Administration of blood products (bsh 2017)

Storage:

RBC +4oC +/-2

Platelets +22oC +/-2

FFP / Cryo -25oC

 

Key documents

SHOT 2017

  • 4 ABO incompatible red cell transfusion, 606 ABO-incompatible near-miss events 

‘Right Patient, Right Blood’ 2006 National Patient Safety agency (NPSA)

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

Patient ID

 

Printed wristbands – minimum of 1st and last name, DOB + unique identifier No.

Positive patient identification at every step

  • Blood sampling

  • Collection from storage and delivery to clinical area

  • 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

  • Must have ID band with temporary ID number + patient’s gender as a minimum

  • Temporary numbers should be issued non-consecutively to minimize error.

Bar-coded IT systems should be used

 

Documentation

 

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.

Pre-Transfusion

  • Indication for transfusion and & document consent process

  • ‘Will I need a blood transfusion?’ Patient information leaflet

Prescription

  • Date, product, volume, rate, special requirements and additional meds

  • NOT a medicinal product, no national legal barrier to who ‘prescribes’ blood

 

Communication

 

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

  • Theory and knowledge

  • Practical observed competency

Competency assessment conducted as per individual UK countries and MHRA requirements

 

Returning units to storage

 

Red Cells

  • If <30 minutes: Can return directly to the issue location

  • If 30-60 minutes:  Can return to quarantined fridge for min. 6 hours then re-issue

  • Max 3 occasions of being removed for 30-60 minutes allowed.

FFP

  • Thawed FFP can be accepted back into a fridge (2-6oC) if this occurs on one occasion of less than 30 minutes.

  • 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

  • No guidance issued on returns to storage

Cryoprecipitate

  • 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.

Platelets

  • No interruption to agitation should last >8 hours, and the combined interruption over the unit lifespan must not be >24 hours.

  • Units can be returned and re-issued retaining the same shelf-life, provided that the non-agitation times are not exceeded.

 

Administration

Transfuse through a 170-200 micron filter

  • Red cells and plasma can be transfused through the same administration set

  • The should be changed if switching to platelets or another drug.

Complete within 4 hours of removal from temperature-controlled storage

Monitoring

  • Pre, during and post observations

  • Contact card for day case patients in case of complications

Post-administration

  • Patients must be informed that they received blood (e.g. surgery)

  • Patient’s discharge letter must include this information