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Template Page: 1 of ManualPROCEDURESectionTitle: Blood AdministrationIssued byORBCoNID: Ontario SOP templateApproved byEffective DateRevised DateYYMMDDYYMMDDVersion: File Name: Controlled document. Any documents appearing in paper form must be used for reference purposes only. The on-line copy on the file server above must be considered the current documentation.1.0 Policy: 1.1 A transfusion order is required prior to blood administration. Consent for transfusion is required except in cases where an urgent transfusion is needed to preserve life or continuing health and patient/substitute decision maker is unable/ not available and there is no evidence of prior wishes refusing transfusion.1.2 Patients being transfused must be properly identified by an identification arm band. Or alternative approved by hospital policy1.3 Blood must not be stored in ward or medication fridges. The BTL should be contacted if the blood cannot be started upon receipt.1.4 The BTL label / tag must remain attached to the blood unit throughout the transfusion1.5 Blood components are required to be infused through blood tubing (170-210 micron filter). 2.0 Purpose: To ensure patients receiving blood components or products are identified correctly, receive the right product, in the right amount, at the right rate and at the right time. Abbreviations and Definitions: Blood Transfusion Laboratory BTLCanadian Blood ServicesCBSBlood Component*Refers to fresh blood components (red cells, plasma, platelets, cryoprecipitate)*this policy refers to the transfusion of blood components and not plasma derivative products such as albumin or intravenous immune globulin4.0 Procedure:Procedure StepsWork InstructionsPreparing the patient and Requesting the blood Ensure appropriate venous access dedicated to the transfusion. Prepare blood tubing – only normal saline may be used to prime the tubing. Administer pre-medications if orderedEnsure patient is ready, IV site patent, consent verified.Arrange for pickup and delivery of the blood from the BTL with appropriate paperwork to ensure the correct unit is retrieved for the correct patientCheck the blood on arrival to patient care unitVisually check the blood unit for clots, unusual colour and any evidence of leaks in the bag Check the expiration date on the CBS label (refer to Appendix 1 – CBS label) Note: May not be policy at some hospitalsCheck that the donor’s blood group (on CBS label) is compatible for the patient (refer to Appendix 2 – Compatibility Chart)Check the transfusion order in the patient’s chart and verify consent has been obtained Checking the blood AT THE BEDSIDE**4.3.1 Check patient’s armband to make sure it is correct. When possible, involve the patient by asking specific questions:How do you spell your name?What is your date of birth?Check that that the patient’s name and unique identifier matches on:ID armbandBTL label / tag attached to the bloodCheck that the blood unit number and donor blood group matches on:CBS label BTL label / tag attached to the bloodIF YOU FIND ANY DISCREPANCIES DO NOT PROCEED WITH THE TRANSFUSION. CONTACT YOUR BTL IMMEDIATELY.** Note: most facilities / hospitals require two individuals complete the pre-transfusion check. Initial vital signs (should be taken within 30 minutes prior to starting the transfusion)Record baseline pre-transfusion vital signs and assessment before starting each unit. Follow hospital policy but these should include: temperatureblood pressure pulse respiration (Oxygen saturation if available and auscultation for patients at risk for volume overload such as elderly, paediatric or cardiovascular disease patients) Spiking the bloodSeparate the port cover until the port is exposedPort covers that are not removable must be held away from the port to prevent contaminationHold the blood bag in one hand and exposed blood tubing spike in the other – do not hang from IV poleInsert spike into port while pushing gently and turning clock-wise with ? turns – DO NOT over-spike. Spiking properly will ensure easy removal of the blood bag if required.To remove the bag, pull gently while turning counter-clockwiseInstruct the patient of symptomsWhen possible, instruct the patient to notify you if they experience:Hives or itchingFeeling feverish or chilledDifficulty breathingBack pain or pain at the infusion siteAny feeling different from usualStart transfusion4.7.1 For the first 15 minutes:Start initially with a slow rate unless transfusion is extremely urgentMonitor your patient closely – serious reactions can present early in the transfusion4.7.2 After the first 15 minutes:Reassess your patient and repeat vital signs and recordIncrease flow to prescribed rate if no reaction observed4.7.3 Repeat vital signs more frequently during transfusion for patients at greater risk for circulatory overload, if they have experienced previous reactions or if they are unstable (refer to hospital specific policy). Completing the transfusionComplete the transfusion within 4 hours of removal from proper storage temperature (issue time from BTL)If desired, flush the blood tubing with normal salineDisconnect blood tubing when transfusion is completedCheck end vital signs and recordRepeat vital signs periodically post transfusion according to your hospital policy – reactions might occur up to 6 hours post transfusionInformation for the patientIf the patient is to be discharged following their transfusion, provide them or their care giver with an information sheet:Signs and symptoms of transfusion reactionsInformation on what to do if they experience a reactionContact information for reporting reactionsComplete documentationDocument each blood transfusion by placing the blood transfusion record (or a copy) in the patient’s chartThe transfusion record should include:DateStart and finish timesType of product transfused and volumeBlood unit numberName of person(s)starting and checking the bloodAdditional information that should be documented in the patient’s chart:Vital signs and patient assessmentsResults of follow up testing such red cell or platelet counts, INR or PT / PTT, fibrinogenAny patient instruction providedAny reaction symptoms noted and treatment provided4.10.4 Follow your hospital BTL policy for return of any documents to the BTLReaction Management4.11.1 If a suspected reaction occurs:i. STOP the transfusion immediatelyii. Maintain IV access for treatment if necessary but do not flush the blood tubingCheck vital signsVerify that patient identification matches the BTL tag / labelVerify that the blood unit number matches the BTL tag /labelNotify the physician but remain with the patientNotify the BTL of the reaction as per hospital specific policyTreat patient’s symptoms as ordered by the physician4.11.2 Before continuing the transfusion:i. Consult the treating physicianii. Medicate the patient if orderediii. Proceed cautiously with more frequent patient assessmentsiv. Remember the 4 hour limit (See procedural note 5.1)v. Report to BTL is required but further investigation is not necessary5.0 Procedure Notes: 5.1 To decrease the risk of bacterial sepsis, each blood component must be completed or stopped by 4 hours after removal from acceptable temperature storage unit (BTL refrigerator)5.2 Disconnect blood tubing post transfusion to decrease the risk of bacterial sepsis. Do not leave attached to the patient.5.3 Dispose of used blood tubing and blood bags in a biohazard container unless your hospital policy requires you to return the blood bags to the BTL. 6.0 References:Lima A, Bloody Easy Blood Administration: A handbook for Health Professionals. Ontario Regional Blood Coordinating Network; March 2010.AABB Primer of Blood Administration, September 20107.0 Related Documents:7.1 A copy of the BTL label or tag must be placed in the patient’s chart as documentation of the transfusion8.0 Appendices: ................
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