Administration of blood products (2017 (prev 2010))

Storage:

RBC +4oC +/-2

Platelets +22oC +/-2

FFP / Cryo -25oC

 

Intro

 

-       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

 

Patient ID

 

-       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

 

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

o   Indication for transfusion and & document consent process

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

-       Prescription

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

o   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

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.

-       FFP

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

-       Cryoprecipitate

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.

-       Platelets

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.

 

Administration

-       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

-       Monitoring

o   Pre, during and post observations

o   Contact card for day case patients in case of complications

-       Post-administration

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

o   Patient’s discharge letter must include this information