Henry Ford Health System Blood Product Administration PDF

# Policy This policy provides the process for the collection of samples for Blood Bank (compatibility) testing, the administration of blood and components, and management of adverse events related to transfusion to ensure that they are done safely and uniformly. This policy does not cover massive...

# Policy This policy provides the process for the collection of samples for Blood Bank (compatibility) testing, the administration of blood and components, and management of adverse events related to transfusion to ensure that they are done safely and uniformly. This policy does not cover massive transfusion, see applicable Tier 2 Massive Transfusion Policies. In an emergency blood product release of Group O blood, follow the downtime process. Blood product administration shall not be started if the patient does not have in place a Henry Ford Health identification band. # Procedure ## Sample collection for blood bank (compatibility) testing (includes TYPE & SCREEN) * Only qualified, trained personnel are to draw blood samples for compatibility testing. * Patient identification using two patient identifiers will occur at the time of specimen collection including, when feasible, asking the patient to state their name, by a qualified personnel. * The sample will be labeled at the time of the blood draw, in the presence of the patient. * Special note: Type and Screen and ABO confirmatory cannot be drawn at the same time and preferably by a different qualified trained personnel. * The personnel who draws the blood sample will record their initials or corp ID, the date and time on the label and attach to the blood tube. * Specimen will be sent immediately to lab for processing. ## Ordering of blood products 1. All blood products must be ordered by a provider. 2. The order must include the patient's name, medical record number, the name of the provider ordering the blood, the component and number of units or volume to be administered. 3. The order should include any special processing required of the component, date and time of the infusion, period for administering the component as appropriate and transfusion indication. ## Before transfusion * Blood/component transfusion therapy shall be initiated only after a provider's order is generated and the consent for transfusion has been obtained. Refer to Tier 1: Informed Consent. * If the reason for blood transfusion changes from what was originally discussed with the patient during the informed consent discussion, a new informed consent discussion needs to take place. The patient has the right to make an informed decision. * The signed consent will be in the patient's medical record (electronically under e-signature or paper copy) unless an emergent Situation. * For patients with no blood bank history, a second blood sample for ABO confirmation is required. 1. The RN or blood bank will generate a lab order for ABO confirmation. * Notification of ABO confirmation order will be seen in EHR by way of "Orders to be acknowledged" or by viewing pending order from the work list. 2. The ABO confirmatory lab will be drawn by a qualified, trained personnel and sent to the lab for immediate processing. This requirement will not delay blood distribution in an emergency. * A patent IV line shall be established with the largest gauge possible prior to obtaining blood/component from the blood bank. * Recommended sizes for transfusion catheter: | Patient population | Catheter size | |---|---| | Adult/Pediatric | 22-18 gauge | | Toddler (syringe-served blood/component only) | 24-22 gauge | | Rapid infusion (Emergency/massive blood replacement) | 8 Fr | * No medications or solutions other than 0.9% sodium chloride injection (USP) shall be administered simultaneously with blood/component through the same tubing. * The transfusion of a unit of blood/component must be started within 20 minutes of issue from the blood bank or be returned immediately to the blood bank, to avoid blood wastage. * Blood/components MAY NOT be stored in patient unit refrigerators. * Blood/components may be stored in blood bank approved 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 shall be administered through a standard blood administration tubing that contains a filter (170-260 microns) designed to remove blood clots and particles formed during blood/component storage. * The tubing will be primed with 0.9% sodium chloride. * A blood administration set can be used for no longer than a 4-hour period unless otherwise indicated in the manufacturer's instructions. * No more than 2 units of blood may be transfused through one tubing set unless using tubing for rapid transfuser. In this case, follow manufacturer's recommendations. * Specific tubing sets are designed for rapid blood administration, allowing infusion rates of 10-25 mL/second. Steps to avoid hypothermia shall be taken. * Only infusion pumps/warmers approved by the manufacturer for the transfusion of blood/components shall be used. * Monitor the patient for signs and symptoms of a transfusion reaction. Transfusion Reaction Signs and Symptoms can be any and not limited to one of the following symptoms during or following an infused blood product: 1. Fever, generally defined as a greater than or equal to 1 degree Celsius rise in temperature above 37 (the most common sign of a Hemolytic Transfusion Reaction (HTR) or Acute Hemolytic Transfusion Reaction (AHTR). 2. Chills with or without rigors 3. Respiratory distress, including wheezing, coughing, and dyspnea 4. Abdominal, chest, flank, or back pain 5. Pain at the insertion site 6. Skin manifestations, including urticaria, rash, flushing, pruritus, and localized edema. 7. Jaundice or hemoglobinuria 8. Nausea/vomiting 9. Abnormal bleeding 10. Oliguria/anuria 11. Blood pressure changes * Monitor the patient for any immediate adverse event during the first 15 minutes of starting a transfusion. * For adult patients, the infusion rate in the first 15 minutes of transfusion should not exceed 2mL/min (i.e. 120 mL/hr) * For pediatric patients, the infusion rate in the first 15 minutes of transfusion is to be determined by ordering physician. * In times of emergency these rates may be increased. * All documentation of transfusions will be done in EHR in the Blood Transfusion Navigator. * Complete a set of vital signs within 15 minutes of starting the transfusion and document as transfusion vital signs in EHR. In the absence of any adverse event, the infusion rate can be increased. The following are the suggested infusion rates in a non-emergency setting: | | Adult | Pediatric | |---|---|---| | Red Blood Cells | 150-300 mL/hr | 2-5 mL/hr/kg | | Thawed plasma | 200-300 mL/hr | 60-120 mL/hr | | Platelets | 200-300 mL/hr | 60-120 mL/hr | | Cryoprecipitate | As rapidly as tolerated | As rapidly as tolerated | * Repeat vital signs at least hourly thereafter until the transfusion is complete (then see post transfusion). If a fever is suspected the nurse will stop the transfusion and notify the physician. * Note: Fever, generally defined as a greater than or equal to 1 degree Celsius rise in temperature above 37 Celsius * If during the transfusion the patient needs to be transported to a different location, a provider, RN or perfusionist must accompany the patient. * If patient is to remain at transferred location a provider, RN or perfusionist at the transfer location must assume monitoring of blood product. * The administration of a unit of blood/component will be completed within four hours of spiking the unit. If, at the end of four hours, the transfusion is not complete, stop the transfusion and record the amount remaining prior to discarding. ## Post-transfusion Flush blood administration with 0.9% Sodium Chloride to clear line (not necessary to use entire amount). Disconnect the blood/component from the catheter. * Repeat vital signs 15-60 minutes after completing the transfusion. Document in EHR in the Blood Transfusion flowsheet as post transfusion vital signs. * Monitor the patient post transfusion for signs and symptoms of a transfusion reaction. * Outpatients should be instructed at discharge about signs and symptoms of reaction to be aware of and report by providing the patient with appropriate education teaching sheets either in paper form or on After Visit Summary. * When the blood/component is complete: 1. Place a zero in the rate row of Blood Transfusion Navigator. This serves to stop the transfusion in EHR. 2. Manually enter the amount of blood product infused in the volume row according to pump volume infused for accurate intake. 3. Equipment used if not already documented (infusion pump or blood warmer) 4. If no transfusion reaction suspected complete transfusion. ## Transfusion reaction management * If a transfusion reaction is suspected: Follow the steps in the blood navigator. 1. Stop the infusion immediately, disconnect tubing and save administration set (Blood unit, attached tubing administration set and attached solutions). 2. Hang a new line of normal saline. 3. Maintain IV access open with infusion of normal saline. 4. Verify the labels on the blood bag, transfusion documentation and the patient identification band at the bedside and document. 5. Notify the physician. Treat patient as ordered. 6. Inquire if a transfusion reaction workup is requested by the physician. 7. Repeat vital signs as necessary. * Document all patient signs/symptoms, physician notification, actions taken in the Suspected Transfusion Reaction section of the Blood Transfusion Navigator for that blood product in EHR. * After confirmed transfusion reaction from provider follow these steps: 1. Notify the Blood Bank of transfusion reaction. 2. Initiate the transfusion reaction order. Draw blood sample (EDTA‐Pink Tube), and label as per hospital policy. 3. Hand deliver to the Blood Bank in a bio hazard bag: Blood sample, blood unit, attached tubing administration set and attached solutions. * Nursing staff will enter a RL completing all required sections and providing as much detail as possible. * KEY POINT: DO NOT document that an incident report/RL risk event was filed in the patient's EHR ## Downtime A paper Blood Transfusion Record will arrive with the blood product. The two licensed professional personnel will verify blood product at the bedside of the patient receiving blood product. One reads out loud and the other is verifying during process. * Compare patient ID band and PATIENT SPECIFIC transfusion label on blood product: 1. MRN 2. Patient Name * Compare the BLOOD LABEL on blood product to the blood transfusion record. 1. Unit Number/Donor Number 2. Blood Type/Component * Compare PATIENT SPECIFIC transfusion label on blood product to the blood transfusion record. 1. Patient Name 2. MRN 3. Blood Product Compatibility (red cells only) * Check and verify blood is not expired on the blood label. * Dual sign off must be documented by the two professionals on the paper downtime form and kept as part of the medical record.