Transfusion Process for Nurses

8/4/2019 Transfusion Process for Nurses

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Blood Transfusion services are a vital part of modern health care system without which

efficient healthcare is impossible.

The aim of Blood transfusion services shouldbe to provide effective blood & blood products,

which are as safe as possible, & adequate to meetpatients need.

The Blood Transfusion services in our country are governed by the Drugs control Deptt. & wecome under the Drugs & cosmetics act, 1940.


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BLOOD DONATIONy Donor recruitment is critical to the success of supply

of safe & adequate blood & its products.y Donor recruitment strategies are:i. Pure voluntary & non remunerated based

recruitments.ii. Replacement donors in case voluntary donors are

not available. Hospital staff, specially clinicians canactively contribute in motivating the relatives &friends of patients, who had or will need bloodtransfusions.


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:

The first & most important step in ensuring thatBlood & its products for transfusion do not haveany pathogenic virus & bacteria. All donors arethere fore given educational material informingthem of high risk activities for HIV, of the clinicalsigns & symptoms of HIV & AIDS & theimportance of refraining from blood donation if they have been engaged in these activities. Age 18 60 yrsIn good health Weight more than 45 kgsHb > 12.5 g%


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The ABO Rh systemy A y By Oy ABUniversal DonorUniversal Recipient


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Plasm

aABO comp

atibi

lity ch

art:

Recipient s Blood Group Plasma Donor s bloodgroup

y O O, A, B, ABy A y B B, ABy

AB

Rh + plasma should not be given to Rh - women inreproductive age.


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BLOOD COMPONENTS

y Blood collected in the blood center is WHOLEBLOOD

Whole blood is then separated into variouscomponents:y PLASMA y PLATELETSy

RED BLOOD CELLSy CRYOPRECIPITATEy Pediatric purposes- Smaller volumes Dividing a unit

of whole blood in a closed system into satellite bags


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She lf Lif e o f Blood Components:

y Whole Blood : 21 to 35 daysy Red Cells : 42 daysy Platelets : 5 daysy FFP : 1 yry Cryoprecipitate : 1yr


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TRANSFUSION MEDICINE PROCESS MAPPINGFORM

y Blood Request Blood/ Blood Component RequisitionForm (90)

y Blood Issue . . ..Blood Component Issue Note(90 A)

y Blood Component Issue Compatibility Report & Sticker (generated online by BB)

y Blood Receipt Report from Ward to BB . .Blood Received Register

y Consent for Blood Transfusion ..Consent Form for transfusion of blood/ blood components (25)

Blood Transfusion at Ward .Blood Transfusion Note

y Transfusion Reporting to BB from Ward Post-transfusion Form (2 nd part of BloodComponent Compatibility Report)

Transfusion Reaction Investigation by BB . . Transfusion Reaction Investigation Form


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Administration of blood products:y A physician or a qualified nurse should administer

blood and blood products.y Before starting transfusion, patient identity check

should be done at the patient s bedside & from therecords of the patients.

y

Ask the patient himself/herself the name, if thepatient is unconscious identify the patient with wristband.


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y

Check the following details on the compatibility report, and the compatibility label attached to theblood product:

y Patient s namey Reg. no.y Blood groupy Bag no.y Collection and expiry dates of Blood

There should be no discrepancy.


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Check the b lood p a ck:y Any sign of damage or leakage of the blood/its

product.y

Collection and expiry date on blood pack.y Any cloty If the pack appears abnormal in any way, the unit must

not be transfused and the blood bank must beinformed immediately.


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Time limits f o r in fu sion Whole blood or R ed cells

y The administration of whole blood or red cells shouldbe started within 30 minutes of issuing from the bloodbank. If it is not required for transfusion it should bereturned immediately to the blood bank with reasons.

y Transfusion should be completed within 4 hours of starting the transfusion . These time limits have beendetermined for temperate climates where temperaturein hospital building is between 22 oC and 25oC. If theambient (room) temperature is very high, shorter out-of-refrigerator times should be used.

y Change the blood administration set after 2 hours, if the patient requires ongoing transfusion support.


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P latelet Concentratesy Platelet concentrate should be administered as soon as

they have been received.y

Infusion should be completed within about 15-20minutes.y Should be kept at room temperature 22 oC and 24 oC.

Do not put in refrigerator.y Should be administered with transfusion set with

filter.y Platelets once issued are not taken back in the blood

bank.


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F resh F rozen P lasmay FFP should be infused as soon as possible after thawing

to avoid loss of labile clotting factors or thawed plasmastored at 2-4 oC should be used within 12 hours.

y In adult, 1 unit of plasma should generally be infused with in about 15-20 minutes.

y Thawed or partially thawed plasma is not taken back inthe blood bank


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Disposable equipment fortransfusion:y Whole blood, red cells, platelet concentrate, plasma

and cryoprecipitate are infused though sterile bloodadministration set containing 170-200 micron filter.

y Leukocyte-depleting filters are expensive but they are

effective in reducing the febrile non-hemolytictransfusion reactions and the development of anti-leukocyte antibodies in multiple-transfused patients.


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Monitoring the transfusedpatients:For each unit of blood transfused, monitor the patient

at the following stages:I. Before starting the transfusionII. As soon as the transfusion is startedIII. For 15 minutes after starting transfusion

IV. At least every hour during transfusion V. On completion of the transfusion VI. 4 hours after completing the transfusion


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At each of these stages, record thefollowing information:

y Patient s general appearancey Temperaturey Blood pressurey Respiratory ratey Sign of any adverse reaction these signs are fever

with back pain (acute hemolytic transfusion reaction),anaphylaxis, hives or pruritus (urticarial reaction).Congestive heart failure (volume over load) or feveralone (febrile non-hemolytic transfusion reaction).


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y Monitor the patient carefully during the first 15minutes of the transfusion to detect any early signsand symptoms of adverse effects.

y The adverse effects of transfusion are usually dose-related, therefore, very slow transfusion rates are usedat the start, 15 to 50 ml are given during the first 15minutes. Once the transfusion is progressingsatisfactorily, the infusion rate can be increased so that

the product is transfused within a reasonable timedepending on the clinical condition of the patient.


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y Only isotonic (0.9 percent) saline or 5% albuminshould be used to dilute blood components or can beinfused with the transfusion set, because other I.V.solutions like dextrose solutions such as 5% dextrosein distilled water may damage the red cells and causehemolysis or calcium containing solutions such aslactated Ringer s solution initiate coagulation in theinfusion set. In addition, many drugs will causehemolysis if injected through the blood infusion set.


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B lood WarmingRoutine warming of blood is not needed; infusing 2-4 units of

refrigerated blood over several hours causes no harm.

Patients who may need benefit from warmed blood include:i. Adults receiving multiple transfusions at rates

greater than 50 ml/kg/hr.ii. Children receiving transfusion at rates greater than

15 ml/kg/hr.iii. Infants receiving exchange transfusioniv. Patients receiving rapid transfusion through

central venous catheter. v. Patients with cold agglutinins.The rapid and massive transfusion of cold blood (2-6 oC) isassociated with an increased risk of ventricular fibrillationand cardiac arrest.


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Blood warming procedure:

y It is carried our using approved blood warmer devices.y Blood is never warmed above 37 oC. Excessive warming

can cause hemolysis and endanger the patient. If blood warmers are being used they should be testedbefore use to ensure that the temperature regulatorsare operating properly.

y

Do not immerse whole unit of blood or red cells in a water bath.


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Transfusion reactions:y Any adverse effect caused by transfusion may be

considered a transfusion reaction. Some are mild,

others are life-threatening.y All reactions should be documented and reported.


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Category 1 Mild reaction:Signs Sy mptoms Possible cause

Localized:Urticaria

Rashes

Itching Hypersensitivity (mild)


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Moderately Severe:signs s y mptoms Possible cause

-Flushing-Urticaria

-Rigor-Fever-Restlessness-Tachycardia

-Anxiety -Pruritus (itching)

-Palpitations-Mild dyspnoea-Headache

-Hypersensitivity (moderately severe)

-Febrile non-hemolytictransfusion reactions-Antibodies to whileblood cells, platelets.-Antibodies to proteins,including IgA.-Possible contamination with pyrogens and/orbacteria.


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Life-Threateningsigns s y mptoms Possible cause

RigorsFever

RestlessnessHypotension (fall of >20% in systolic BP)Tachycardia (rise of >

20% in heart rate)Haemoglobinuria (red

urine)Unexplained bleeding

(DIC)

Anxiety Chest pain

Pain near infusion siteRespiratory distress/shortness of breathLoin/back painHeadacheDyspnoea

-Acute intravascularhaemolysis

-Bacterial contaminationand septic shock.-Fluid overload-Anaphylaxis,-Transfusion associatedlung injury.


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Cau ses:

Clerical errorsy Inadequate or incorrect labeling of Blood Bag, recipient s blood sample.y Confusion in the identity of patients at the time of collection of sample or at

the time of transfusiony Improper identification of patient s blood sample by blood bank techniciany Wrong blood issuedT echnical errorsy Error in blood grouping & cross matching.y Incompatibility not detected in cross matching due to improper method.y Weak antibodies not detected by routine tests.y

Destruction of recipient red cells by donor ab - may not be serious as donorantibodies are diluted in patient s blood. It mostly occurs in transfusion of group O to other groups.

y Incorrect interpretation of test results.


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Management in AdverseTransfusion ReactionsCategor y I: M ildy Stop transfusion.y

Replace the given set and keep I.V. line open with normal saline.y Notify the doctor responsible for the patient.y Administer antihistamine IM and oral antipyretic (eg.

Paracetamol).y Send blood unit with giving set, fresh blood samples (1 clotted and 1

in EDTA) from vein opposite to infusion site with appropriate

reaction form to blood bank of investigations.y Collect urine for next 24 hrs. for evidence of haemolysis and sent tolaboratory.

y In clinical improvement, restart transfusion slowly with new bloodunit if required and observe carefully.

y If no clinical improvement with in 15 minutes or if signs andsymptoms worsen, treat as Category 2.


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Category 2 : Moderately Severe/ Life-threatening :y Stop the transfusion, replace the giving set and keep I.V.line open with normal saline.y Infuse normal saline (initially 20-30 ml/kg) to maintain

systolic BP.y Notify the doctor responsible for the patient.y Maintain airway and given high f low oxygen by mask.y Give adrenaline (as 1:1000 solution) 0.01 mg/kg body weight

by intramuscular injection in severe allergic reaction.y Give I.V. corticosteroids and bronchodilators if there are

anaphylactoid features (e.g. bronchospasm, stridor).y Give diuretic: e.g. frusemide .y Send blood unit with BT set, fresh blood samples (1 clotted

and 1 in EDTA) form vein opposite to the infusion site, withappropriate reaction form to blood bank for investigation.

y Check a fresh urine specimen visually for signs of

hemoglobinuria (red to pink urine).


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y Start at 24 hour urine collection and fluid balance chart andrecord all intake and output. Maintain fluid balance

y Assess for bleeding from puncture sites or wounds. If there isclinical or laboratory evidence of DIC, give platelets (adult 5-6units) and either cryoprecipitate (adult 12 units) or fresh frozenplasma (adult : 3 units).

y Reassess. If hypotension persists:y Give further saline 20 30 ml/kg.y Give Ionotrope (Dopamine, IV infusion)y If urine output falling or laboratory evidence of acute renal

failure (rising K+, urea, creatinine):y Maintain fluid balance accurately y Give further frusemide.y Consider dopamine infusion.y Seek expert help: the patient may need renal dialysis.y If bacteraemia is suspected (rigors, fever, collapse, no evidence

of a haemolytic reaction), start broad spectrum antibiotics I.V. to

cover pseudomonas and gram positives organisms.


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Prevention:y There should be a written procedure for all aspects of

procuring, issuing & administering transfusion.y All staff should be trained in proper use of equipment,

IV solutions & drugs.y Medications should never be injected into Blood bags.y Care must be exercised in selection & use of IV

devices.


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SAFE TRANSFUSION

BLOOD DONORS

Safe Transfusion

Transfusion Process for Nurses

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