Administration of blood products (2017 (prev 2010))
RBC +4oC +/-2
Platelets +22oC +/-2
FFP / Cryo -25oC
- SHOT 2016
o 3 ABO incompatible red cell transfusion, 264 additional near-misses
- Key documents
o ‘Right Patient, Right Blood’ 2006 National Patient Safety agency (NPSA)
o 2005 Blood Safety and Quality Regulations (BSQR)
§ Blood component = a therapeutic constituent of blood (RBC,plt,FFP,Cry,Gran)
§ Blood product = a medicinal product derived from whole blood (Alb, SD-FFP)
§ Regulate who is competent to collect blood from storage locations
- Vein-to-vein journey and use of electronic information management
- Printed wristbands – minimum of 1st and last name, DOB + unique identifier No.
- Positive patient identification at every step
o Blood sampling
o Collection from storage and delivery to clinical area
o Administration to patient
- For patients unable to identify themselves, it is acceptable to ask relative/carer if they are present at the bedside. Local policies should otherwise be followed.
- For unknown patients
o Must have ID band with temporary ID number + patient’s gender as a minimum
o Temporary numbers should be issued non-consecutively to minimize error.
- Bar-coded IT systems should be used
- Complete documentation must enable an unambiguous audit trail
- All paperwork must have the minimum patient identifiers
- Full traceability must be possible for every unit transfused.
o Indication for transfusion and & document consent process
o ‘Will I need a blood transfusion?’ Patient information leaflet
o Date, product, volume, rate, special requirements and additional meds
o NOT a medicinal product, no national legal barrier to who ‘prescribes’ blood
- Clear and unambiguous communication policies must be in place – written or electronic
- Clinical, laboratory and support staff all involved
Training and Competency
- All staff need minimum 3 yearly training
o Theory and knowledge
o Practical observed competency
- Competency assessment conducted as per individual UK countries and MHRA requirements
Returning units to storage
- Red Cells
o If <30 minutes: Can return directly to the issue location
o If 30-60 minutes: Can return to quarantined fridge for min. 6 hours then re-issue
o Max 3 occasions of being removed for 30-60 minutes allowed.
o Thawed FFP can be accepted back into a fridge (2-6oC) if this occurs on one occasion of less than 30 minutes.
o Any returned units can only be re-issued if the transfusion will have completed within four hours of the original first issue time.
- SD-FFP and MB-FFP
o No guidance issued on returns to storage
o Cannot be refridgerated and so must be used within 4 hours of issue. Could be returned to ambient temperature storage if re-issued and transfusion completed within the four hours from time of first original issue.
o No interruption to agitation should last >8 hours, and the combined interruption over the unit lifespan must not be >24 hours.
o Units can be returned and re-issued retaining the same shelf-life, provided that the non-agitation times are not exceeded.
- Transfuse through a 170-200 micron filter
o Red cells and plasma can be transfused through the same administration set
o The should be changed if switching to platelets or another drug.
- Complete within 4 hours of removal from temperature-controlled storage
o Pre, during and post observations
o Contact card for day case patients in case of complications
o Patients must be informed that they received blood (e.g. surgery)
o Patient’s discharge letter must include this information