CMV negative or irradiated products. Routine testing takes about 1 hour to complete and some products require extra preparation time.

Because blood contains living cells and has special storage requirements, nurses should not send for the product until an IV has been started, necessary equipment is gathered, and both patient and staff are ready to begin the transfusion. If the recipient requires medication to prevent an allergic or febrile reaction, it should be given immediately prior to transfusion.

The transfusion should be started as soon as the blood arrives on the floor. If it will be delayed more than 20 minutes, the product should be returned to the Blood Bank for proper storage and later reissue.

Transfusion Equipment


Blood Infusion Sets
Blood components must be filtered during transfusion to remove the clots and small clumps of platelets and white blood cells that form during collection and storage. Standard blood infusion sets contain 170 - 260 micron filters. Smaller component sets with in-line filters for plasma, platelets, and red cell aliquots are also available.

The manufacturer provides instructions for priming and use on the set package. Blood sets should not be piggy-backed into other lines if this can be avoided. If they must be piggy-backed, the Injection port closest to the IV line should be used and the primary IV line shut off. Straight-type sets are primed directly with the blood component. Y-type sets can be primed with blood or Normal Saline. Usually, a new set is used for each component transfused. If 2 units are to be given consecutively and they are ABO compatible with one another, one set may be used for both as long as they are infused within 4 hours.

Needles And Catheters
Needle size depends on the size and integrity of a patient's vein. An 18-gauge needle is standard, but a needle or catheter as small as 23-gauge can be used for transfusion if necessary. The smaller the gauge, the slower is the flow rate and the higher is the risk of clotting. Care must be taken to avoid excessive pressure and resulting hemolysis when very narrow devices are used. Diluting red cells with saline or asking the Transfusion Service to split a unit and giving only half at a time may help if the flow rate is too slow.

Leukocyte-Removing Filters
Special bedside filters may be provided by the Transfusion Service when pre-storage leukocyte-reduced red cells or platelets are not available. Red cell and platelet filters do not use the same technology for leukocyte removal and are not interchangeable. Some are designed to attach to standard infusion sets; others come with a set already attached. Most leukocyte-removing filters are designed for gravity drip use and have special priming requirements, so it is essential to check the manufacturer's directions before use.

IV Pumps
Mechanical pumps may be useful for controlling the very slow infusion rates required by neonatal and pediatric patients, but care is needed to avoid hemolysis. Only pumps specifically approved for blood transfusion should be used. Some pumps can be used with standard infusion sets; others require special software.

Pressure Bags
Pressure bags are needed only in emergency situations when blood must be transfused rapidly, such as 5 minutes per unit. The bag should be inflated only until blood flow through the drip chamber is continuous, about 200 mm Hg. Pressure approaching 300 mm Hg may cause the red cells to Iyse and the blood bag seams to split.

Blood Warmers
Blood warmers are used to prevent cardiac arrhythmia associated with the rapid infusion of large volumes of cold blood. Specific indications include:

    * Adults receiving blood at a rate in excess of 100 mL per minute.
    * Children receiving blood over 15 mL/kg/hour.
    * Patients with clinically significant cold agglutinins.
    * Rapid infusion of blood through central lines.

Blood should not be warmed to a temperature that causes hemolysis. Only temperature-controlled and monitored in-line devices are acceptable for use, and some require special software. The blood warmer must have a visible thermometer and, ideally, an audible alarm. The warmer should be set up according to the manufacturers' directions and its temperature checked periodically during use.

IV Solutions and Medications
Normal Saline (0.9% sodium chloride) can be added to blood, but drugs and medications must never be added. Compatible Fresh Frozen Plasma, 5% Albumin, and Plasma Protein Fraction can be added to blood following approval by the patient's physician. Isotonic electrolyte solutions that do not contain calcium may mix with blood if the FDA approves the solution for such use or if there is adequate documentation of safety. Some solutions should not contact blood in the bag or tubing. Solutions containing glucose (e.g. 5% dextrose) may cause red cells to aggregate and Iyse and those containing calcium (e.g. Ringer's Lactate) may cause blood to clot.

Confirming Patient And Donor Identity


When blood arrives on the nursing unit, the patient's medical record should be checked to verify the physician's request and to assess special transfusion instructions that may impact patient care. Then 2 responsible individuals must confirm the identity and compatibility of the donor and recipient. This is a 3-step process:

1. By reading aloud to one another from the blood bag label and the attached transfusion form, two nurses or physicians verify that:

    * Patient name and ID number is identical on all paperwork.
    * Donor number is identical on all paperwork.
    * The correct blood component product was received.
    * ABO & Rh type of the patient and donor are compatible.
    * Expiration date & time has not passed.
    * Color or appearance of blood is normal.
    * Special instructions, if noted, are carried out.

2. At the patient's bedside, these same 2 individuals verify that the patient's name and ID number are identical on the:

    * Patient's hospital ID band.
    * Blood Bank Transfusion Form.

3. These same 2 individuals then sign the transfusion form and immediately start the transfusion.

Transfusion should not begin unless this identity check is accurate and complete. Discrepant information must be resolved with the Transfusion Service beforehand. If the unit cannot be started immediately after the identity check, all 3 steps should be repeated. The compatibility tag should remain attached to the bag during transfusion; the transfusion form may be placed in the chart or on a clipboard in the patient's room until the transfusion is complete.

Monitoring the Patient during Transfusion


Patients must be observed during transfusion for signs and symptoms of an adverse transfusion reaction. This includes monitoring vital signs and general well being and documenting the results in the medical record. Because life-threatening reactions can occur within minutes, a physician or nurse should remain at the bedside for 5 to 15 minutes after the transfusion is started.

Baseline vital signs such as temperature, pulse, blood pressure and respiration rate should be documented immediately prior to spiking the bag and starting the transfusion. Comparison values are recorded again approximately 15 minutes after starting the transfusion and then periodically during the transfusion.

Any change in the patient's clinical status during or following a transfusion or an inadequate response to transfusion should be carefully evaluated. Because some reactions are delayed, patients should be monitored up to 1 hour post transfusion.

Infusion Rates


Packed red blood cells can be diluted with 0.9% NaCl to decrease viscosity and improve flow rate. Adsol units do not require further dilution, because they have already been diluted by the addition of preservative. Red cells should be infused through a large bore IV catheter and a standard 170 micron filter at a rate of 2 mL/minute for the first 15 minutes. The recipient should be observed for evidence of a transfusion reaction during this time period. If no adverse effects occur, the rate can be increased to 4 mL/minute for nonemergent transfusions. An infusion rate of 17mL/min allows an entire unit of blood to be transfused in 30 minutes. The usual recommended time period ranges between 1.5 and 2 hours per unit. The maximum time period allowed for infusion of a single unit of blood is 4 hours. In emergency situations, the infusion rate is not as well established. Infusion rates greater than 60mL/min are dangerous, and infusion rates greater than 100mL/min are associated with cardiac arrest. External pressure devices can be used to increase the rate of infusion. The pressure exerted should not exceed 300 mm Hg. Blood pressure cuffs should not be used because they apply pressure non-uniformly and can cause leakage.

    * Platelets are transfused through platelet filters at a rate which allows a pool of random donor platelets or a single donor platelet to be transfused within 30 to 60 minutes.
    * FFP should be transfused through a standard blood filter at a rate of 30 to 60 minutes per bag.
    * Cryoprecipitate should be infused through a standard blood filter at a rate of 4 to 10 mL/minute. At this rate, a pool of 10 bags can be infused in approximately 30 minutes.

Transfusion Follow-Up


After the blood component is transfused, the transfusion form must be completed and placed in the patient's medical record. The blood component (e.g. red cells, platelets, etc), donor number, and transfusion time are recorded on the hospital transfusion record. Observations and/or patient responses during transfusion are charted in the nursing notes. There must be enough information documented in the medical record to show that protocols were followed in the event there is a reaction or complication.

The empty blood bag and its attached administration set are considered to be biologically contaminated waste and should be disposed of according to hospital policy. If a transfusion reaction occurs, the bag and set should be sealed in a plastic bag and returned to the Transfusion Service for the reaction investigation.
« Last Edit: January 23, 2012, 12:37:41 AM by Andy »
Andy

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Offline nice friend

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Re: Blood Administration
« Reply #1 on: October 30, 2008, 09:47:08 AM »
Hi Andy ,
Thanx for a super sharing ,,,
 :ty  you are superb ....

Take Care
Umair
Sometimes , God breaks our spirit to save our soul.
Sometimes , He breaks our heart to make us whole.
Sometimes , He sends us pain so we can be stronger.
Sometimes , He sends us failure so we can be humble.
Sometimes , He sends us illness so we can take better care of our selves.
Sometimes , He takes everything away from us so we can learn the value of everything we have.

===========
Umair

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Offline Zaini

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Re: Blood Administration
« Reply #2 on: October 30, 2008, 10:45:10 AM »
That's very informative Andy,it should be printed,framed and hanged in every hospital.

Zaini.
^*^Xaini^*^

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Offline Manal

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Re: Blood Administration
« Reply #3 on: October 30, 2008, 11:25:31 AM »
Thanks Andy for such a detailed reference for blood transfusion that i hope it is actually done in hospitals

manal

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Offline nice friend

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Re: Blood Administration
« Reply #4 on: October 30, 2008, 11:59:23 AM »
Quote
That's very informative Andy,it should be printed,framed and hanged in every hospital.

it should be printed,framed and hanged in every hospital , but not to read ......  :rotfl :veil :veil :crackup :stars :love :party :happydance :happydance :happydance :happydance :happydance :happydance :laugh

Hi Zaini Sis ,
Please dont mind i m just kidding ..... sorry in advance ....  sorry if i offend you ...

Best Regards
Take Care
Umair
Sometimes , God breaks our spirit to save our soul.
Sometimes , He breaks our heart to make us whole.
Sometimes , He sends us pain so we can be stronger.
Sometimes , He sends us failure so we can be humble.
Sometimes , He sends us illness so we can take better care of our selves.
Sometimes , He takes everything away from us so we can learn the value of everything we have.

===========
Umair

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Offline Zaini

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Re: Blood Administration
« Reply #5 on: October 30, 2008, 12:36:21 PM »
You are right Umair,this will be the case here  :wink

Zaini.
^*^Xaini^*^

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Offline Sharmin

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Re: Blood Administration
« Reply #6 on: October 30, 2008, 03:18:03 PM »
Andy,

This is excellent information for patients and parents to know - Dr. Vichinsky has said that the number one reason for death during a transfusion is the patient getting the wrong blood!  So everyone should read this for themselves as human error can occur. 

Sharmin
Sharmin

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Offline T @ r ! Q

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Re: Blood Administration
« Reply #7 on: November 12, 2008, 05:26:45 PM »
wow Andy, excellent complete guideline, thanks for sharing (specially the transfusion rate and temperature guideline)
Falling down is not defeat... Defeat is when you refuse to get up...
The one who kneels to Allah, can standup to anything.

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Offline Sara76

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Re: Blood Administration
« Reply #8 on: July 05, 2014, 09:04:05 PM »
This is very helpful information, as I am new to receiving regular transfusions. After reading, I have a couple of questions.
1. The above states that 1 unit of blood can be given in 30 minutes, but typically it takes 1.5 hours per unit.
How long does it  take you to receive 1 unit? 2 units?
2. Are you actually monitored for an entire hour after the transfusion is complete?

From the start of transfusion (2 units), I am done in 2 hours. Then I leave right away and drive about an hour home. (Highway through big city). Is this not safe? Should I wait a bit before driving home? I never really thought about a reaction taking place while driving home. Obviously I want to get out of there as quickly as possible, but I certainly don't want to put anyone in danger.
Any thoughts/experiences would be appreciated.

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Offline Andy Battaglia

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Re: Blood Administration
« Reply #9 on: July 06, 2014, 03:19:50 PM »
It is not recommended that a unit of blood be given in 30 minutes. I wanted to clarify that. For non-emergency transfusions, the rate should not exceed 4 ml/minute. The 30 minute rate is reserved for emergencies.
Quote
Red cells should be infused through a large bore IV catheter and a standard 170 micron filter at a rate of 2 mL/minute for the first 15 minutes. The recipient should be observed for evidence of a transfusion reaction during this time period. If no adverse effects occur, the rate can be increased to 4 mL/minute for non-emergeny transfusions. An infusion rate of 17mL/min allows an entire unit of blood to be transfused in 30 minutes. The usual recommended time period ranges between 1.5 and 2 hours per unit. The maximum time period allowed for infusion of a single unit of blood is 4 hours.

Also, keep in mind that these instructions are for transfusions in general. For those chronically transfused, the patient history is taken into account as far as how long after completion they should be monitored, so if you have no history of reactions and nothing is observed at an individual transfusion, the waiting period is not necessary.
Andy

All we are saying is give thals a chance.

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Offline Sara76

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Re: Blood Administration
« Reply #10 on: July 07, 2014, 08:23:18 PM »
Andy, thank you very much for the clarification!

 :thankyou2 :ty

 

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