Boston Medical Center Policy and Procedure Manual Policy and Procedure Manual

Policy #: 3.34 Issued: June 8, 2000 Reviewed/ June 2007, August 2008 Revised: Section: Clinical Care/Patient Rights

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ADMINISTRATION OF BLOOD COMPONENTS Purpose:

To ensure the safe administration of blood components.

Policy Statement: Application:

All patients at Boston Medical Center.

Exceptions:
None.

Procedure:
1. Prior to the transfusion, the patients informed consent is required (see Patient Consent Policy #3.2). The consent is valid for 30 days or the admission duration or outpatient treatment as long as it is related to the same illness. The surgical consent form encompasses the transfusion consent as long as the transfusion is related to the surgical procedure. Patients receiving on-going transfusions for a chronic condition require an annual consent The administration of any blood product or derivative requires a physicians order, which includes the type of component to be given, the number of units and, if clinically indicated, the rate of infusion. Prior to beginning the blood or blood component transfusion, the patient is objectively matched to the blood or blood component during a two person bedside or chairside verification process, using at least two unique identifiers. During the verification process, one individual conducting the identification verification must be the qualified transfusionist who will administer the blood or blood component to the patient, and the other must be qualified to participate in the process..

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CLINICAL INFORMATION 1. All patient specimens drawn for blood bank use must be labeled at the time and place drawn with; a) the patients full name and medical record number, b) time and date sample obtained, c) legible name or initials of the phlebotomist, and d) legible name or initials of the second individual verifying the patient's identity. The verifying

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Policy 3.34

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individual can be a lab phlebotomist, RN, LPN, NP, PA, CNM, MD or third/fourth year medical student. A new blood sample is required every 72 hours, except for selected preoperative samples. 2. If the patients pre-transfusion temperature is greater than 100.5 F, the physician must be contacted prior to administering blood components, and a decision made and documented as to necessary interventions and increased frequency of monitoring of temperature and vital signs. 3. With the exception of patients who are expected to have been multiply transfused, routine premedication prior to transfusion is not necessary or recommended. 4. Red blood cells and platelets should be leukoreduced prior to administration, either pre-storage, or at the bedside with a pall filter.
REQUISTIONING OF BLOOD AND BLOOD PRODUCTS

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1. Type and Screen: A current type and screen is needed for red blood cells. 2. A blood bank requisition or printed physicians order entry, with the patients name and medical record number, must be completed for: Red blood cells Fresh frozen plasma Rhogam Platelets Albumin Cryoprecipitate Coagulation Factors 3. A patent IV line, 22 gauge or larger for adults (20 gauge preferred), 22 gauge for pediatrics, must be in place before ordering delivery of blood components from the Blood Bank. 4. Except in cases of emergency, the Blood Bank will be notified of request for blood/blood products at least 1 hour before planned infusion time. 5. The requesting nurse or designee will provide the patients name and medical record number (or account number) in writing to the blood bank for procurement of the blood products. Autologous and directed donor units will be issued first from the blood bank. These will have a bright pink ALERT label on the unit and on the cooler ID tag. Additional crossmatched banked units may be obtained. 6. Blood being delivered to the unit should be handed by the transport worker to a nurse or physician, and not left unattended.
CHECKING OF BLOOD COMPONENTS PRIOR TO ADMINISTRATION (2 steps)

A. Step I: Verify the correct product has been received Two persons, one, the transfusing RN, Anesthesiologist, Blood Bank technologist, or perfusionist, together with a licensed member of the nursing or medical staff, must a. Read physician's order for specific blood product; and b. Read the blood tag aloud, compare tag and blood bag and verify the following: Received blood product is the ordered blood product

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The expiration date of the component, The ABO, Rh and unit number on the blood tag match those of the blood component label. If there is any discrepancy, the blood bank will be notified and the unit will not be administered. The ABO and Rh groups of the recipient are compatible with those of the component sent for transfusion (Look up patient blood type in hospital information system (Sunrise); see ABO compatibility chart, 3.34b). ABO and Rh matching are not required for platelets, cryoprecipitate, immune globulin, albumin, Rhogam or Coagulation Factors. All products except IVIG and albumin require a 2-person check. B. Step 2: Verification of patient identification using name and medical record number 1. At the bedside, two persons, one the transfusing RN, anesthesiologist, perfusionist, or Blood Bank technologist (apheresis procedures) will read aloud and compare the patients name and medical record number on the blood tag and the patients identification band. The second verifier is a licensed member of the nursing or medical staff who is qualified to participate in the process Blood will not be administered to a patient who does not have an identification band. 2. In the event that the patients ID band needs to be removed in the course of patient care, the ID band will be compared to the face sheet or anesthesia record to ensure the patients identity; the face sheet or anesthesia record may be used to check the blood. The ID band must be replaced before the patient leaves the Operating Room and immediately in other areas. 3. At the time of blood administration, the two people verifying (one of whom is the transfusionist) must both sign, date, and time the transfusion slip. 4. All components must be inspected for gas bubbles, aggregates or any abnormal color. The component must be returned to the blood bank if any of these conditions exist. 5. Those checking the blood component will verify that any restrictions such as irradiated blood are present and that special equipment required for administration such as special tubing or filter has been obtained.
ADMINISTERING BLOOD AND BLOOD COMPONENTS

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1. Blood components must be hung by a Registered Nurse, anesthesiologist, or perfusionist, or by blood bank technologists as instructed by a blood bank physician in the course of performing therapeutic apheresis. 2. Antihemophilic Factor (Factor VIII) should be administered by IV push. 3. Blood and blood products must be administered immediately upon arrival from the blood bank. With the exception of blood distributed in a cooler, any blood product not hung within 20 minutes of arrival must be returned to the blood bank. Blood may not be stored in the patient care unit refrigerator. A unit of red blood cells must be transfused within 4 hours of spiking the blood bag. 4. Blood may not be piggybacked into a main IV line. 5. Only normal saline is to be used opposite blood components on a Y type administration set.

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6. Medication and IV fluids must never be added to or piggybacked into the blood component while it is being transfused. Blood components may be temporarily interrupted for the administration of IV medications should other IV access be unavailable. The IV line must be flushed with normal saline before and after the administration of the medication. 7. Once any blood component has been spiked or opened, unused portions must be discarded as contaminated medical waste. 8. Red Blood cells may be transfused using a pump and Y-type blood administration sets. Refer to 3.34a Blood Administration Addendum. 9. Initiate red blood cells slowly for the first 5 minutes while observing for a reaction when clinically appropriate (exceptions are rapid blood loss, patients in the operating room). 10. A pressure infuser bag (blood pump) may be utilized only in the critical care area or the operating room and may not be used in the administration of platelets or cryoprecipitate. 11. At the completion of the transfusion, the peelable unit tag should be removed and the transfusion documented by sticking the tag for each component transfused directly on the pink Transfusion Record form or progress notes section of the medical record. 12. Each unit of blood or component must be recorded on the I and O record and/or eMAR. 13. Blood bags and tubing are to be disposed of as hazardous waste.
MONITORING DURING ADMINISTRATION OF BLOOD/BLOOD COMPONENTS

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1. The registered nurse remains with and monitors the patient for the first 15 minutes of transfusion of red blood cells. The RN visually assesses the patient every 30 minutes during the transfusion. 2. Baseline vital signs will be recorded prior to the start of each transfusion, after 15 minutes and, if the patient is without symptoms, at the completion of the transfusion. 3. A progress note will be written if there is any unusual occurrence related to the transfusion. Increased frequency of monitoring of temperature and vital signs will be determined by the nurse and physician. 4. Transporting of a patient should be avoided. Unless medically necessary, transport should be performed only if the blood component has been infusing for at least 20 minutes and the patient has stable vital signs and no signs or symptoms of a transfusion reaction. Appropriate monitoring personnel must be available. 5. Patients receiving blood while under the care of an anesthesia care provider will be monitored according to ASA standards. 6. The LPN monitors the patient under the direction of the RN during the transfusion.

Responsibility:
RN, Blood Bank Technologists (apheresis procedures), Anesthesiologists, Perfusionist: Blood Administration. LPN: Monitoring of patient under direction of RN; Transport worker (Patient Equipment Transportation)

Related Policies:
Stem cell infusion #10.4.4

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Exchange Transfusions #10.4.3 Clinical Care/Patient Rights links: 3.62

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Forms:
Pink Transfusion Sheet #999255 (Wallace) Transfusion blood tag #90379 (Wallace)
Section: 3.0 Clinical Care/ Patient Rights

Policy No.: 3.34 Title: Administration of Blood Components Initiated by: Nursing Policy and Procedure Committee Contributing Departments: 1. Laboratory Medicine
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Section 3.0 Clinical Care/Patient Rights

Policy 3.34