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Mary Marsden & Carmel Parker. Transfusion Practitioners. Ext 68041 bleep 2010 or 8041. Blood Transfusion Administration. Trust Blood Transfusion Policy. Two National Fatal errors 2007. Case 1 Lack of care and accuracy in paediatric prescribing results in overtransfusion;
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Mary Marsden & Carmel Parker. Transfusion Practitioners. Ext 68041 bleep 2010 or 8041
Two National Fatal errors 2007 • Case 1 • Lack of care and accuracy • in paediatric prescribing • results in overtransfusion; • Very sick preterm infant, platelets 48 • Platelets 15 ml/kg prescribed • Transfused 50 ml/kg, • (300 ml over 30 mins) • Infant suffered cardiorespiratory arrest and died • Case 2 • Faulty blood sampling • technique and a wrong • decision to transfuse • 80 year old woman, fractured neck of femur • Post-op Hb 3.9g/dL, diluted by IV infusion • Pre-op Hb was 9.5g/dL, little intra-op bld loss • 6 units red cells given over 16 hrs, post-tx Hb 18.2 • Death from cardiac failure
Patients understanding of Transfusion Why do I need a transfusion?
Decision to Transfuse • Communicate with patient • Patient information leaflet • Document in patient notes
Documentation What would you consider to be good transfusion documentation in the patient’s notes?
Good Documentation • Minimum Transfusion Dataset: the following should be documented in the notes Reason for transfusion Current blood results Component type and amount to be prescribed Anticipated outcome Any reported transfusion adverse events/reactions Review following the transfusion including how much blood has been transfused
Communication • MAKE A PHONE CALL • (You should be a doctor or senior nurse who has full knowledge of the situation) • to the HospitalBlood Bank (Ext 4400 or 4887or Out-of-hours bleep 2525) • *In extreme emergency only, if no reply or line is engaged, dial 0161 273 2968 • (emergency outside line) • State clearly: • Reason (diagnosis, extent of bleeding) • Patient Details • First name • Surname • Date of birth • Gender • - Hospital/A&E number • What blood component is required, how much and how soon.
Frequently asked questions Cannulae size does it matter? Can you warm blood, if so why? Duration of transfusion – minimum & maximum Can other drugs be added to blood? Use of diuretics Type of infusion sets Where can you store RBC, Platelets, FFP?
I V Canulae For Transfusion There are no special requirements and selection would be dependant on the desired infusion rate
Warming blood WHY WARM BLOOD ?
Warming blood • Patients undergoing surgery will already be losing body heat due to wound or cavity exposure. • Large volumes of cold blood may induce hypothermia or cardiac arrhythmia • Exchange transfusion • If requested by the laboratory. i.e.. The patient has cold agglutinins • Never warm blood by any other method
Who can administer blood? Refer to the Trust Blood Transfusion Policy Blood administration – must take place at the patient bedside not in remote locations such as the ward clinic
Monitoring patients on Blood Transfusions Base line observations – Temperature, pulse and blood pressure Further observations (as above) at 15 minutes A set of observations at the end of transfusion More frequently if the patient is unwell, unobservable, unconscious or a child.
Administration procedure • Step 2: Check the patient’s • First name • Surname • Date of birth • Hospital number • on the compatibility/ • traceability label against • the patient’s ID wristband
Administration Procedure Step 3: Check the compatibility/traceability label with the blood bag label
Reporting transfusion reactions/incidents Stop the Transfusion and seek Medical Input and inform the Transfusion Laboratory staff Check the Blood component matches the patient details Replace the unit and giving set with Normal Saline 0.9% Send the discontinued unit with giving set attached back to transfusion capped off at the end with a white venflon cap – and any previous transfused bags sealed with the blue plugs all in biohazard bags Documentation (complete the checklist) Complete a Trust Incident form
A patient receiving a red cell transfusion complained of severe back pain, and then developed rigors. • The deputy Sister attended the patient, noticed it was the wrong blood, took it down and bleeped the HO. • The ward then phoned Blood Bank requesting a further unit of blood for another patient as the first had been 'wasted'. • Only when the BB manager asked for the bag was it revealed that the unit had erroneously been given to the wrong patient. BB Mgr contacted a consultant haematologist who went to see patient immediately. • The sticky label from the blood bag tag had been removed from the medical notes, and the name had been crossed out on the blood bag label. • The bag of blood had been thrown into the sharps bin, this was retrieved by consultant haematologist. The nurse who put up the blood admitted she had not performed any bedside checks.
