blood administration 2009
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Mary Marsden & Carmel Parker.
Transfusion Practitioners.
Ext 68041 bleep 2010 or 8041
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Blood Transfusion Administration
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Trust Blood Transfusion Policy
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Two National Fatal errors 2007
Case 1
Lack of care and accuracyin paediatric prescribing
results in overtransfusion;
Very sick preterm infant, platelets48
Platelets 15 ml/kg prescribed Transfused 50 ml/kg,
(300 ml over 30 mins)
Infant suffered cardiorespiratoryarrest and died
Case 2
Faulty blood samplingtechnique and a wrong
decision to transfuse
80 year old woman, fractured neckof femur
Post-op Hb 3.9g/dL, diluted by IVinfusion
Pre-op Hb was 9.5g/dL, little intra-op bld loss
6 units red cells given over 16 hrs,
post-tx Hb 18.2 Death from cardiac failure
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Patients understanding of Transfusion
Why do I need a transfusion?
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Decision to Transfuse
Communicate with patient
Patient information leaflet
Document in patient notes
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Documentation
What would you consider to begood transfusion
documentation in the patientsnotes?
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Good Documentation
Minimum Transfusion Dataset: thefollowing should be documented in thenotes
Reason for transfusion
Current blood resultsComponent type and amount to be prescribed
Anticipated outcome
Any reported transfusion adverse events/reactions
Review following the transfusion including howmuch blood has been transfused
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Communication
MAKE A PHONE CALL
(You should be a doctor or senior nurse who has full knowledge ofthe situation)
to the HospitalBlood Bank(Ext 4400 or 4887or Out-of-hours bleep2525)
*In extreme emergency only, if no reply or line is engaged, dial 0161 2732968
(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.
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Trust Blood Transfusion Policy
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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?
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There are no special requirements and
selection would be dependant on the desiredinfusion rate
I V Canulae For Transfusion
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Warming blood
WHY WARM BLOOD ?
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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 inducehypothermia 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
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Blood Prescription
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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
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Monitoring patients on Blood Transfusions
Base line observations
Temperature, pulse and bloodpressure
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.
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Administration procedure
Step 2: Check the patients First name
Surname Date of birth
Hospital number
on the compatibility/
traceability label againstthe patients ID wristband
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Unique Donor Number
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Administration Procedure
Step 3: Check the compatibility/traceability label with the
blood bag label
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Transfusion Paperwork
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Signs and Symptoms of Reaction
Mild Reaction Severe ReactionFever Pyrexia/Rigors
Rash Hypotension
Pruritis Loin/Back Pain
Urticaria Increasing Anxiety
Pain at the infusion site
Respiratory Distress
Dark urine
Severe Tachycardia
Unexpected bleeding (DIC)
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Reporting transfusion reactions/incidents
Stop the Transfusion and seek Medical Input and informthe 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 backto transfusion capped off at the end with a white venfloncap and any previous transfused bags sealed with the
blue plugs all in biohazard bags
Documentation (complete the checklist)
Complete a Trust Incident form
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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 itdown and bleeped the HO.
The ward then phoned Blood Bank requesting a further unit of blood foranother 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 aconsultant haematologist who went to see patient immediately.
The sticky label from the blood bag tag had been removed from the medicalnotes, 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 hadnot performed any bedside checks.
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Follow guidelines and Policies Be Safe