Académique Documents
Professionnel Documents
Culture Documents
POLICY STATEMENTS:
I. Written, informed consent is required for transfusion of blood products, except in emergency
situations.
II. A physician's order is required for administration of all blood products (whole blood, packed
cells, platelets, plasma and cryoprecipitate). The order must include the indication(s) for use
of any blood product ordered (see SUF Form #15-0373-0 Physician’s Order for Transfusion
Service).
III. Patients must have a blood identification band at the time of specimen collection for
crossmatch and for blood product administration.
IV. Two clinical care providers (CCP) must verify patient identification using two patient
identifiers (patient name and MR#). Verification must take place in the presence of the
patient at the time the blood band is applied and the specimen is obtained. Documentation
of verification must accompany specimen to Blood Bank (BB) for acceptance.
V. The Blood Identification Band is to be completed in handwriting in the presence of the
patient.
VI. Two individuals, one of whom must be the transfuser, must verify all blood products prior to
transfusion. Those verifying must be comprised of at least an RN, ECMO specialist, PA or
MD.
VII. If the unit has been verified and transfusion has not been immediately initiated or the
verification process is interrupted, the unit verification process must be repeated.
VIII. Blood products must be administered only by an RN, ECMO Specialist, PA, or MD.
IX. An LPN who has successfully completed the competency for blood administration:
A. may not initiate a blood product transfusion,
B. may monitor the blood product transfusion under the direction of an RN,
C. may verify blood product only with an RN.
X. Only blood bank monitored refrigerators in the ICUs can be used for the storage of blood
products when a delay of emergent transfusion greater than 15 minutes would impact
patient outcome. Use of medication or any other refrigerator is unacceptable.
SPECIAL INSTRUCTIONS:
II. Collecting & Labeling Initial Specimen for Compatibility Testing (See Appendix B)
III. Collecting & Labeling Subsequent Specimen for Compatibility Testing (after initial
Banding)
IV. Other Blood Bank Diagnostic Tests (see Appendix E for specifics)
VII. Administration
A. Blood Administration Set (tubing - see Appendix J & Infusion Devices section below for
more details):
i. All blood products must be administered through a standard infusion set (150-280
micron filter screen).
ii. Prime blood tubing with NS only.
iii. Blood tubing may be used for 2 consecutive units of red blood cells or plasma in
routine use.
iv. Tubing must be changed at least every 4 hours.
v. Platelets should be administered via the tubing available on the unit or in clinic.
vi. Blood may be administered via IV pump.
a. AABB Standard 5.19.10 “With the exception of 0.9% sodium chloride (USP),
drugs, or medications shall not be added to blood or components unless one of
the following conditions are met:
1. They have been approved for this use by the FDA.
2. There is documentation available to show that the addition is safe and
does not adversely affect the blood or component.”
B. Initiating Transfusions: (Note: LPN may not initiate blood product transfusions.)
i. Check the pt ID band one more time just prior to releasing the flow control clamp.
ii. Begin the infusion slowly.
iii. Record start date and time of transfusion on blood tag.
iv. Monitor vital signs prior to blood transfusion, 15 minutes into transfusion, then after
15 minutes and observe patient for reaction.
a. Transfuser must stay with the patient for the first 5 minutes to observe for
reaction.
A. Monitor patient for signs & symptoms of a transfusion reaction such as:
i. Fever, with or without chills
ii. Heat at the infusion site and along vein
iii. Flushing
iv. Hives, rash, erythema, itching
v. Dyspnea or shortness of breath
vi. Increase in blood pressure (>50mmHg)
vii. Abdominal pain or nausea
viii. Rigors, lumbar pain
ix. Anxiety, chest pain, flank pain
x. Hypotension
xi. Unexplained bleeding, blood in urine
B. If the patient develops signs & symptoms of a transfusion reaction:
i. Stop transfusion
ii. Keep IV open with NS
iii. Verify correct unit was given to correct patient
iv. Document patient re-verification on the back of the blood tag by checking the box
and initialing the appropriate spot.
v. Notify attending physician and blood bank
A. Keep blood product bag/syringe and administration set intact and place in biohazard
bag.
B. Collect blood and urine samples then send with blood unit and administration set to
Blood Bank for all other symptoms other than hives & itching.
i. Obtain specimens:
a. Adults: 1, 6 mL EDTA lab tube (Pink) and 1, 7 mL (Red) lab tube (no serum
separator)
XI. Transporting Blood Products (refer to blood transport module) (back to top)
A. Transporter
i. Do not transport blood while eating, drinking or smoking.
ii. Follow Universal Precautions.
iii. Provide patient’s Name and MR# to Blood Bank (BB) upon arrival to ensure that the
right blood is transported.
iv. Show ID badge to BB staff.
v. Take blood product directly to the patient care-giver that dispatched you.
vi. Use the shortest route to/from the BB and the patient care location.
vii. Deliver blood product quickly but safely (less than 5min).
viii. Do not leave blood products unattended.
ix. Transport blood in the appropriate container (biohazard bag or designated blood
transport box/cooler).
x. Keep transport container lid tightly closed.
xi. Never place Platelet or Cryo blood products in the same transport container as Red
Cells and Plasma.
xii. Return cooler, coolant and temperature monitor to the Blood Bank.
xiii. Return blood issued in a biohazard bag if transfusion not started within 30 minutes.
xiv. Return cooler for replacement coolant if cooler in use for more than 2 hours.
B. Receiver
i. Keep transport container lid tightly closed.
ii. Never place Platelet or Cryo blood products in the same transport container as Red
Cells and Plasma.
iii. Return blood issued in a biohazard bag if transfusion not started within 30 minutes.
iv. Return cooler for replacement coolant if cooler in use for more than 2 hours.
v. Return cooler, coolant, temperature monitor and all unused blood products to the
Blood Bank immediately following the crisis ¨Return cooler and its contents if the
temperature monitor beads are mobile (cooler is no longer cold).
C. Policy: The temperature of blood and blood components transported to customers must
be maintained within the limits prescribed in the AABB standards 5.1.8.
i. Proper Transport Temperatures:
a. Cold – Red Cells & Plasma (1º-10ºC)
b. Room Temp – Platelets & Cryo (20º-24ºC)
ii. Maximum Storage Time in Transport Container:
a. Cooler or Blood Box – 4 hrs
b. Biohazard bag – 30 minutes
A. Any refrigerated blood product that has been out of a Blood Bank monitored refrigerator
for greater than 30 minutes must be returned to the main blood bank for proper
evaluation and disposal if necessary.
B. The following blood bank monitored refrigerators may be used to store blood products:
i. PICU
ii. CICU
iii. OR
iv. SICU
v. BICU
vi. ER
vii. Cancer Center Lab
C. Nursing or clerical staff may sign-in or sign-out blood products from the satellite
refrigerators.
D. Record the following information on the sign-out log to place blood products in the
satellite refrigerator.
i. Date and time placed in refrigerator.
ii. Recipient name and MR#.
iii. Component type.
iv. Donor number.
v. Appearance of beads, in cooler, if applicable.
E. To remove blood products from the satellite refrigerator for transfusion, record the
following information adjacent to the corresponding documented donor number on the
sign-out log:
i. Date and time product removed.
ii. Signature of staff removing blood product.
F. Blood products may be returned to the satellite refrigerator only if the product has been
out of the refrigerator less than 30 minutes, or properly stored in a cooler and maintained
between 1-10ºC.
G. To return unused blood products to the satellite refrigerator, record the following
information adjacent to the corresponding donor number on the sign-out log:
i. Signature of staff returning blood product.
ii. Date and time returned.
iii. Appearance of beads in cooler, if applicable.
H. Blood Bank staff removes expired blood products and products assigned to patients with
expired Type & Screen from the satellite refrigerators nightly.
I. Additional Information
i. It is the responsibility of the unit staff or PST to sign blood in on the “Satellite
Refrigerator Sign-out” log designated for each refrigerator.
ii. Never refrigerate Platelets, Platelet Pheresis, Cryoprecipitate or Leukocytes.
iii. In cases of pediatric split products that have been entered, write the date and time
entered on the unit label.
iv. Return unit(s) to the Blood Bank if:
a. Temperature beads are mobile.
b. Unit out of refrigerator greater than 30 minutes.
c. Temperature is greater than 10ºC.
v. Aliquotting or repeat entry into a unit on the floor is unacceptable. Aliquotting must be
performed in the blood bank under appropriate conditions.
vi. All blood products expire within 4 hours of being entered on the floor.
KEYWORDS: labeling, patient ID band, crossmatch, hang time, transfusion, blood component
REFERENCES:
SIGNATURES:
_________________________________________
_________________________________________
Your physician has ordered a blood test before you have surgery. When your blood sample is
drawn, you will receive a blood identification bracelet that will be placed on your wrist.
This blood ID bracelet has a unique number on it that will be used to identify special blood
products in case you need a blood transfusion during surgery or after. Keep wearing this
bracelet, even if you are not scheduled for surgery for another three days.
If you remove your blood ID bracelet, we will have to re-draw your blood, give you a
new bracelet and re-test your blood – all of which will be charged to you.
So please do not take off your blood ID bracelet. Your cooperation with this safety
measure is appreciated.
Type & Screen (Diagnostic Only) - generally used for Prenatals, Pre-ops greater than 3days in
advance of surgery and for transplant evaluations. In these cases, transfusion within 3 days is not the
primary goal. This test will be used to determine if there will be a problem finding units for possible
future transfusions. No BBID band required.
ABO & Rh Confirmation - to be used for 2nd type (generally requested by transplant group or Blood
Bank).
Create an out-patient tracking number by using the delivery location prefix*, the current date and the
patient’s initials. Ex: #INF092605SMG for a unit going to the infusion center for patient Sally M. Gator.
This number (not the patient name or MR# - for HIPAA reasons) is given to the courier or driver. When
the driver arrives with the tracking number, it is compared to the tracking number on the faxed dispense
slip or the already packaged transport box/cooler.
APPENDIX H: ABO/Rh Compatibility Chart for ABO Incompatible Bone Marrow Transplant Patient Population
(back to section or top)
To be followed post transplant & until documented ABO/Rh conversion occurs.
ACCEPTABLE
PATIENT'S ABO (Listed in order of preference)
Donor ABO Packed Cells FFP & #Cryo Platelets
Pack all plasma ABO incompatible
O A $O any Rh A, AB A, *AB, !O, *!B
O B $O any Rh B, AB B, *AB, !O, *!A
O AB $O any Rh AB AB, !A, !B, !O
A O $O any Rh A, AB A, *AB, !O, *!B
A B $O any RH AB *AB, !A, !B, !O
A AB $A, $O any Rh AB AB, !A, !B, !O
B O $O any Rh B, AB B, *AB, !O, *!A
B A $O any Rh AB *AB, !B, !A, !O
B AB $B, $O any Rh AB AB, !B, !A, !O
AB O $O any Rh AB AB, !A, !B, !O
AB A $A, $O any Rh AB AB, !A, !B, !O
AB B $B, $O any Rh AB AB, !B, !A, !O
Patient's Rh Donor's Rh
pos pos any Rh any Rh any Rh
neg neg neg any Rh 1st neg 2nd *pos
pos neg neg any Rh 1st neg 2nd *pos
neg pos neg any Rh 1st neg 2nd pos
*Red cell free $Washed !Packed (low titer) #Type specific should be given if AB not available
Back
M A N A G E M E N T O F A C U T E T R A N S F U S IO N R E A C T I O N S
Im m e d ia te S te p s fo r A ll R e a c tio n s :
1. S t o p T r a n s f u s io n . 3. V e r if y c o r r e c t u n i t w a s g iv e n t o c o r r e c t p a t i e n t .
2. K e e p IV O p e n w it h 0 . 9 % N a C l 4. N o t if y a t t e n d in g p h y s i c ia n a n d b lo o d b a n k .
A f t e r T r a n s f u s i o n i s T e r m in a t e d ( e x c e p t m i ld a l le r g ic , s e e b e l o w ) :
5. S e n d r e q u e s t f o r r e a c t i o n w o r k u p , f r e s h l y c o ll e c t e d b l o o d a n d u r in e s a m p le s w it h b lo o d u n i t
a n d a d m in is t r a t io n s e t t o b l o o d B a n k
R e a c tio n T y p e S ig n s & S y m p t o m s E t io lo g y C li n ic a l A c t i o n / P r e v e n t i o n
A c u te h e m o ly t ic A n x ie t y , c h e s t p a in , fla n k H e m o ly t ic t r a n s fu s io n S t e p s 1 - 5 a b o v e ; t r e a t w it h v a s o p r e s s o r s , I V f lu id s ,
p a in , d y s p n e a , c h ills , f e v e r , r e a c t io n ; u s u a lly d u e t o c o r t ic o s t e r io d s a s n e e d e d ; m a in t a in a ir w a y ;
s h o c k , h e m o g lo b in u r ia , c a r d ia c A B O in c o m p a t ib ility o r in c r e a s e r e n a l b lo o d f lo w ( I V f lu id s ; fu r o s e m id e ) ;
a r r e s t , h e m o g lo b in e m ia , c o m p le m e n t - f ix in g m a in ta in b r is k d iu r e s is ; m o n it o r r e n a l s t a tu s f o r
u n e x p la in e d b le e d in g r e d c e ll a n t ib o d y a c u t e r e n a l f a ilu r e . M o n it o r c o a g u la t io n s t a t u s f o r
D I C ; a d m in is t e r b lo o d c o m p o n e n t s a s n e e d e d
a f te r e t io lo g y is c le a r .
E n s u r e p r o p e r s a m p l e /r e c ip i e n t i d e n t i f ic a t io n .
A c u te lu n g in ju r y F e v e r , c h ills , d y s p n e a , A n t ib o d ie s f r o m d o n o r S u p p o r t iv e t h e r a p y f o r r e s p ir a t o r y f a ilu r e , o x y g e n ,
( T R A L I) r e s p ir a t o r y f a ilu r e , h y p o x ia , p a ls m a t o r e c ip ie n t 's m e c h a n ic a l v e n t ila t io n , l e u k o c y t e - r e d u c e d b l o o d
p u lm o n a r y e d e m a , W B C s ; le s s c o m m o n ly c o m p o n e n t s u n t il e tio lo g y is c le a r ( d o n o r v s
h y p o t e n s io n r e c ip ie n t a n t ib o d ie s t o r e c ip ie n t a n t ib o d y ) .
W BCs
A le r g ic ( m ild ) P r u r it u s , u r t ic a r ia ( h iv e s ) A n t ib o d ie s t o p la s m a S t e p s 1 - 4 a b o v e ; a d m in is t e r a n tih is t a m in e s
p r o t e in s ( P O , I M o r I V ) ; r e s u m e tr a n s f u s io n if im p r o v e d ; if n o
im p r o v e m e n t in 3 0 m in u t e s t r e a t a s b e lo w .
A le r g ic H iv e s , d y s p n e a , a b d o m in a l A n t ib o d ie s t o p la s m a S t e p s 1 - 5 a b o v e ; a d m in is t e r a n tih is t a m in e s ,
(m o d e ra te to p a in , h y p o t e n s io n , n a u s e a , p r o t e in s , in lc u d in g Ig A e p in e p h r in e , v a s o p r e s s o r s , a n d c o r t ic o s t e r o id s a s
s e v e re ) a n a p h y la x is , t h r o a t t ig h te n in g n e e d e d ; a v o id f u t u r e r e a c t io n s b y p r e m e d i c a t i o n
w h e e z in g a n d u s e o f w a s h e d re d c e lls .
C h e c k p re tra n s fu s io n Ig A le v e l.
C ir c u la t o r y H e a d a c h e , s h o rtn e s s o f b re a th ; T o o r a p id a n d / o r I n d u c e d iu r e s is ; p h le b o t o m y ; s u p p o r t c a r d io -
o v e r lo a d s y s t o lic h y p e r t e n s io n ( > 5 0 m m H g e x c e s s iv e t r a n s f u s io n r e s p ir a t o r y s y s t e m a s n e e d e d . A v o i d r a p i d o r
r is e ) , p u lm o n a r y e d m a , c o n g e s t iv e e x c e s s iv e tra n s fu s io n .
h e a r t f a ilu r e ; c a r d ia c a r r h y t h m ia s
F e b r ile ( m ild t o F e v e r , c h ills , r ig o r s , a n x ie t y , A n t ib o d ie s t o le u k o c y t e S t e p s 1 - 5 a b o v e ; m ild - a d m in is t e r a n t ip y r e tic s a s
m o d e ra te ) m ild d y s p n e a a n tig e n s , ( m o s t ly H L A ) ; n e e d e d ; a v o id f u r t u r e r e a c t io n s b y p r e m e d ic a t io n
c y t o k in e s a n d u s e o f le u k o c yte -re d u c e d re d c e lls & p la te le ts .
H y p o t e n s io n H y p o t e n s io n , ta c h y c a r d ia B r a d y k in in g e n e r a t io n , S t e p s 1 - 3 a b o v e ; f lu id s ; T r e n d e le n b e r g p o s it io n ;
m a y b e e x a c e rb a te d b y d is c o n t in u e A C E in h ib it o r ; a v o i d b e d s i d e l e u k o c y t e
A C E in h ib it o r s r e d u c t io n f i l t e r s . ( L e u k o c y t e r e d u c t io n p e r f o r m e d
in S U F - B lo o d B a n k . )
S e p t ic / t o x ic C h ills , r ig o r s , f e v e r B a c te r ia c o n t a m in a t io n S t e p s 1 - 5 a b o v e ; t r e a t s h o c k w it h v a s o p r e s s o r s ,
h y p o t e n s io n , t a c h y c a r d ia o f b lo o d p r o d u c t s I V f lu id s ; g iv e a n tib io t ic s . C u lt u r e s a m p le s f r o m
lu m b e r p a in , n a u s e a , v o m it in g , p a t ie n t a n d b a g .
s h o r tn e s s o f b r e a t h ; c h a n g e in
s y s t o lic b lo o d p r e s s u r e
APPENDIX L – POST
TRANSFUSION INSTRUCTIONS
FOR OUT PATIENTS
(back to section or top)
Nurse: Fill out form and make two photocopies. Keep one copy for medical
records and give one copy to patient.
This blood transfusion has been administered to you by order of your physician as
part of his treatment of your condition.
The blood you received is crossmatched with your blood prior to the transfusion in
order to assure that the blood transfused is as safe as possible using current
approved laboratory tests.
The majority of blood transfusions cause no reaction; however even with the
assurance of pre-transfusion testing, blood transfusions my produce some adverse
reactions. Following is a list of possible reactions from infusing blood:
I hereby acknowledge receipt of a copy of these instructions and have had them
explained to me. I understand them and agree to follow-up care, as instructed if
needed.
____________________________________________________
Patient or representative signature
RBCs = red blood cells; Hct = hematocrit; WBCs = white blood cells; CMV =
cytomegalovirus; PMN = polymorphonuclear leukocytes; FFP = fresh frozen plasma;
PPF = plasma protein fraction; IV = intravenous; IM = intramuscular
*Order from Pharmacy