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Blood Administration click here for pdf version of this page

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The Transfusion Administration Checklist is a useful tool to ensure the correct steps are followed when administering blood products.
atient reparation
rior to Collection of Blood roduct
!"uipment
Collecting the Blood roduct
retransfusion Check
#uration of Transfusion
Co$Administration of %edication and other fluids
%onitoring of Transfused atients
#ocumentation
#isposal of &aste
References


atient reparation
The patient should be ready for transfusion prior to picking up blood from the Transfusion Service e.g.
Medical order for transfusion.
nformed consent documented. !or any non"emergency transfusion the patient # parents should have had the benefits # risks of
transfusion discussed and an opportunity to have any $uestions answered. Blood'afe Consent Quick Reference (uide %&'!( for
medical staff who need to obtain informed consent for blood and blood products.
)ppropriate * access patent.
+heck resuscitation e$uipment, including o,ygen and adrenaline are available and in working order.
Transfusion Basics) rescribing Blood *++, " a guide for Medical -fficers for prescribing blood products.
Blood &ho needs it- Consumer Brochure (./ 0B)1 )lso available in.

Arabic %/021 23(
(reek %/420 23(
2talian %65 23(
'panish %6/ 23(
Turkish %/7/1 23(
3ietnamese %2026 23(

atient (uide " 8uestions to )sk 9our 'octor.

rior to Collection of Blood roduct

+heck the medical order for transfusion.
n non"urgent#non"bleeding#stable patients red blood cells should :-T be transfused between 2200"0600hrs where ever possible for
patient safety. )lways check urgency with the medical officer. f there is doubt do not delay the transfusion.
;nsure informed consent documented in the medical record %non"emergency patients(.
;,plain the procedure to the patient#parent, including possible transfusion reactions.
+heck the patient is wearing an ' band and that the details are correct %check against the patient<s medical record(.
;nsure intravenous access is patent.
Take the patient<s T&= and 3&
+heck for any premedication re$uirements and if ordered administer sufficiently in advance to allow effectiveness.
+heck resuscitation e$uipment, including o,ygen and adrenaline are available and in working order.

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!"uipment
!or red cells, platelets, fresh fro>en plasma %!!&( and cryoprecipitate.
)lways use * blood line incorporating a /60"200 micron filter to remove clots and clumps of debris.
o * blood lines must be changed every 5 hours, with new * fluids or on completion, whichever
comes first.
o 3a,ter * blood lines contain a 200 micron filter and are therefore appropriate to use when
administering blood products
* pole#hook " never share an * pole with 2 patients
:ormal saline to prime line if re$uired.
n neonates and small paediatric patients the blood product is used to prime the line to prevent unnecessary fluid
volume being administered to the patient.
'isposable gloves and eye protection glasses
)lcohol Swab
Tape to secure * line as re$uired


5eonates
Syringe &ump
Medication label
* blood line incorporating a /60"200 micron filter
Three way tap , 2
30 m? luer lock syringe
'isposable gloves and eye protection glasses
Sterile trolley cover
Minimum *olume e,tension tubing %/70 cms(
umps
&umps may be used only if the manufacture has documented evidence of safety of blood product
administration %e.g. does not damage the red cells or platelets(.
The ma,imum rate at which the manufacturer has tested the pump for safe administration of blood products
must not be e,ceeded.
!!& and +ryoprecipitate contain very few cells and can be given safely via any pump.
The pump line must incorporate a /60"200 micron filter to remove clots and clumps of debris.
Staff using the pump must be competent with its use. The rate and volume administered must be checked at

least hourly and with any rate change.
;,amples of manufactures that have stated their pumps can be used for blood product administration include.

Ba6ter Colleague
=ed cells @ ma,imum rate /200 m?#hr
&latelets @ ma,imum rate 300 m?#hr

(emini 'eries
=ed cells @ ma,imum rate 111 m?#hr
&latelets @ ma,imum rate /70 m?#hr


Syringe 'rivers
Syringe divers are safe for blood administration in neonates and small infants.
Ahen blood is being administered by syringe, the blood must be drawn into the syringe via a new *
blood line incorporating a /60"200 micron filter.
)lways maintain aseptic techni$ue.
+arefully label the syringe with correct patient details. 3oth staff checking the right patient identification
and right blood product must sign the syringe label verifying correct patient#pack detail


Blood &armers
3lood components may be warmed during or Bust prior to transfusion, if clinically indicated.
3lood should be warmed using a specifically designed commercial blood warming device.
These must be operated strictly according to the manufacturerCs instructions and re$uire a /2 monthly maintenance and validation
program.
:;*;= warm blood in a microwave, immersion in water or by placing on heat generating machinery.
+onsider warming red blood cells in the following circumstances.
&atients receiving massive transfusion
Dypothermic patient re$uiring transfusion
ntrauterine and ;,change transfusion

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Collecting the Blood roduct

3lood products should only be picked up when the transfusion is ready to commence in order to ensure appropriate storage and maintain
safe and viable products.
3lood products must not be stored in ward areas or domestic fridges and should not be placed on heat"generating machinery.
f the transfusion cannot commence within 30 minutes, the product must be returned to the Transfusion Service immediately for
appropriate storage and to prevent wastage of the product.
f a blood product is not used it should be returned to Transfusion Service for updating of the laboratory database so the product is not
recorded as transfused to a particular patient.
:ote. that !resh !ro>en &lasma and +ryoprecipitate are thawed %in a temperature monitored water bath( by Transfusion Service prior to
issue. Telephone Transfusion Service when these products are re$uired and allow 30 minutes for thawing.
There are remote 3lood !ridges in the Daematology#-ncology +linic and =ogerson Theatres. Strict documentation of blood unit
movement @ in and out of these fridges is re$uired by Transfusion Service @ staff must complete the =emote 3lood !ridge =egister.

Blood7roduct Authorisation Form
) 3lood#3lood &roduct )uthorisation !orm is re$uired for all products to be picked up from the Transfusion Service. The release order
can be completed by all clinical staff %nursing#midwifery and medical(.
)ttach patient identification label, sign and date form and indicate which product is to be collected.
Ahen staff remove blood products from a =emote 3lood !ridge, they need to take paperwork with the patient details to the fridge to
check they have collected the correct unit. The =emote 3lood !ridge =egister is completed when blood is entered and removed from the
fridge.

Collecting the Blood ack
) &S), theatre orderly, nurse#midwife or medical staff may collect a unit of blood from Transfusion Service.
The person collecting the product must.
o +heck they have the correct blood product with a Transfusion Service staff member.
o +ompare the patient details on the 3lood#&roduct )uthorisation !orm with those on the 3lood#&roduct Transfusion =eport and
those on the blood pack labels with a Transfusion Service staff member. f there is any discrepancy, this must be resolved before
leaving the Transfusion Service.
o Sign and print their name, plus record the date and time of collection on the white copy of the 3lood#&roduct Transfusion =eport
%this copy is retained by the Transfusion Service(.
The blood must then be taken to the ward#unit without delay or deviation to another area.
Epon arrival to the ward#unit the blood must be handed to a responsible clinical staff member @ not left unattended on a bench#desk.

retransfusion Check




.
Safe transfusion re$uires a final identity check at the patient<s side before blood administration. This is vital to ensure the right blood is given
to the right patient.
The pretransfusion check must be completed before commencing the transfusion by two clinical staff %registered nurse#midwife, anaesthetic
nurse or medical officer( one of whom must then spike and connect the product. The staff members signing for the blood transfusion are
verifying that the check has been correctly completed prior to the transfusion, and that no discrepancies were identified.
The following checks are carried out at the patient<s side to ensure the right patient receives the right blood product.
+heck the blood product for signs of leaks, clots or abnormal colour.
&atient dentification.
)sk the patient to state#spell their surname, first name and date of birth %wherever possible( and make sure that these details are the
same on the patient<s ' band.
Special care should be taken for those patients who cannot state their name for whatever reason.
*erification of patient identity should be checked with the parent#carer#spouse if the patient is unable to state his#her name and the
carer is present.
The patient must be wearing an ' band detailing the patient<s Surname, !irst :ame%s(, 'ate of 3irth, E= :umber and Fender.
)lternative methods of patient identification such as photo ' %3oyland Aard( or unknown patient uni$ue identifier may be used as
per hospital guidelines.
*ery low birth weight neonates in :+E nursed in an enclosed isolette are an e,ception. !ollow :+E patient identification
guidelines e.g. two identification bands labeled as stated above will be placed inside the cot facing outwards.


The checking process involves both staff verball8 confirming the follo9ing details)

=FDT &)T;:T

Check the %edical :rder; Blood roduct Transfusion Report; atient 2dentification Band and atient Compatibilit8 <abel for
the follo9ing and ensure the8 are identical7correct)
atients 'urname
&atient<s !irst :ame%s(
'ate of 3irth and#or Medical =ecord :umber %or unknown patient uni$ue identifier(.

=FDT 3?--' &=-'E+T
Check the %edical :rder; Blood roduct Transfusion Report; Blood Component <abel and atient Compatibilit8 <abel for the
follo9ing and ensure the8 are correct)
roduct
'pecial re"uirements if re"uired = leucodepletion; irradiated; C%3 negative; ><A matched or 9ashed
=FDT &)+2
+heck the Medical -rder, 3lood &roduct Transfusion =eport, 3lood +omponent ?abel and &atient +ompatibility ?abel for the
following and ensure they are identical#compatible.
Blood (roup of atient and #onor
Blood #onation7Batch 5umber
!6pir8 #ate and Time
The colour coding on the images belo9 outlines the details to be checked on the %edical :rder; Blood ack; atient
2# Band and Blood Transfusion Report Form1

%edical :rder

Blood ack









Blood roduct Transfusion
Report

2f there are an8 discrepancies detected during the checking process #: 5:T R:C!!# until the8 have been rectified and it is safe to do so1
+ontact Transfusion Service immediately if there are any concerns or doubts with the blood product " phone /6320 or /60/4.
-nce the checking procedure has been correctly completed without any discrepancies, one of the two people involved in the checking process must spike and
connect the pack.
o ;nsure protective eye wear and gloves are used.
o Ese an aseptic techni$ue as per * management standards.
o &rime the * blood line with normal saline or the blood product. ;nsure all air is removed from the line.
o Dang the pack on the * pole and attach the * blood line to the correctly identified patient. !ollow * management standards.
o +heck the rate of the infusion. =emember to start infusion slowly for the first /7 minutes. f using a pump check rate is accurately set.
o +ommence transfusion.

5eonates
Esing aseptic techni$ue, wearing sterile gloves and eye protection connect the transfusion set, syringe and three way tap.
Second checking person connects infusion set to the blood pack.
Aithdraw the re$uired volume into the syringe %G 3 mls(, e,pel air
Turn 3 way tap off to blood pack
+lose roller clamp
'isconnect syringe from 3 way tap %)t the completion of the transfusion this set up is returned to Transfusion
'epartment(.
)ttach syringe to minimum volume e,tension tubing and second 3 way tap.
&rime the tubing and 3 way tap
?abel the syringe with the medication label
&lace the syringe in the pump and set the re$uired rate. =e check the medical order.
)ttach to * cannula or 20g lumen of E.*.+. and check infusion has been set up correctly. +heck 3 way tap is on to neonate and syringe.
+ommence transfusion.
=emove the second detachable &atient +ompatibility ?abel and attach it to the 3lood and 3lood &roduct )dministration =ecord. 3oth staff must sign and print
their name and document date and time of commencement.

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#uration of Transfusion

Transfusion should proceed at a rate that is appropriate to the patient<s clinical state as ordered by the medical officer.
The ma,imum infusion time for each pack of red cells, platelets, !!& and dose of cryoprecipitate is four hours from spiking the pack to
completion of transfusion.
The transfusion should commence at a slower rate than ordered for the first fifteen minutes. f the patient does not have any side effects
at this time, increase rate as ordered by the Medical -fficer.

The recommended transfusion times in stable paediatric and adults are.
=ed cells 2 " 4 hours
&latelets 30 " 60 minutes
!!& 30 " /20 minutes
+ryoprecipitate /0 " 30 minutes

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Co$Administration of %edication and other fluids

:o medications or solutions should be added to or infused through the same tubing as blood products e,cept
for sodium chloride 0.1H. See flippin? blood for individual product solution compatibilities.
!luids containing de,trose %glucose( are :-T compatible with red blood cells. &rolonged contact between red
cells and de,trose can result in a loss of water from the red cell with subse$uent destruction. This includes
glucose 7H with sodium chloride 0.47H %7H and I(.
+rystalloid or colloid solutions %DaemaccelJ, Dartmann<s solution( should never be added to or administered
concurrently with any blood product because they contain calcium. 3lood products contain citrate as an
anticoagulant therefore the addition of any calcium based solutions will result in the reversal of anticoagulant
causing clot formation.
Medications may interfere with the anticoagulant solution in the pack or cause unpredictable damage to the
blood product.
f a medication needs to be given.

;ither.
Ese of insert another cannula for drug administration

-r
Stop the transfusion
!lush the line with normal saline using the inBection port closest to the patient. ;nsure the line is clamped
above the inBection port.
)dminister the medication.
!lush the line again with normal saline. Enclamp the line.
=estart the infusion.
;nsure this manoeuvre does not result in the transfusion e,ceeding four hours.
The only e,ception is the following as it has been shown not to adversely affect red cells.
+o"administration of morphine %/mg#m? in sodium chloride 0.1H(, pethidine %/0mg#m? in sodium chloride
0.1H( and ketamine %/mg#m? in sodium chloride 0.1H( has been shown not to adversely affect red blood cells
or these medications %incorporate a non"reflu, value in the * lines(.

!6treme Circumstances for 5eonates and 'mall Children
t is recognised that intravenous access in neonates#children can be limited and lead to significant problems when
multiple intravenous blood products, fluids and medications need to be administered. n extreme circumstances the
medical officer may need to consider the risks of co"administration. f this is re$uired the blood product and
medication should be delivered via separate * lines. The blood product line should be connected closest to the patient
to minimise mi,ing of the medication and blood product. ) non"reflu, valve is re$uired on both the blood and
medication line. +ontact the Transfusion :urse +onsultant for further information &age.4/46.

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%onitoring of Transfused atients
&atient receiving blood products should be monitored for signs and symptoms of potential transfusion reactions #
complications.

-bservations
The patient must be observed closel8 during the first /. minutes of each pack of red cells, platelets and
!!& as some life"threatening reactions may occur after the infusion of only a small amount of blood.
) cryoprecipitate dose usually includes more than one pack. !or cryoprecipitate only, the patient must be
observed closely for the first /7 minutes of the transfusion.
Ahere possible, patients should be informed of potential symptoms of a transfusion reaction and should
inform staff immediately if they feel unwell during the transfusion.
The patient<s condition should be documented at this /7 minute interval.

:eonates
Temperature, pulse, respiration and blood pressure prior to commencement of each blood pack or blood
product.
Temperature, pulse and respiration hourly during administration.
Temperature, pulse, respiration and blood pressure on completion of each blood pack or blood product.

Children and Adults@ $ Temperature, pulse, respiration and blood pressure
prior to commencement of each blood pack or blood product.
hourly during administration.
on completion of each blood pack or blood product.K

-ther +onsiderations
The patient<s clinical status should determine the observations re$uired.
Some clinical areas may re$uire more fre$uent observations particularly in unstable or unconscious
patients.
More fre$uent vital signs should be taken if the patient has an unstable underlying condition or if the patient
becomes unwell or shows signs of a transfusion reaction.
K-bstetric patients %e.g. post partum haemorrhage( may re$uire hourly observations %for four hours( after
the completion of the transfusion to observe ongoing blood loss.

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#ocumentation
The following must be documented in the medical record.
&atient observations and outcome of the transfusion including any adverse effects.
3lood product administration start and finish times.
Eni$ue donation#batch numbers of product. 'ocument on the 3lood and 3lood &roduct )dministration
=ecord. This legal document must be filed in the patients medical record and be available for 20 years.
:ames and signature of both persons checking the product %on above mentioned form(.
*olume and type of product administered.
)ny e$uipment used such as pumps or blood warmers.

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#isposal of &aste
The following instructions are for all areas e,cept :+E and for patients who have had a transfusion reaction.
'ispose of * blood ?ine as per nfection +ontrol &olicy.
Esed blood packs must be return to the Transfusion Service.
o =emove * blood line @ fold blood bag tab over and tape down.
o &lace used bag in a pathology bioha>ard bag and seal.
o &lace bioha>ard bag into a brown plastic bag and have a &S)#theatre orderly return it to
Transfusion Service.
52CA
?eave * blood line attached to bag. This is done as only a portion of the blood will be used for a neonatal
and this will prevent spillage.
&lace partially used bag and attached line in a pathology bioha>ard bag and seal. The * blood line used in
:+E is smaller than the * blood line used elsewhere and is able to fit into a pathology bioha>ard bag.
&lace bioha>ard bag into a brown plastic bag and have a &S) return it to Transfusion Service.

Transfusion Reactions
?eave * blood line attached to bag.
'o not leave any sharp ends e,posed.
&lace in a brown plastic bag and have a &S) return it to Transfusion Service.

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References
)merican )ssociation of 3lood 3anks, 3lood Transfusion Therapy Aorking Froup /111, ) Fuide to 3lood
+omponent )dministration, 3ethesda.
)ustralian :ew Lealand Society 3lood Transfusion and the =oyal +ollege of :ursing )ustralia 2004, Fuidelines for
)dministration of 3lood +omponents, /st ;dition, Sydney, )ustralia.
)ustralian =ed +ross 3lood Service 2006, 3lood +omponent nformation, +ircular of information, )n e,tension of
blood component labels, *ictoria, )ustralia.
3irch, +., Dogan, +. M Mahoney, F. 200/, N+o )dministration of 'rugs and 3lood &roducts<, )naesthetic ntensive
+are, vol. 21, pp /36"/40.
+allum, O.?. M &inkerton, &.D. 2003, Nbloody easy, 3lood Transfusions, 3lood )lternatives and Transfusion
=eactions, ) Fuide to Transfusion Medicine< Sunnybrook and Aomen<s +ollege Dealth Sciences +enter, -ntario,
+anada.
+ouncil of ;urope &ublishing 2006, Fuide to the preparation, use and $uality assurance of blood components, /2th
;dition, +ouncil of ;urope &ublishing, Strasbourg, +ede,.
'oherty, M. 200/, )dministration of 3lood &roducts through the Femini nfusion &ump, )laris Medical Systems,
nc.
;insele, D., :orthoff, D. M :eumeister, 3. 2004, NFranulocyte Transfusion<, *o, Sanguinis, vol. 56, pp 207"205.
Doughton, A.O. 2003, 3a,ter Dealthcare +orporation ?etter date /1 March, llinois, ES).
=oyal +hildren<s Dospital, Melbourne, )ustralia, www.rch.org.au#bloodtrans
Aorld Dealth -rgani>ation 3lood Transfusion Safety /115, The +linical Ese of 3lood, Medicine, -bstetrics,
&aediatrics, Surgery M )naesthesia, Trauma M 3urns, Feneva.
)ccessed via www.who.int#bloodsafety#clinicalPuse#en#ManualP;:.pdf


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!urther information is available from Trudi 3errall, Transfusion :urse +onsultant 3loodSafe, &h. 6/"5"5/6/6000, ;,tension /6526, &ager. 4/46
rintable 3ersion
<ast %odified) +*$+B$*++C /B)*+)/+D #isclaimerD Cop8right