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What must be completed prior to obtaining blood or components from the blood bank?
What must be completed prior to obtaining blood or components from the blood bank?
What is the maximum time allowed to start the transfusion after a blood component issue from the blood bank?
What is the maximum time allowed to start the transfusion after a blood component issue from the blood bank?
Which catheter size is recommended for rapid infusion in emergency situations?
Which catheter size is recommended for rapid infusion in emergency situations?
What must remain attached to the blood component's container during the transfusion?
What must remain attached to the blood component's container during the transfusion?
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Which of the following fluids can be administered simultaneously with blood/components through the same tubing?
Which of the following fluids can be administered simultaneously with blood/components through the same tubing?
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How long can a blood administration set be used before it must be replaced?
How long can a blood administration set be used before it must be replaced?
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What should a nurse monitor for during a blood transfusion?
What should a nurse monitor for during a blood transfusion?
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Which type of tubing should be used to administer packed red blood cells?
Which type of tubing should be used to administer packed red blood cells?
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What should be done if the administration of a blood unit is not complete within four hours?
What should be done if the administration of a blood unit is not complete within four hours?
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What are patients instructed to do upon discharge after a blood transfusion?
What are patients instructed to do upon discharge after a blood transfusion?
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What immediate action should be taken if a transfusion reaction is suspected?
What immediate action should be taken if a transfusion reaction is suspected?
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After a transfusion is completed, what is the first step in the documentation procedure?
After a transfusion is completed, what is the first step in the documentation procedure?
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Which of the following is NOT a part of the monitoring post-transfusion protocols?
Which of the following is NOT a part of the monitoring post-transfusion protocols?
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What should be included in the documentation after a suspected transfusion reaction?
What should be included in the documentation after a suspected transfusion reaction?
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What fluid should be hung immediately after stopping a transfusion suspected to be causing a reaction?
What fluid should be hung immediately after stopping a transfusion suspected to be causing a reaction?
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What is the purpose of flushing the blood administration line with 0.9% Sodium Chloride after transfusion?
What is the purpose of flushing the blood administration line with 0.9% Sodium Chloride after transfusion?
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What must be obtained before initiating blood/component transfusion therapy?
What must be obtained before initiating blood/component transfusion therapy?
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Which statement is true regarding the labeling of blood samples during compatibility testing?
Which statement is true regarding the labeling of blood samples during compatibility testing?
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Which of the following is NOT a requirement when ordering blood products?
Which of the following is NOT a requirement when ordering blood products?
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What should occur if the reason for a patient’s blood transfusion changes after informed consent?
What should occur if the reason for a patient’s blood transfusion changes after informed consent?
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Which personnel are authorized to draw blood samples for compatibility testing?
Which personnel are authorized to draw blood samples for compatibility testing?
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What is the first step in the transfusion process according to policy?
What is the first step in the transfusion process according to policy?
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What is required for patient identification during blood sample collection?
What is required for patient identification during blood sample collection?
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What should be included in the order for blood products concerning the infusion?
What should be included in the order for blood products concerning the infusion?
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Which symptom is most commonly associated with a Hemolytic Transfusion Reaction?
Which symptom is most commonly associated with a Hemolytic Transfusion Reaction?
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What is the maximum infusion rate for adult patients during the first 15 minutes of transfusion?
What is the maximum infusion rate for adult patients during the first 15 minutes of transfusion?
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What should a nurse do if a fever is suspected during a transfusion?
What should a nurse do if a fever is suspected during a transfusion?
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Which of the following is a potential symptom of a transfusion reaction?
Which of the following is a potential symptom of a transfusion reaction?
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What is the recommended infusion rate for pediatric patients receiving red blood cells?
What is the recommended infusion rate for pediatric patients receiving red blood cells?
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How often should vital signs be repeated after starting a transfusion?
How often should vital signs be repeated after starting a transfusion?
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In the event of needing to transport a patient during a transfusion, who must accompany them?
In the event of needing to transport a patient during a transfusion, who must accompany them?
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What documentation is required within 15 minutes of starting a transfusion?
What documentation is required within 15 minutes of starting a transfusion?
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What must be done with the blood/component container identification during the transfusion?
What must be done with the blood/component container identification during the transfusion?
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How often can a blood administration set be used before needing to be replaced?
How often can a blood administration set be used before needing to be replaced?
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Which fluids can be administered through the same tubing simultaneously with blood/component?
Which fluids can be administered through the same tubing simultaneously with blood/component?
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What action should be taken if a unit of blood is not transfused within the required time frame?
What action should be taken if a unit of blood is not transfused within the required time frame?
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What is the maximum number of blood units that can be transfused through one tubing set without using special equipment?
What is the maximum number of blood units that can be transfused through one tubing set without using special equipment?
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Which guideline must be followed regarding the storage of blood/components?
Which guideline must be followed regarding the storage of blood/components?
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What type of tubing must be used for administering packed red blood cells?
What type of tubing must be used for administering packed red blood cells?
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Which patient population is recommended to use a 24-22 gauge catheter for transfusion?
Which patient population is recommended to use a 24-22 gauge catheter for transfusion?
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What action should be taken if a transfusion reaction is confirmed?
What action should be taken if a transfusion reaction is confirmed?
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Which step is necessary after completing a blood transfusion?
Which step is necessary after completing a blood transfusion?
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What should the healthcare professional do if the transfusion is not complete at the end of four hours?
What should the healthcare professional do if the transfusion is not complete at the end of four hours?
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During a suspected transfusion reaction, what is the first action that must be taken?
During a suspected transfusion reaction, what is the first action that must be taken?
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What is a requirement when instructing outpatients at discharge post-transfusion?
What is a requirement when instructing outpatients at discharge post-transfusion?
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What should be done with the used blood administration set after a transfusion?
What should be done with the used blood administration set after a transfusion?
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What procedure must be followed to ensure proper flushing of the blood administration line after transfusion?
What procedure must be followed to ensure proper flushing of the blood administration line after transfusion?
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Which of the following statements is true regarding post-transfusion vital signs?
Which of the following statements is true regarding post-transfusion vital signs?
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Who is authorized to draw blood samples for compatibility testing?
Who is authorized to draw blood samples for compatibility testing?
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What must be done for patient identification during specimen collection?
What must be done for patient identification during specimen collection?
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When preparing to administer blood products, which of the following is required?
When preparing to administer blood products, which of the following is required?
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What should be included in the order when requesting blood products?
What should be included in the order when requesting blood products?
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What is necessary if the reason for the blood transfusion changes after consent is obtained?
What is necessary if the reason for the blood transfusion changes after consent is obtained?
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What action should be taken if the Type and Screen and ABO confirmatory tests need to be drawn?
What action should be taken if the Type and Screen and ABO confirmatory tests need to be drawn?
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What must be included on the label of the blood sample collected for testing?
What must be included on the label of the blood sample collected for testing?
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What happens if the patient does not have a Henry Ford Health identification band before starting blood product administration?
What happens if the patient does not have a Henry Ford Health identification band before starting blood product administration?
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Study Notes
Sample Collection for Blood Bank Testing
- Blood draws for compatibility testing should be performed by qualified and trained personnel.
- Two patient identifiers should be used for verification at the time of sample collection.
- Samples should be labeled at the time of the draw, in the presence of the patient.
- Type and Screen and ABO confirmatory tests should not be drawn at the same time and preferably by different qualified trained personnel.
- The individual drawing the sample should record their initials, the date, and time on the label and attach it to the blood tube.
- The sample should be sent to the lab for processing immediately.
Ordering Blood Products
- All blood products must be ordered by a provider.
- The order must include the patient's name, medical record number, ordering provider's name, blood component requested, number of units or volume required, and any special processing needs.
- The order should also include the date and time of the infusion, duration of administration, and transfusion indication.
Before Transfusion
- Transfusion therapy can only be initiated after a provider's order is generated and informed consent has been obtained.
- If the reason for transfusion changes from the original informed consent discussion, a new informed consent discussion is required.
- The signed consent form must be documented in the patient's medical record (electronically or in hard copy), unless an emergent situation exists.
- Each unit of blood or blood component must be transfused within four hours of being spiked. If not completed within this time frame, the transfusion should be stopped, the remaining volume recorded, and the unit discarded.
Post-Transfusion
- Flush the blood administration line with 0.9% Sodium Chloride to clear the line after the transfusion (not necessary to use the entire amount).
- Repeat vital signs 15-60 minutes after completing the transfusion.
- Monitor the patient post-transfusion for any signs or symptoms of a transfusion reaction.
- Outpatients should be educated about signs and symptoms of transfusion reactions at discharge to encourage reporting.
- When the blood/component transfusion is complete:
- Place a zero in the rate row of the Blood Transfusion Navigator to stop the transfusion in the EHR.
- Manually enter the amount of blood product infused in the volume row based on the pump volume for accurate intake documentation.
- Document any equipment used for the transfusion (infusion pump or blood warmer) if not already recorded.
- Ensure transfusion completion is documented if no transfusion reaction is suspected.
Transfusion Reaction Management
- If a transfusion reaction is suspected:
- Stop the infusion immediately, disconnect the tubing, and save the administration set (including the blood unit, attached tubing administration set and attached solutions).
- Hang a new line of normal saline.
- Maintain IV access open with infusion of normal saline.
- Verify the labels on the blood bag, transfusion documentation, and the patient identification band at the bedside and document.
- Notify the physician and treat the patient as ordered.
- Inquire about the need for a transfusion reaction workup from the physician.
- Repeat vital signs as needed.
- Document all patient signs/symptoms, physician notification, and actions taken in the Suspected Transfusion Reaction section of the Blood Transfusion Navigator for that blood product in the EHR.
- If a confirmed transfusion reaction is reported by the provider:
- Notify the Blood Bank.
- Draw a blood sample (EDTA-Pink Tube) and label it according to hospital policy.
- For patients without a prior blood bank history, a second blood sample for ABO confirmation is required.
- The RN or Blood Bank will generate a lab order for ABO confirmation.
- This confirmatory lab sample will be drawn by qualified trained personnel and sent to the lab for immediate processing. This will not delay blood distribution in an emergency.
Blood Transfusion Catheter Size Recommendations
- A patent IV line shall be established with the largest gauge possible prior to obtaining blood/component from the blood bank.
- Recommended catheter sizes for transfusion:
- Adult/Pediatric: 22-18 gauge
- Toddler (syringe-served blood/component only): 24-22 gauge
- Rapid infusion (Emergency/massive blood replacement): 8 Fr
Administration Guidelines
- Only 0.9% sodium chloride injection (USP) should be administered simultaneously with blood/components through the same tubing.
- Transfusion of a unit of blood/component must be started within 20 minutes of issue from the blood bank or returned immediately to avoid waste.
- Blood/components should not be stored in patient unit refrigerators.
- Blood/components can be stored in approved blood bank coolers with temperature monitoring in place.
During Transfusion
- All identification attached/affixed to the container shall remain attached until the transfusion has been terminated.
- All packed red blood cells and blood components should be administered through a standard blood administration tubing that contains a filter (170-260 microns) to remove blood clots and particles formed during storage.
- The tubing should be primed with 0.9% sodium chloride.
- A blood administration set can be used for a maximum of 4 hours unless otherwise indicated by the manufacturer.
- No more than 2 units of blood can be transfused through one tubing set unless using tubing for rapid transfusion. In this case, follow the manufacturer's recommendations.
- Specific tubing sets are designed for rapid blood administration, allowing infusion rates of 10-25 mL/second. Steps to avoid hypothermia should be taken.
- Only infusion pumps/warmers approved by the manufacturer for the transfusion of blood/components should be used.
- Monitor the patient for signs and symptoms of a transfusion reaction.
Blood Bank (Compatibility) Testing & Blood Administration Policy
- This policy covers blood sample collection, blood and component administration, and transfusion-related adverse event management.
- This policy applies to all blood transfusions except massive transfusions.
- Two patient identifiers are required during blood sample collection.
- Blood samples for Type and Screen and ABO confirmatory cannot be drawn at the same time.
- A patent IV line with the largest gauge possible must be established before receiving blood products.
- Blood transfusions should begin within 20 minutes of being issued by the blood bank.
- Only 0.9% sodium chloride should be used for blood transfusion.
- A blood administration set can be used for no longer than 4 hours, unless otherwise instructed by the manufacturer.
- No more than 2 units of blood can be transfused through one tubing set, except when using rapid transfusion tubing.
- All blood transfusions should be monitored closely for signs and symptoms of transfusion reactions.
- Monitor the patient for any immediate adverse events during the first 15 minutes of starting a transfusion.
- The infusion rate for adult patients during the first 15 minutes of transfusion should not exceed 2 mL/min.
- Document all transfusions in EHR Blood Transfusion Navigator, including vital signs.
- Repeat vital signs at least hourly until transfusion is complete.
- A provider, RN, or perfusionist must accompany the patient if they need to be transported during transfusion.
- The administration of a unit of blood/component will be completed within four hours of spiking the unit.
- Flush the blood administration line with 0.9% Sodium Chloride after completion.
- Repeat vital signs 15-60 minutes after completing the transfusion.
- If a transfusion reaction is suspected, stop the infusion immediately, disconnect the tubing, and save the administration set.
- Maintain IV access open with infusion of normal saline.
- Notify the physician and treat the patient as ordered.
- Document all patient signs/symptoms, physician notification, and actions taken in the Suspected Transfusion Reaction section of the Blood Transfusion Navigator.
- If a transfusion reaction is confirmed, notify the Blood Bank, initiate the transfusion reaction order, and draw a blood sample (EDTA-Pink Tube).
Transfusion Reaction Management
- Transfusion reaction signs and symptoms may include fever, chills, respiratory distress, abdominal pain, skin manifestations, jaundice, hemoglobinuria, nausea, vomiting, abnormal bleeding, oliguria, anuria, and blood pressure changes.
- Fever is generally defined as a greater than or equal to 1 degree Celsius rise in temperature above 37 Celsius.
- Outpatients should be instructed at discharge about signs and symptoms of transfusion reactions.
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Description
This quiz covers essential procedures for sample collection and ordering blood products for compatibility testing in blood banks. It emphasizes the importance of proper identification, labeling, and protocol for blood product orders to ensure patient safety and compliance. Test your knowledge on these critical practices.
