Muhammad Asif Zeb Lecturer Hematology

IPMS-KMU Peshawar

THE ADMINISTRATION OF blood and blood

components incorporates multiple personnel and

hospital services.

It involves not only the transfusion service but also

surgeons, primary-care physicians, transporting

personnel, and the nurse.

Once a patient has been identified as needing a transfusion, many steps and considerations are involved which are…..

Recipient consent for the transfusion must be obtained from patients who are competent to make such decisions.

The recipient consent document should contain indications, risks, possible side effects, and alternatives to transfusion of allogeneic blood components.

The patient has the right to accept or reject a transfusion. If the patient is unable to give consent, a legally authorized representative or surrogate may provide consent.

The patient should have the opportunity to ask

questions.

The physician or nurse starting the transfusion should go over with the patient the symptoms to report that are suggestive of a reaction and how long the patient should expect the transfusion to last in addition to answering any other questions the patient may have.

It is important to take a history from the patient before the component is ordered so that it can be determined if the patient has had reactions to components in the past.

Blood Component There must be an order from a licensed care provider for

components to be administered. The order should specify the following: The patient’s name and other identifiers (eg, date of birth,

medical record number, etc). The component [eg, Red Blood Cells (RBCs), Platelets,

etc]. Any special processing required of the component (eg,

washing, irradiation, or filtration). The number of units or volume to be administered (and

crossmatched, if re- quired). The date and time of infusion. The flow rate or period for administering the component

(must be <4 hours).

After receiving an order from a licensed provider, the transfusion service initiates a series of steps to ensure the provision of a compatible component.

In order to issue blood for a specifically identified patient (except in the case of a true emergency transfusion), the laboratory must have a blood sample from the patient to run a serial of test.

If a medication has been ordered before the infusion, it should be administered in advance of the component’s arrival to the transfusion unit.

Although antipyretics (acetaminophen) are commonly ordered to reduce the occurrence of febrile non hemolytic transfusion reactions.

indications for their use are controversial

The transfusionist must determine whether the patient has a central line or peripheral intravenous line in place that is acceptable for infusion of blood components.

Acceptable intravenous catheter sizes range from 22 to 14 gauge.

A 20- to 18- gauge intravenous catheter is a good compromise for the general population and provides adequate flow rates without excessive discomfort to the patient.

In transfusing an infant or a toddler, a 24- to 22-gauge intravenous catheter may be suitable

The transfusionist should know how to obtain and administer emergency interventions.

Items that should be available for emergency use during a transfusion include the following:

Medications to treat an allergic reaction, ranging from

antihistamines for mild reactions to epinephrine for severe reactions.

0.9% sodium chloride intravenous (IV) solution and

administration set to keep an IV line open. Oxygen source.

The patient’s vital signs should be taken before the initiation of the transfusion as a baseline for subsequent comparison.

This will help to identify possible untoward reactions that may result from the transfusion.

If the patient has an elevated temperature before transfusion, it may be difficult to ascertain if a transfusion reaction presenting with an elevation of temperature has occurred during blood administration.

In addition, a patient with an elevated temperature may destroy cellular components at an increased rate.

Before dispensing, transfusion service personnel should check the appearance of the unit.

The blood should not be issued if it appears discolored, abnormally cloudy, or foamy, or if clots or loss of bag integrity are detected.

Components should not leave the controlled environment until the transfusion site for the patient has been identified, the patient has been properly prepared, and the transfusionist is ready to begin the infusion.

If an unexpected occurrence takes place that does not allow for the prompt start of the component infusion, the unit should be returned to the blood bank for proper storage.

Blood banks frequently set limits to the time that a unit can be out of the controlled storage environment before it is considered unsuitable for reissue (usually 30 minutes).

Blood banks may also have methods to determine if the component is suitable for reissue.

If a refrigerated component rises above 10 C, reissue is not permissible.

PREADMINISTRATION EVENTS

AND

CONSIDERATIONS

Once the unit is received, the transfusionist should take it to the patient’s bedside and check the following

Appearance of the unit. Units should be returned if there is discoloration, foaming, or bubbling of the component; abnormal cloudiness; presence of clots; or loss of integrity of the bag.

Identification of patient and unit. The patient’s name and identification number must match the label on the unit bag or tag and medical order

Medical order. The transfusionist should verify that the component is the one requested on the medical order.

Blood type. The patient’s blood type should be compatible with the unit.

Expiration date.

ADMINISTRATION

The infusion should start slowly at approximately 2 mL per minute for the first 15 minutes while the transfusionist remains near the patient.

Severe reactions may occur with as little as 10 mL transfused.

Potentially life threatening reactions most commonly occur within 10 to 15 minutes of the start of a transfusion.

If there is no sign of a reaction after the first 15 minutes, the flow rate can be increased to the designated infusion rate

The transfusionist should continue to monitor the patient throughout the infusion and check the IV site and flow rate.

If the IV rate has slowed down, the transfusionist should take one or more of the following actions:

1) check to make sure that the IV site is patent and there is no swelling at the IV site;

2) attempt to administer the component through an infusion pump;

3) raise or elevate the unit;

4) examine the filter for air, excessive debris, or clots; or

5) consider the addition of 0.9% sodium chloride as a diluent if the unit

If components need to be administered rapidly, the use of pressure infusion, large bore administration tubing, and 8 Fr intravenous catheters can decrease the infusion time without the occurrence of hemolysis.

Specific tubing sets are designed for rapid blood administration with appropriate filters.

Flow rates as fast as 10 to 25 mL/second (600-1500 mL/minute) have been reported with this tubing.