Pediatric/Adult Transfusion Therapy

2009

Annual Review for RNs and other TransfusionistsAnnual Review for RNs and other Transfusionists*

*“Transfusionist” includes Physicians, Licensed Independent Practitioners, Registered Professional Nurses, Clinical Laboratory Technologists, and Cardiovascular Perfusionists. Graduate Nurses (GNs) may transfuse (check and administer) blood only with a Registered Professional Nurse (RN)

Purpose:

The purpose of this activity is to provide a review of Kaleida Health policy CL.53: review of Kaleida Health policy CL.53: Adult/Pediatric Transfusion Therapy Adult/Pediatric Transfusion Therapy for Registered Nurses and other for Registered Nurses and other Transfusionists*.Transfusionists*.

Objectives:At the end of this activity the Registered Nurse

and other Transfusionists will be able to:

1. List the steps involved in obtaining blood products.

2. Cite the steps involved in checking and administering blood products.

3. Recognize signs and symptoms of common transfusion reactions

The Process BeginsThe unit is busy, and you are

precepting a newly hired nurse.

Michael Jones, one of your patients, has an order for the administration of 1 unit of packed red cells.

It is your intent to teach the new nurse the correct process.

The ProcessIn order to make sure that no steps are missed, you give

a checklist to your new nurse that includes:1. Check MD order for transfusion and assess patient2. Obtain informed transfusion consent3. Draw sample for blood bank testing4. Obtain blood product5. Check blood product6. Administer blood product7. Document administration of blood product

1. Check MD order and assess patient

You instruct the nurse to: Review the MD order in the patient chart Assess the patient for:

History of previous transfusion reaction Pre-transfusion symptoms that could be confused

with a transfusion reaction (ex. fever, chills)

2. Obtain Informed Consent

Obtain informed transfusion consent from Mr. Jones prior to issuance of the blood product if the patient is an adult.

If Michael is a minor, obtain consent from parent or legal guardian.

Informed transfusion consent

M. Jones

Acceptable consent forms are:

Consent for Transfusion of Blood Products (KH 00049-029)

Authorization for Medical and/or Surgical Consent (KH 00049)

You note that there is no transfusion consent form in Mr. Jones’ chart. You guide your nurse to:

3. Draw blood sample for blood bank

Blood is needed for a type and cross match, so you instruct your nurse to use standard venipuncture procedure to obtain the sample. Once finished you make sure that the:

Label on tube for blood bank testing containscontains the following:

InitialsInitials of person drawing sample

TimeTime sample is drawn DateDate sample is drawn, and that the label was placed on

tube at the bedside.at the bedside.

Initials

Time

Date

4. Obtaining blood productThe Blood Bank notifies you that the unit

of packed red blood cells is ready. The new nurse asks who to send to pick it up. You tell the nurse:

Who can pick up blood products: Registered Nurse (RN) Graduate Nurse (GN) UAP, PCAYou make sure to note that only hospital

employees, with the exception of LPNs, are authorized to pick up blood products.

You emphasize that the following MAY NOT pick up blood products:

Volunteers, Student Nurses, LPNs

4. Obtaining the blood product:At the blood bank

Healthcare worker will read and Blood Bank staff will verify the following regarding the patient:

Patient name Patient identification number Patient date of birth Patient blood type

Healthcare worker will read and Blood Bank staff will verify the following regarding the blood product:

Unit number Donor blood type Unit expiration dateNote: only one unit is issued at a

time, unless special authorization from the Director of Transfusion Services has been obtained.

The nurse decides to pick up the blood himself. You make sure that the nurse knows how to check the unit in the Blood Bank. Your instructions include:

5. Checking the blood product:At the bedside of the patient

a. Physician’s order

b. Consent

c. Blood product with attached Transfusion Record

d. Patient with attached ID band

e. Vital signs (TPR and BP)

Once the nurse returns with the blood, you make sure that just prior to administration, following are checked at the patient’s bedside:

5. Checking blood, at the bedsideBlood Unit Tag

5. Checking blood products*:You are careful that the following

are checked by two (2) authorized healthcare professionals (LPNs and UAPs may not check blood at the bedside) Patient name, Patient

identification number, Patient date of birth, Patient blood

type, Donor blood type, Unit expiration,

Unit number

(*blood products include: Whole blood, packed red cells, plasma, platelets, white blood cells, cryoprecipitate)

5. Checking blood products at the bedside

You and the new nurse compare the information on the blood unit tag against the patient ID band.

Pt. name

Date of Birth

Medical record number

5. Checking blood products: ABO compatibility

ABO and Rh group of the donor MUST match or be compatible with the patient’s information.

You must check blood compatibility table on the back of the transfusion record if information does not match patient’s information

If there are any questions, consult the blood bank.

You make sure to emphasize that:

5. Checking Blood Products: Blood group compatibility tables

DONOR (Person who has donated blood)

REC

IPIE

NT-

Wh

ole

Blo

od

or P

RB

C

GROUP O A B AB

O Yes No No No

A Yes Yes No No

B Yes No Yes No

AB Yes Yes Yes Yes

GROUP O= Universal Whole Blood or Red Cell Donor

GROUP AB= Universal Whole Blood or Red Cell Recipient

GROUPO A B AB

REC

IPIE

NT-

Pla

sm

a

O Yes Yes Yes Yes

A No Yes No Yes

B No No Yes Yes

AB No NO No Yes

GROUP O= Universal Plasma RecipientGROUP AB=Universal Plasma Donor

DONOR (Person who has donated plasma)

6. Administering blood productIn order to transfuse the unit of PRBC, you have the new nurse:

• Insert a large bore IV Cannula (18-20 gauge is preferred in the adult patient, 22-24 gauge in pediatric patients.) • For PICC or midline catheters:

• 4 Fr or 16-18 gauge for adults• 3 Fr or 20 gauge for pediatric patients

• Set up tubing for pump administration (pump required). Emphasize that:

Only normal saline (0.9% sodium chloride) may be used No drugs or medications may be infused through same

line as blood Pediatric patients, due to their smaller size, are at

greater risk for fluid overload.

6. Administering blood products

Infuse blood slowly for the first 15 to 30 minutes, while observing the patient for reactions.

After 15 to 30 minutes, reassess the vital signs and adjust the flow rate to

the desired speed.

You make sure that the new nurse knows to:

Refer to Adult/Pediatric Transfusion Therapy Policy CL.53

Attachment A Blood Product Administration Chart (Adult Patient)

Attachment B Blood Product Administration Chart (Pediatric Patient)

for specific recommendations regarding blood product, use of filters, infusion instructions, etc.

6.

6. Administering blood productsYou make certain to check that:

Vital signs were taken (TPR and BP) BEFORE beginning transfusion, and values written on blood unit tag.

Time and date have been indicated

TWO required signatures are in place.

6. Administering Blood Products:Vital Signs

You give careful instructions on when to take vital signs:

1.1. Immediately Immediately BEFOREBEFORE beginning transfusion

2.2. 15 minutes15 minutes after start of transfusion

3. On completioncompletion of transfusion

6. Administering blood product

WarmingWarming: specific physician order required Blood product must be hung as soon as as soon as

possiblepossible after issuing. If there is a delay in starting the transfusion FOR ANY REASON, the unit must be returned to the Blood Bank within 30 minutes after issuance.

Transfusions MUST BE FINISHED within 4 MUST BE FINISHED within 4 hourshours; if not finished in the 4-hour time limit, unit must be taken down.

The nurse has some questions about the process of administering blood. Your answers include the following information:

6. Administering blood products:Safety/Infection ControlSafety/Infection Control

Patient identificationPatient identification and comparison to blood unit tag MUST BE DONEMUST BE DONE with each with each unit!unit!

Handle all blood products with gloved handsgloved hands Dispose ofDispose of empty blood packs and

administration sets in biohazard bagsbiohazard bags. Tubing changes: after each unitTubing changes: after each unit which is

not to exceed 4-hours

You make sure that the following safety and infection control details are clear:

Transfusion ReactionTransfusion ReactionYou explain that if the patient has a transfusion reaction that the

Adverse Reactions portion of the Transfusion Record Adverse Reactions portion of the Transfusion Record must be completed:

Transfusion ReactionTransfusion ReactionAnd you point out that the most common reactions are listed on the back of the blood unit tag:

Transfusion ReactionTransfusion ReactionYou make sure that your new nurse understands the steps to

take if a transfusion reaction is noted:1. Stop transfusion, leave IV (0.9% sodium chloride) running2. Recheck patient information and tag information3. Notify responsible physician4. Complete premedication, and volume information5. Draw blood: 1 pink or lavender tube6. Send blood sample and unfinished unit to Blood Bank

asap.7. Make sure that signature, date, and timesignature, date, and time are on form.

The Process ContinuedYour new nurse has completed all the steps Your new nurse has completed all the steps

for a safe transfusion. The patient has for a safe transfusion. The patient has tolerated the procedure without tolerated the procedure without reactionreaction.

Make one final checkfinal check:1. Are allall vital signsvital signs written in the

appropriate spaces?2. Are there two signaturestwo signatures in the

verification area?3. Is there a date and timedate and time indicated

for start and end of transfusion?If so, you may now detach the blood detach the blood

transfusion tagtransfusion tag, and place it in the medical record.