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Blood administration

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    Nursing Competence

    It is recommended that all nurses at RCH, providing care to children receiving blood transfusions have completed the blood transfusion competency package.  You can access the package via the following link Blood Trans comp (PDF 80 KB)

    Patient Preparation

    The patient should be ready for transfusion prior to picking up blood from the blood bank. eg appropriate IV access, written order for transfusion.
    For any non-emergency transfusion the patient/parents should have had the benefits/risks of transfusion discussed and an opportunity to have any questions answered.  Consent for transfusion should then be documeted in the medical record.

    For further information and for parent and patient information packs see: Consent and Consumer Information Guideline

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    Pretransfusion check

    Safe transfusion requires a final patient identity check at the patient bedside before blood administration. This is vital to ensure the right blood is given to the right patient. 

     

    The pretransfusion check must be completed before commencing transfusion by two clinical staff, one of whom must then spike and connect the product. The staff members signing the blood transfusion record are indicating that the check has been completed prior to transfusion, and that no discrepancy was identified.

    The following checks are carried out at the bedside to ensure the right patient receives the right blood product:

    1. Check blood product for any signs of leakage, clumps or abnormal colour.
    2. Patient identification. Check name, DOB and UR on the Blood Transfusion Record and pack tag/label.  Check name, DOB & UR on the patient's wristband.  Are they identical?
    3. Blood product identification.  Check the pack number on the Blood Transfusion Record, pack tag/label and the product.  Are they identical?
    4. Blood Group. Check the blood group (ABO and RhD) of the product on the Blood Transfusion Record (this form reports compatibility), pack tag/label and the product.  Do they match?
    5. Check expiry date on the pack.
    6. Check medical orders re product type, special requirements (eg irradiation, leucocyte depletion) and administration requirements (eg volume, rate).
    7. Complete documentation: sign, date, time the Blood Transfusion Record and file in the patient's medical record.

    IMPORTANT

    If there is any discrepancy between the blood product, patient details & pack tag/label or if you
    are concerned about the appearance of the product DO NOT TRANSFUSE.  Report to Blood Bank immediately: RCH Xn 5829, RWH Xn 2055.

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    Blood Transfusion Record

    A Blood Transfusion Record (MR/201) accompanies the release of fresh blood products.blood transfusion record2.gif

    The Blood Transfusion Record is a legal document and must be filed in the patient medical record at the completion of transfusion. The record must be available for at least 20 years.

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    Transfusion Tag

    A tag is attached to each blood product.

    new transfusion tag.gif

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    Care and monitoring of transfused patients

    Patients receiving transfusion should be monitored for symptoms/signs of potential complications of transfusion. 

    The Royal Women's Hospital

    Frequency of vital signs:

    Adults - temperature, pulse, respiratory rate and blood pressure should be measured and recorded:

    • before the start of each pack of blood or blood product
    • at 15 minutes after commencement
    • hourly during transfusion
    • at the completion of each pack

    Neonates - temperature, heart rate and respiratory rate should be measured and recorded:

    • before the start of each pack of blood or blood product
    • hourly during transfusion
    • at the completion of each pack

    Note that more frequent vital signs should be taken if the patient has an unstable underlying condition or it the patient becomes unwell or shows signs of a transfusion reaction.

    Patients should be observed during the first 15 minutes of transfusion as some life-threatening reactions may occur after the infusion of only a small amount of blood. Where possible, patients should be informed of possible symptoms of a transfusion reaction and should inform staff immediately if they feel unwell during transfusion.

    Royal Children's Hospital

    Vital signs (temperature, pulse, respirations, blood pressure, oxygen saturations and site observations) should be measured and recorded

    • before the start of each pack of fresh blood product
    • at 15 minutes after commencement of each pack
    • hourly until conclusion
    • at the completion of transfusion

    This is a minimum requirement. Some clinical areas may require more frequent observations particularly in unstable or unconscious patients.

    Patients should be observed during the first 15 minutes of transfusion as some life-threatening reactions may occur after the infusion of only a small amount of blood. Where possible, patients should be informed of possible symptoms of a transfusion reaction and should inform staff immediately if they feel unwell during transfusion.

     

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