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Review of Standards of Practice: Blood Transfusions. Prepared for Case-Based Learning May 30, 2002 Lou Ann Montgomery, PhD, RN, CCNS, CCRN Director, Nursing Education Department of Nursing Services and Patient Care. Standards of Practice:.

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review of standards of practice blood transfusions
Review of Standards of Practice:Blood Transfusions

Prepared for

Case-Based Learning

May 30, 2002

Lou Ann Montgomery, PhD, RN, CCNS, CCRN

Director, Nursing Education

Department of Nursing Services and Patient Care

standards of practice
Standards of Practice:
  • Blood specimen collection for Type and Screen/Type and Crossmatch
1 prepare requisition
1. Prepare Requisition
  • Patient’s name
  • Hospital number
  • Doctor’s name and CLP number
  • Blood products ordered
  • Other information, testing, preparation as appropriate
  • Blood availability (routine/emergency)
2 prepare typenex band
2. Prepare Typenex Band
  • Patient’s name (first and last)
  • Hospital number
  • Date sample drawn
  • Detach one numbered label from the band and attach it to the requisition in the location indicated
3 obtain a witness
3. Obtain a Witness
  • All blood draws and labeling must be witnessed!

- Doctor

- Physician's assistant

- Medical student

- Registered nurse

- Licensed Practical Nurse

- Nursing Assistant

- Nursing Unit Clerk

- Pathology Personnel

- Similar healthcare providers but not including patient/family

4 identify the patient
4. Identify the Patient
  • Ask the patient to state their name
  • Verbally verify that ID bands (inpatients),

Typenex band and requisition are correct

  • If anything is incorrect, DO NOT PROCEED
  • Correct as necessary!
  • If no discrepancy, proceed
5 draw sample
5. Draw Sample
  • Phlebotomist and witness sign requisition and initial Typenex band
  • Label tube in the presence of the patient*
  • Attach Typenex band to patient; it not possible to physically attach, consult UIHC policy for acceptable alternatives

* Whenever possible, confirm identification with a patient, a family member or other persons familiar with the patient.

6 deliver sample and requisition to the blood bank
6. Deliver Sample and Requisition to the Blood Bank
  • Any specimen mislabeled or completely/illegibly labeled (including missing signatures) must be discarded and will need to be redrawn
standard of practice
Standard of Practice
  • Blood Transfusion
1 doctor s order
1. Doctor’s Order
  • Doctor will have written an order to transfuse the patient
  • Verify the doctor’s order to transfuse the patient
2 obtain blood from blood center
2. Obtain Blood from Blood Center
  • Imprint a 3x5 card with the patient’s addressograph (or write the patient’s name & hospital number legibly) AND the blood product desired
  • Go to the Blood Center
  • Verbally check the blood unit labeling with Blood Center Personnel
  • Sign for blood product in Blood Center dispensary log
  • Take blood to patient care area
3 verification checks in the presence of the patient
3. Verification Checks in the Presence of the Patient *
  • The transfusionist and another staff member must recheck ALL blood and recipient information verbally:

- primary label on front side of unit

- pink label on back of unit

- pink chart label

- patient ID bracelet

- Typenex band

  • Sign the chart copy, pink label – verifies that labeling was checked

and found to be correct

  • Whenever possible, confirm patient identification with the patient, a

family member or other person familiar with the patient

  • If patient is in Isolation/witness can’t enter room, transfusing RN should be in room and other staff member in doorway, using “chart copy” label for verification. Transfusing RN verbally does the identification steps
4 prepare to transfuse
4. Prepare to Transfuse
  • Assure IV is patent
  • Prime blood administration set/filter (0.9% saline is the only solution approved for direct mixing of blood)
  • Instruct patient regarding reaction sign/symptoms*

- dyspnea/wheezing

- cyanosis

- anxiety

- chills/fever (> 1º C baseline)

- flushing/hives/errythema/uticaria

- sudden severe headache

- flash pain/hematuria

- sudden abdominal pain/diarrhea

4 prepare to transfuse cont d
4. Prepare to Transfuse (cont’d)
  • If there is difficulty in determining if sign/symptoms are due to transfusion or acute illness:
    • Per UIHC Transfusion committee, house staff, if notified of potentially critical transfusion reaction symptoms, must consult with attending/faculty physician before ordering continuation if any of the following are present

- Marked, sustained change from baseline (two, 60 seconds apart)

- Hematuria

- Marked back or abdominal pain

- Altered sensorium

        • decrease systolic BP , 30 mm Hg
        • increase in HR  30 BPM or age determined
        • increase in temperature  1.5º C, with/without chilling
        • marked SOB, dyspnea, 02 sat. decrease 10%
5 transfuse
5. Transfuse
  • Initiate transfusion at slow rate – no more than 50 ml in first 15 minutes
  • Monitor patient and document
    • Vital signs
      • Baseline
      • After first 15 minutes
      • At completion
      • PRN if s/s occur
    • Signs and symptoms of reaction
      • Constant first 15 minutes
      • Every 30 minutes during transition
      • At completion
6 if a transfusion reaction occurs
6. If a Transfusion Reaction Occurs
  • Stop the transfusion
  • Notify the doctor
  • Monitor vital signs
  • Follow procedure from Blood Center