243 lines
6.8 KiB
Markdown
243 lines
6.8 KiB
Markdown
# Standard Operating Procedure: Blood Transfusion Administration
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| Document ID | SOP-BB-002 |
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|-------------|-------------|
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| Title | Blood Transfusion Administration |
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| Revision | 1.0 |
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| Effective Date | [DATE] |
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| Author | [AUTHOR] |
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| Approved By | [APPROVER] |
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| Department | Transfusion Services |
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---
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## 1. Purpose
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To establish standardized procedures for the safe administration of blood and blood components to minimize transfusion errors and adverse reactions.
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## 2. Scope
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This procedure applies to the administration of:
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- Packed red blood cells (PRBCs)
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- Fresh frozen plasma (FFP)
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- Platelets (random donor and apheresis)
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- Cryoprecipitate
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- Granulocytes
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## 3. Responsibilities
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### 3.1 Ordering Physician
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- Determine transfusion indication
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- Order appropriate blood component
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- Obtain informed consent
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- Respond to transfusion reactions
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### 3.2 Blood Bank/Transfusion Service
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- Perform compatibility testing
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- Issue blood products
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- Maintain inventory
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- Investigate transfusion reactions
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### 3.3 Nursing Staff
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- Verify patient identity and blood product
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- Administer transfusion
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- Monitor for reactions
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- Document transfusion
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## 4. Definitions
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| Term | Definition |
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|------|------------|
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| Crossmatch | Compatibility test between donor RBCs and recipient serum |
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| Type and Screen | ABO/Rh typing and antibody screen |
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| Transfusion Reaction | Adverse response to blood transfusion |
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| Emergency Release | Issue of uncrossmatched blood in emergencies |
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## 5. Procedure
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### 5.1 Pre-Transfusion
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1. **Physician Order Review**
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- Verify order includes:
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- Patient identification
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- Blood product type
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- Number of units
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- Rate/duration
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- Special requirements (irradiated, CMV-negative, etc.)
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- Confirm indication appropriate
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2. **Type and Screen/Crossmatch**
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- Collect sample per specimen requirements
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- Label at bedside with two identifiers
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- Complete blood bank request form
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- Allow time for testing (45 min - 1 hour typical)
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3. **Informed Consent**
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- Explain benefits and risks
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- Discuss alternatives
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- Answer patient questions
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- Obtain written consent (FRM-BB-003)
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- Document in medical record
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4. **Pre-Transfusion Assessment**
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- Baseline vital signs:
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- Temperature
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- Pulse
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- Respiratory rate
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- Blood pressure
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- Assess IV access (18-20 gauge preferred)
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- Review history of previous reactions
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### 5.2 Blood Product Issue
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1. **Request Blood from Blood Bank**
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- Verify order and patient identification
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- Note any special requirements
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- Confirm expected time of transfusion
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2. **Blood Bank Verification (Issue)**
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- Match unit to patient (ABO, Rh, crossmatch)
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- Check expiration date
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- Inspect unit for abnormalities:
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- Hemolysis
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- Clots
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- Discoloration
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- Bag integrity
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3. **Transport**
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- Transport promptly (within 30 minutes)
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- Do not store in nursing unit refrigerators
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- Return to blood bank if transfusion delayed >30 min
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### 5.3 Bedside Verification (CRITICAL)
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**Two qualified staff must verify at bedside:**
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| Item to Verify | Check |
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|----------------|-------|
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| Patient wristband name matches blood bag | ☐ |
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| Patient wristband MRN matches blood bag | ☐ |
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| Patient wristband DOB matches blood bag | ☐ |
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| ABO/Rh on blood bag matches compatibility label | ☐ |
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| Unit number on blood bag matches compatibility label | ☐ |
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| Expiration date is valid | ☐ |
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| Blood product type matches order | ☐ |
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| Blood bag appears normal (no clots, hemolysis) | ☐ |
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| Patient confirms identity (if possible) | ☐ |
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**DO NOT TRANSFUSE IF ANY DISCREPANCY EXISTS**
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### 5.4 Transfusion Administration
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1. **Blood Administration Set**
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- Use blood administration set with 170-260 micron filter
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- Prime set with normal saline only
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- Never add medications to blood products
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- Maximum hang time: 4 hours
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2. **Compatible IV Fluids**
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| Compatible | NOT Compatible |
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|------------|----------------|
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| 0.9% Normal Saline | Lactated Ringer's |
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| | Dextrose solutions |
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| | Medications |
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3. **Infusion Rates**
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| Product | Initial Rate (first 15 min) | Routine Rate | Maximum Time |
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|---------|---------------------------|--------------|--------------|
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| PRBCs | 2 mL/min (50 mL) | Per order/tolerance | 4 hours |
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| FFP | 2 mL/min | 10 mL/min or per order | 4 hours |
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| Platelets | 2 mL/min | Per tolerance | 4 hours |
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| Cryoprecipitate | 2 mL/min | Per tolerance | 4 hours |
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4. **Monitoring Schedule**
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| Time | Action |
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|------|--------|
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| Pre-transfusion | Baseline vital signs |
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| 15 minutes | Vital signs + assessment |
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| 30 minutes | Vital signs |
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| Hourly | Vital signs |
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| Post-transfusion | Final vital signs + assessment |
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### 5.5 Transfusion Reaction Management
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**Signs/Symptoms Requiring Immediate Action:**
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- Fever (≥1°C rise)
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- Chills/rigors
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- Hypotension or hypertension
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- Tachycardia
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- Dyspnea/respiratory distress
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- Chest or back pain
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- Hives/urticaria/rash
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- Nausea/vomiting
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- Hemoglobinuria (dark urine)
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- Anxiety/sense of doom
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**Immediate Response:**
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1. STOP the transfusion immediately
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2. Keep IV line open with normal saline
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3. Notify physician immediately
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4. Check vital signs
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5. Verify patient/blood product identities
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6. Notify blood bank
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7. Complete FRM-BB-004 Transfusion Reaction Report
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8. Return blood bag and tubing to blood bank
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9. Collect post-reaction blood and urine samples
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**Reaction Workup**
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| Sample | Purpose |
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|--------|---------|
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| EDTA tube (lavender) | DAT, visual hemolysis check |
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| Clot tube (red/gold) | Repeat crossmatch, visual hemolysis |
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| First voided urine | Hemoglobinuria |
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| Blood cultures | If bacterial contamination suspected |
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### 5.6 Post-Transfusion
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1. **Documentation**
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- Product type and unit number
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- Start and end times
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- Volume transfused
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- Vital signs (all)
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- Adverse reactions (or "none")
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- Patient response
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2. **Disposition of Blood Bag**
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- Per facility policy (typically to blood bank)
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- Retain for minimum time specified
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## 6. Special Situations
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### 6.1 Emergency/Massive Transfusion
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- O-negative PRBCs for females of childbearing potential
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- O-positive PRBCs for others acceptable in emergencies
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- Type-specific blood as soon as available
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- Activate massive transfusion protocol if indicated
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### 6.2 Pediatric Transfusion
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- Adjusted volumes (10-15 mL/kg)
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- Smaller filter volumes
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- Consider irradiated products
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## 7. Documentation
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- FRM-BB-003 Transfusion Consent Form
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- FRM-BB-004 Transfusion Reaction Report
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- Transfusion Record (in EMR or paper)
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- Blood bank compatibility record
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## 8. References
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- AABB Standards for Blood Banks and Transfusion Services
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- AABB Technical Manual
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- FDA regulations 21 CFR 606
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- Circular of Information for Blood and Blood Components
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---
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## Revision History
|
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| Rev | Date | Description | Author |
|
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|-----|------|-------------|--------|
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| 1.0 | [DATE] | Initial release | [AUTHOR] |
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