Review of Standards of Practice: Blood Transfusions

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Review of Standards of PracticeBlood
Transfusions

• Prepared for
• Case-Based Learning
• May 30, 2002
• Lou Ann Montgomery, PhD, RN, CCNS, CCRN
• Director, Nursing Education
• Department of Nursing Services and Patient Care

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Standards of Practice

• Blood specimen collection for Type and
  Screen/Type and Crossmatch

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1. Prepare Requisition

• Patients name
• Hospital number
• Doctors name and CLP number
• Blood products ordered
• Other information, testing, preparation as
  appropriate
• Blood availability (routine/emergency)

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2. Prepare Typenex Band

• Patients name (first and last)
• Hospital number
• Date sample drawn
• Detach one numbered label from the band and
  attach it to the requisition in the location
  indicated

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3. Obtain a Witness

• All blood draws and labeling must be witnessed!
• - Doctor
• - Physician's assistant
• - Medical student
• - Registered nurse
• - Licensed Practical Nurse
• - Nursing Assistant
• - Nursing Unit Clerk
• - Pathology Personnel
• - Similar healthcare providers but not
  including patient/family

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4. Identify the Patient

• Ask the patient to state their name
• Verbally verify that ID bands (inpatients),
• Typenex band and requisition are correct
• If anything is incorrect, DO NOT PROCEED
• Correct as necessary!
• If no discrepancy, proceed

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5. Draw Sample

• Phlebotomist and witness sign requisition and
  initial Typenex band
• Label tube in the presence of the patient
• Attach Typenex band to patient it not possible
  to physically attach, consult UIHC policy for
  acceptable alternatives
• Whenever possible, confirm identification with
  a patient, a family member or other persons
  familiar with the patient.

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6. Deliver Sample and Requisition to the Blood
Bank

• Any specimen mislabeled or completely/illegibly
  labeled (including missing signatures) must be
  discarded and will need to be redrawn

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Standard of Practice

• Blood Transfusion

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1. Doctors Order

• Doctor will have written an order to transfuse
  the patient
• Verify the doctors order to transfuse the
  patient

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2. Obtain Blood from Blood Center

• Imprint a 3x5 card with the patients
  addressograph (or write the patients name
  hospital number legibly) AND the blood product
  desired
• Go to the Blood Center
• Verbally check the blood unit labeling with
  Blood Center Personnel
• Sign for blood product in Blood Center
  dispensary log
• Take blood to patient care area

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3. Verification Checks in the Presence of
the Patient

• The transfusionist and another staff member must
  recheck ALL blood and recipient information
  verbally
• - primary label on front side of unit
• - pink label on back of unit
• - pink chart label
• - patient ID bracelet
• - Typenex band
• Sign the chart copy, pink label verifies that
  labeling was checked
• and found to be correct
• Whenever possible, confirm patient identification
  with the patient, a
• family member or other person familiar with
  the patient
• If patient is in Isolation/witness cant enter
  room, transfusing RN should be in room and other
  staff member in doorway, using chart copy label
  for verification. Transfusing RN verbally does
  the identification steps

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4. Prepare to Transfuse

• Assure IV is patent
• Prime blood administration set/filter (0.9
  saline is the only solution approved for direct
  mixing of blood)
• Instruct patient regarding reaction
  sign/symptoms
• - dyspnea/wheezing
• - cyanosis
• - anxiety
• - chills/fever (gt 1º C baseline)
• - flushing/hives/errythema/uticaria
• - sudden severe headache
• - flash pain/hematuria
• - sudden abdominal pain/diarrhea

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4. Prepare to Transfuse (contd)

• If there is difficulty in determining if
  sign/symptoms are due to transfusion or acute
  illness
• Per UIHC Transfusion committee, house staff, if
  notified of potentially critical transfusion
  reaction symptoms, must consult with
  attending/faculty physician before ordering
  continuation if any of the following are present
• - Marked, sustained change from baseline (two,
  60 seconds apart)
• - Hematuria
• - Marked back or abdominal pain
• - Altered sensorium
• decrease systolic BP ?, 30 mm Hg
• increase in HR ? 30 BPM or age determined
• increase in temperature ? 1.5º C, with/without
  chilling
• marked SOB, dyspnea, 02 sat. decrease 10

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5. Transfuse

• Initiate transfusion at slow rate no more than
  50 ml in first 15 minutes
• Monitor patient and document
• Vital signs
• Baseline
• After first 15 minutes
• At completion
• PRN if s/s occur
• Signs and symptoms of reaction
• Constant first 15 minutes
• Every 30 minutes during transition
• At completion

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6. If a Transfusion Reaction Occurs

• Stop the transfusion
• Notify the doctor
• Monitor vital signs
• Follow procedure from Blood Center