Blood Administration 2009

7/31/2019 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

Blood Administration 2009

Documents

Transcript of Blood Administration 2009