Blood administration

  • Refer to EMR tip sheet for further information

    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 through your Nursing Competence workbook.

    Patient preparation

    The patient should be ready for transfusion prior to picking up blood from the blood bank. eg appropriate IV access, consent completed, pre-medication administered if required. 
    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 documented on a blood transfusion consent form

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

    This video shows the correct blood administration process which should be followed. 

    Issue of blood products from the blood bank

    Blood products should only be released in EMR and retrieved from blood bank when the transfusion is ready to commence. This ensures appropriate storage of blood products. Blood products must not be stored in ward areas or domestic fridges.

    Fresh blood products must be commenced within 30 minutes of leaving the blood bank. If circumstances change the fresh blood product must be returned to blood bank for storage.

    This does not apply to albumin products. Albumin can be kept at room temperature for a maximum of 24 hours. If the requirement for albumin changes, it should be returned to blood bank at the earliest convenience.

    Release form

    When ready to transfuse the blood product:

    • In ‘flowsheets’ select the ‘blood’ tab
    • Select ‘release transfusion report’
    • Select the ‘release’ hyperlink for the blood product you wish to transfuse

    This will print a release form to the nearest printer. Complete all fields including your name, clinical area, PTS number (if applicable) and phone number. This will allow prompt communication from blood bank when the blood product is ready.

    There are three ways to send it to blood bank.

    1. CARPS
    2. PTS
    3. You can deliver it yourself.

    For general wards, release will be limited to the following quantities at a time:

    • (1) unit of red blood cells
    • (4) units of platelets (or one pooled or apheresis bag)
    • (2) units of FFP
    • (5) units of cryoprecipitate

    Special arrangements are available to the Emergency Department, ICU, NICU and Operating Suites for release of greater quantities. 

    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.

     

    Two clinicians must independently complete the patient and blood product identification check at the bedside. By electronically signing the blood administration flowsheet checks in EMR they indicate they have correctly completed this process. 

    • At the bedside, if possible ask the patient or parent/guardian to state full name and birth.
    • Check these details match exactly on and include the MRN:
      1. Identification band
      2. Blood product tag attached to blood product
      3. EMR order
    • In EMR:
      • Complete pre-transfusion documentation
      • Open the blood administration flowsheet by clicking on ‘Action’
      • Select the IV line you will use for the transfusion
        1.Scan the patient’s identification band
        2.Scan the unit number
        3.Scan the registration number on the blood product tag attached to the blood product
        4.Scan the product code on the blood product under the product description
        5.Scan blood type. Ensure this is compatible with patient blood type.
      • Green thumb and ‘ready’ appears if all details match
    • Check the order to ensure the following:
      • Transfusion consent present
      • Previous alert for transfusion reaction
      • Clinical notes- premedication on MAR
      • Transfusion indication relevant
      • Type of blood product ordered matches blood product provided
      • Duration per unit/transfusion is specified and appropriate
      • Dose to be transfused (mls or units)
      • Modifications or specialised blood products (e.g. irradiation, CMV negative, cryodepleted, IgA negative, HLA matched, washed, phenotype matched)
    • Check the blood product:
      • Expiry date
      • Modifications or specialised blood products (e.g. irradiation, CMV negative, cryodepleted, IgA negative, HLA matched, washed, phenotype matched)
      • Integrity of the blood product
    • Enter all other required information in EMR including the rate of transfusion, date and time commenced.
    • Co-sign to indicate the 2nd user has independently completed the above checks  

    If the blood product is removed from the bedside after the patient identification check is complete, the whole checking process must be repeated. This includes blood products removed from the bedside for priming of circuits. 

    Spike the unit only after all checks listed above are completed. The person spiking the unit must be one of the clinicians undertaking the patient and blood product identification check. 1

    Prime blood administration set at the bedside. 

    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: extension 55829

    Care and monitoring of transfused patients

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


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

    • before the start of each transfusion
    • 15 minutes after commencement of each pack
    • hourly until conclusion
    • at the completion of transfusion
    • 4 hourly in the 24 hours following transfusion

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

    Patients should be directly 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 and families should be informed of possible symptoms of a transfusion reaction and should inform staff immediately if they feel unwell during transfusion.

    For information about observation requirements for fractionated blood products, refer to the product page.