BloodManagementSession_March08

7/27/2019 BloodManagementSession_March08

1/65

Mary Metcalfe & Carmel Parker.Transfusion Practitioners.

Ext 8041 bleep 2010 or 8041.


2/65

To gain understanding of best clinical practiceinvolved in Blood/Blood componets therapy.

How to safely and appropriately order bloodproducts for transfusion.How to safely set up a transfusion and monitorpatients at this point.

Management of suspected adverse Transfusionreaction.


3/65


4/65

Patient clinical details and presentation.Up to date blood results.Transfusion history and any adverse events.

Drug history and dosage.Colleagues, patient, nursing staff, family membersare a viable source of information.Transfusion policy and practitioners, lab staff.


5/65

EU directive Blood Safety 2002/98/EU.Transposed into law in November 2005.Vein-to-vein traceability.

Set standards for collection,processing,distribution,testing andstorage of products.

Record keeping extended to 30 YEARS.!!

Operational Impact Group


6/65

Check the patients details and case note history.Are special requirements needed? E.g. CMV orirradiated.

Use the indication codes for RBC & FFP.Is it an appropriate transfusion, what are thealternatives?Is it an EMERGENCY or is it routine.


7/65

Aims of thesession

Station 1.HospitalBlood

Bank/products.

Station 2.Venous

Sampling - risk

Station 3. Bloodadministration

TransfusionReactions/Review

& feedback


8/65


9/65


10/65

NEAR MISS EVENTS 1997/98 - 2003 (n=2427)

57%

14%

11%

10%

8%


11/65

Acute blood loss R1To maintain circulating blood volume and Hb>7g/dl Peri-operative, assuming normovolaemia R2 Hb < 7 g/dlR3 Hb < 9 g/dl in presence of cardiovascular disease or

significant risk factors for cardiovascular diseaseR4 Critical care: Transfuse to maintain Hb > 7 g/dl(>9g/dl if at risk as R3)

R5 Post-chemotherapy; there is no evidence base guideto practice usually Hb 8 or 9 g/dl

R6 Radiotherapy: transfuse to maintain Hb > 10 g/dlR7 Chronic Anaemia: transfuse to maintain thehaemoglobin just above lowest concentration that is

not associated with symptoms of anaemia.


12/65


13/65

Check the patients case note

Transfusion historySpecial requirements- e.g., irradiated, CMV negative

Complete request form or ordercommunications


14/65

CasenoteSurname

Forename

DOBEthnic Origin

LocationConsultantSex

Patient Category NHSDate of Request

Entered byOriginatorDate of Specimen

Service (Type of Request)Blood Group

Previous Transfusion

Units (amount) Date ReqdReaction

Specimen typeVacutainer 7mls pink + 4.5 mls EDTA

Antibodies

Specimen taken by Sign and print Name Requesting Medic Sign and Print name

Copy of this request must be filed in the notes. See Trust Transfusion policy

Diagnosis, referral reason, relevant medication

Information found on the RequestForms


15/65

Step 1: Ask the patient to tell you their:

Full Name + Date of Birth

Be extra vigilant when checking the identity of theunconscious / compromised patient

Check this information againstthe patients ID wristband


16/65

Only bleed one patient at a time usingAseptic non touch techniqueDo NOT use pre-labeled tubesLabel the sample tube beside the patient

Send the sample to the laboratory in themost appropriate way for the clinicalsituation, i.e. routine / emergency

Remember emergency requests mustalways be phoned through to theTransfusion Laboratory.

Sampling Procedure


17/65

Labelling the venous blood sample

Information to include:-Full nameDate of birthHospital numberGenderDateSignature of person who has taken the

sampleAt the bedsideBy the person taking the sample


18/65


19/65


20/65

Positive Patient Identification

I cdnuolt blveiee that I cluod aulacltyuesdnatnrd what I was rdgnieg

The phaonmneal pweor of the hmuan mnid


21/65

Patient X bled into a pre-labelled sample tube withpatient Ys details Patient Y (23 year old) experienced a post-ophaemorrhage

Patient Y was Group O and received a unit of groupA red cellsPatient complained of loin pain - transfusion reactionqueried but transfusion continued

Patient developed renal failurePatient died as a direct result of incompatibletransfusion


22/65

IV Blood/ Blood Component Chart

Observations must be recorded please ensure all detail are

complete on the prescription chart e.g. all patient details .


23/65


24/65

Blood TransfusionAdministration


25/65

Found on all Wards/Units & Hospital Intranet


26/65

Decision to Transfuse Communicate with patientPatient information leaflet

Document in patient notes


27/65

Minimum Transfusion Dataset: the following should bedocumented in the notes

Reason for transfusionCurrent blood resultsComponent type and amount to be prescribedAnticipated outcomeAny reported transfusion adverseevents/reactions

Review following the transfusion including howmuch blood has been transfused


28/65

There are no special requirements and selection

would be dependant on the desired infusion rate


29/65

WHY WARM BLOOD ?


30/65

1 PATIENTS UNDERGOING SURGERY WILLALREADY BE LOSING BODY HEAT DUE TOWOUND OR CAVITY EXPOSURE

2 LARGE VOLUMES OF COLD BLOOD MAYINDUCE HYPOTHERMIA OR CARDIACARYTHMIAS


31/65

3 Exchange transfusion

4 If requested by the laboratory. i.e.. The patienthas cold agglutinins

Never warm blood by any other method


32/65

1st checkersRegistered Nurse/ Midwife or

Sick Childrens Nurse, Doctor& a qualified Agency Nursethat holds a Trust contract

2nd Checkers

Any of the above &

Qualified Theatre Practitioner

or qualified agency nurse thatdoes not hold a TrustContract.


33/65

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.


34/65

Ensure the venflon is secure, patent and there areno signs of inflammationGive the patient the call bell

Patients should remain in a clinical area for theduration of the TransfusionReview the patients fluid balance and medication.


35/65

LEAKSDISCOLOURATIO

NCLUMPINGEXPIRY DATE

If there is ANY discrepancy - DO NOT transfuse

Pre-administration Procedure

Step 3: Undertake visual inspection

Step 1: Check the blood component has been prescribedStep 2: Undertake baseline observations


36/65

Pre-administration checks

Personal checks:- ANTT- wear personal protective equipment

Equipment checks:- Personal protective equipment is available andis clean and sterile- A correctly completed prescription chart

- Observation chart- Giving set- Disposable bags- Trolley


37/65

Be extra vigilant when checking the identity of theunconscious / compromised patient

Step 1: Ask the patient to tell you their:Full Name + Date of Birth

Check this informationagainst the patients IDwristband


38/65

Step 2: Check the patients First name Surname Date of birth Hospital number

on the compatibility/

traceability label againstthe patients ID wristband

Administration Procedure


39/65

Any discrepancies DO

NOT TRANSFUSE !

Administration ProcedureStep 3: Check the compatibility/traceability label with theblood bag label


40/65


41/65

Stop the Transfusion and seek Medical Input and inform theTransfusion 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 back totransfusion capped off at the end with a white venflon cap and any previous transfused bags sealed with the blue plugsall in biohazard bags

Documentation (complete the checklist)

Complete a Trust Incident form


42/65


43/65


44/65


45/65

Signs:Fever

(1.5 C rise)TachycardiaHypotension

HaemoglobinaemiaHaemoglobinuria

Generalised oozingfrom wounds

Symptoms: Apprehension AgitationFlushingPain at cannula sitePain in abdomen, flankOr chest


46/65


47/65

Fever and any other symptoms/signs ofhaemolysis more than 24 hours after transfusionUnexpected fall in HbMay have postive Direct Antiglobulin test(Coombs test) or positive crossmatchConsider sending samples to the NBS


48/65

Non-Haemolytic Febrile (Fever) TransfusionReaction

Between 1-2% of transfused patients experiencesome sort of febrile reaction

Caused by antibodies in the patients plasma reacting

against the leucocytes in the donors blood


49/65

Fever or rigor 30 - 60 minutes after thestart of the unit +/- rash

TREATMENT:

Stop the transfusion

Give antipyretic e.g. Paracetamol +/- PiritonContinue transfusion if symptomes subside.


50/65

Transfusions of blood & blood componentsare labour intensive & expensive but arefrequently life saving events

In a few patients, however they can result inpotentially fatal complications

It is therefore essential that they are onlygiven when the benefits outweigh the risks


51/65

The donors blood (the graft) mounts animmune response against the recipient (the

Host)

There is no effective treatment and thecondition is nearly always fatal


52/65

Platelet antibodies from the donor destroythe recipients platelets

These lowered platelet levels cause bleedingfrom micro vessels in to the skin.

This manifests as purple areas ( purpura ) seenon the patients skin


53/65

DefinitionThrombocytopenia within 12 days after transfusion

of red cells, associated with the presence in thepatient of antibodies directed again the HPAsystems.Need to exclude DICNeed to send blood for HPA typing and antibody

screen


54/65

Viral infections screened for at the time ofdonation

Bacterial infections from contaminated bloodcomponents


55/65

Each unit of blood contains 250 mg of iron

For patients on long term transfusion therapythis starts to accumulate and become toxic

causing damage to the liver heart, pancreasand organs of the endocrine system

Drug therapy is given to excrete this excess


56/65

Fluid OverloadCaused when too much fluid is transfused orthe transfusion is to rapid

Signs & Symptoms includeAcute Left ventricular failure,dyspnoea,Hypotension, Tachycardia raised jugularvenous pressure


57/65

Signs & Symptoms can range from:

Mild and common (estimated risk 1 in100Urticaria (a raised red itching rash) Treated with anantihisamine with the transfusion beingrecommenced if the symptoms subside

ToRare (estimated risk 1 in 500,000)but very severe and sometimes fatal anaphylaxismanifesting in:- low BP, laboured breathing oroedema, respiratory and cardiac arrest respiratory &cardiac arrest


58/65

Caused by antibodies in the donors plasmareacting strongly with the patients leucocytes

Signs & Symptoms

Transfusion is followed by a rapid onset ofbreathlessness and non productive coughChest x ray characteristically shows bilateralpulmonary infiltrates or white out


59/65

Acute dyspnoea with hypoxia and bilateralpulmonary infiltrates during or within 6 hours oftransfusionInform transfusion as soon as possibleTreat as adult respiratory distress syndromeNeed to inform the National Blood Service

Wh t i thi ? Wh t i ith it?


60/65

What is this? What is wrong with it?What would you do if you saw it?


61/65

Can occur during collection, storage & thehandling processes

Bacterial ContaminationEstimated frequency

per unit

Red Cells 1/500,000

Platelets 1/12,000


62/65

An Acute medical emergency Caused by ABO incompatible transfused red cells.

Probably due to misidentification of

The patientThe product

orThe sample

Seek Haematology Input immediately


63/65


64/65

Stop the Transfusion and seek Medical Input and inform theTransfusion 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 back totransfusion capped off at the end with a white venflon cap and any previous transfused bags sealed with the blue plugs allin biohazard bags

Documentation (complete the checklist)

Complete a Trust Incident form


65/65

Transfusions of blood & blood componentsare labour intensive & expensive but arefrequently life saving

In a few patients, however they can result inpotentially fatal complications.

It is therefore essential that they are onlygiven when the benefits outweigh the risks

BloodManagementSession_March08

Documents

Transcript of BloodManagementSession_March08