Download Consult with an attending physician

Red Blood Cell
Administration
Facilitator: Barbara Bischoff
Policy
• Physicians:
Administer and discontinue blood products by order
• RN’s and LPN’s:
Administer and discontinue blood products by
physician’s order
• LPN’s:
Second witness must be an RN or physician
Purpose
• RBCs contain hemoglobin
• RBCs serve as primary agent for oxygen transport to cells
• RBC components increase :
Mass of circulating red cells
Oxygen carrying capacity
Contraindications
RBC containing components should not be used:
Solely for volume expansion
To increase oncotic pressure of circulating blood
To treat anemias treatable with hematinic medications
such as:
Iron
Vitamin B12
Folic acid
Erythropoietin
Ordering
• Written consent must be obtained prior to ordering
• Nurses use order entry for request
• Complete:
Consent for Infusion of Blood, Blood Product(s), Derivatives
and/or Tissue
• Computer downtime use:
Instructions for Completing Blood/Blood Product Orders
Transfusion Checklist
Consent Form
Equipment
• Unit Issue and Transfusion Record form
• IV Tray (#18 Cathlon preferred)
• Blood Secondary set with 170 micron filter
• IV Pole
• Infusion Pump
• Extension Set
• Vital Sign Machine
• Normal Saline
• Transfusion Checklist
• Unit of packed cells
Requisition for Pick Up
• LPN or RN may pick up blood from Blood Bank
• Blood Product Pickup slip:
Contains patient information
Indicates red blood cells are ready
Issuing of Red Blood Cell Product
• “Issue Unit” in Meditech
• Generates Transfusion Record form
• Preprinted:
• Issue time
• Date
• Messenger’s initials
• Blood Bank technologist’s initials
Signature
Signatures
Fill out completely
Lab Check
• Completed by both Blood Bank technologist and LPN/RN.
• Preprinted:
Issue time
Date
Messenger’s initials
Technologist's initials
• Both persons sign on the appropriate signature line
• Secure form to unit bag
• Place both in a sealed biohazard Zip-lock bag for transport
Lab Check (Cont)
• Check:
Patient’s ID number
Red blood cell unit ID number
ABO compatibility
• Documents to be checked:
Written request for pick-up
Unit Issue and Transfusion Record Form
Label on packed red blood cell bag
Warning
• All comparisons must match exactly
• Do not initiate transfusions with discrepancy
• Contact Blood Band immediately
Packed Red Blood Cell Unit Verification
• At bedside:
• Compare patient armband
• Form attached to unit of cells.
• Verify:
• Patient: Name, ID number, Blood type
• Donor Unit: Number, Blood Type, Expiration Date
• Patient must state their name
• Both identifiers sign the Unit Issue and Transfusion Record Form
• Most transfusion reactions result from identification error.
Precautions
• Verify with the attending physician:
• Interruption of existing IV solution
• Starting a new line
• Consider total fluid volume
• Never add medication to unit of blood
• Use new Blood Secondary Set with every unit
• Patient must always receive ABO compatible blood.
Storage and Handling
• Maximum room temperature time prior to infusing:
• 30 minutes
• Blood Bank will dispose as Regulated Medical Waste
• May be returned to Blood Bank Refrigerator for:
• Delay before use
• Temporary discontinue
• Never place in Nursing Unit refrigerator
• Not adequate for safe storage
Procedure
• Prior to obtaining blood product
• Administer pre-medications
• Check order verification
• Obtain baseline vital signs:
• Temperature
• Pulse
• Respirations
• Blood Pressure
• Chart vital signs
Procedure (Cont)
• Set up blood secondary set following instructions
• Don gloves and personal protective equipment.
• Connect blood Secondary set with a 170 micron filter to red
blood cell blood unit
• Rotate pack gently to mix cells and small amount of plasma.
• Close clamp and suspend red blood cell unit from IV pole.
Procedure (Cont)
• Compress plastic chamber filling filter and drip chambers
• Make sure filter is submerged with blood
• Blood dripping on filter can damage RBC’s
• Open clamp to expel all air from tubing
Transfusion Time
• Recommendation: < 2 hours
• Never > 4 hours
• Delay of completion increases:
• Deterioration of labile components
• Possibility of inadvertent bacterial contamination
• Transfusion time dependent on size of IV cathlon
• Infusion time increased with smaller cathlon
Flow Rate
• Adjust flow to 20-30 drops per minute for first 10-15 minutes
• If no immediate adverse symptoms occur:
• Flow rate may be adjusted to 40-45 drops per minute
• Closely follow transfusion to verify the desired rate continues
• Adjust as necessary
Gravity
Pump
4 hours
=20 drops/min
=90 ml/hr
3 hours
=40 drops/min
=120 ml/hr
2 hours
=60 drops/min
=175 ml/hr
35 minutes
=200 drops/min
=700 ml/hr
Management of Flow
• Causes of slow flow:
• Obstruction of the filter or needle
• Excessive viscosity of the component
• Steps to investigate and correct the problem include:
• Elevating the blood container to increase hydrostatic
pressure.
• Checking the patency of the needle.
• Examining the filter for excessive debris.
• Consult with an attending physician
Observation
• Observe patient closely during the transfusion:
• Continuously for the first 15 minutes
• Recheck after second 15 minutes
• Continue to assess patient every half hour
• Monitor and document vital signs.
• Observe for signs and symptoms of a transfusion reaction.
Monitor
• Monitor the patient for signs of possible transfusion
reaction:
• Flushing of face
• Tachypnea
• Wheezing
• Tachycardia
• Sudden chills and fever
• Distended neck veins
• Oppressive feeling in chest
• Sharp pain in lumbar area
• Decrease in blood pressure
Flushing
• Flush only with Normal Saline
• Dextrose and calcium ions (L R) can hemolyze, clot
• Do not interrupt Blood Transfusion for any medication
Action for Reaction
• If any signs of reaction occur
Stop the Transfusion
• Add 50 ml normal saline piggyback to keep vein open
• Notify:
• Attending physician
• Nursing supervisor
• Blood Bank.
• Follow instructions: “Suspected Transfusion Reaction Form”
Suspected Transfusion Reaction
Documentation
• Record:
• Date and start time
• Vital signs throughout transfusion
• Date and time discontinued
• Amount given and any reaction
• Signature
• Use Unit Issue and Transfusion Record form
• Second nurse verifies no omissions on the form
Completion
• Place white copy of Unit Issue and Transfusion Record on the
patient’s chart
• Return to the Lab:
• Yellow copy
• Empty blood container
• Tubing in a clear plastic biohazard bag.
• Never place sharps in bag.
• Separate yellow copy from empty unit
using the outside pocket.
Delayed Reactions
• Ambulatory Care Patients
• Discharged patient’s who received blood/blood products
• Notify doctor of:
• Rash
• Fever
• Chills
• Difficulty Breathing
• Leg or Chest pain
Thank you for your attention !
Any questions or comments?
References
• Swartz, C.F. (2012). Red blood cell administration.
Amsterdam, NY. St Mary’s Hospital.