HEALTH SERVICES CODE B.1 TITLE: BLOOD COMPONENT

Approved: December 20, 2018 Page 1 of 43

HEALTH SERVICES

CODE B.1

NURSING PROCEDURE

TITLE: BLOOD COMPONENT ADMINISTRATION

Crossmatched & Uncrossmatched Components: red blood cells (RBC), platelets, plasma, cryoprecipitate (homologous, autologous & directed donor)

A. Prior to Obtaining Blood Component

B. Obtaining Blood Component

C. Preparation to Commence Blood Component

D. Commencing Blood Component

E. Transfusion Reaction (Actual or Suspected)

F. Following Transfusion

CATEGORY: RN - General RPN - General LPN - General

PURPOSE

Safe administration and documentation of blood components (RBC, platelets, plasma, cryoprecipitate).

Report and management of adverse reactions.

NOTE: For Neonatal Intensive Care Unit (NICU) administration see unit specific procedure.

NOTE: Massive Transfusion Protocol (MTP) go to Appendix 18a and 18b for nursing

guidelines and algorithm.

NOTE: There are 3 types of blood transfusions included in this procedure: o Homologous Blood Donation – blood collected by blood agency from volunteer

donors. o Autologous Blood Donation – blood donated by client for use in his / her own

surgery. (Appendix 12a, 12b, 12c). o Directed Blood Donation – blood donated by a parent for use by their child, 18

years or younger. (Appendix 13).

HEALTH SERVICES

CODE B.1


NURSING ALERT:

Prior to obtaining blood component, VERIFY CROSSMATCH EXPIRY DATE utilizing Blood Bank Report. o Confirmatory crossmatch is required for clients with only one crossmatch sample and no

historical blood group. A separate sample collected by a separate person must be done. Clients with no confirmatory crossmatch will be issued group O Rh specific crossmatched red cells until confirmatory crossmatch is completed.

o Red Blood Cells (RBC) crossmatch is valid for 14 days. o For clients previously transfused or pregnant in last 3 months, or those who are currently

pregnant, crossmatch is valid for 4 days (96 hours). o Neonatal specimens may be used for up to 4 months from date of birth, regardless of

previous transfusions. o Platelets, cryoprecipitate and plasma require group and screen, once per hospital stay. o If patient presents with Antibody Card, nursing to notify client’s Practitioner and Transfusions

Department.

If blood component cannot be infused immediately, return blood to Transfusion Department within 30 minutes of lab issue. DO NOT store in unit’s refrigerator.

Ensure Notification of Administration of Blood and/or Blood Products (RQHR form 425 (10/18)) is obtained from lab and signed by client as soon as possible and at minimum prior to discharge.

All nursing staff that transfuse blood components must complete blood and blood product nursing e-quiz and review transfusion practice audit annually within calendar year.

A. Prior to Obtaining Blood Component EQUIPMENT 1. Documents (see APPENDICES for sample transfusion forms):

Ordering of Red Blood Cells Adults PPO #PP-601(if giving Red Blood Cells) Appendix 1 for example. Always use most current online version of PPO

Informed consent. Appendix 2a, 2b & 2c o Consent/Refusal for Administration of Blood/Blood Components and or Plasma Protein

Products RQHR 1163 (02/20) Appendix 2a https://sharepoint.ehealthsask.ca/sites/SHA_forms/RQForms/RQHR%201163.pdf

o Consent to Diagnostic and Treatment Procedures RQHR 370 (04/19) Appendix 2b https://sharepoint.ehealthsask.ca/sites/SHA_forms/RQForms/RQHR%20370.pdf

o Consent to Diagnostic and Treatment Procedures Outpatient & Ambulatory RQHR 254 (04/19) Appendix 2c https://sharepoint.ehealthsask.ca/sites/SHA_forms/RQForms/RQHR%20254.pdf

Blood Transfusion Information (CEAC # 0235) – Appendix 3. Always use most current online version of CEAC document http://rhdintranet/ceac/public/brochures/0235.pdf

Transfusion Services Identification Number (TSIN) Orange/Red Armband number – Appendix 4 (if applicable)

Blood and Blood Products Administration Checklist – Appendix 5

Blood Product Administration Chart Appendix 6

Request for Transfusion Service Requisition for cross match Appendix 7

https://sharepoint.ehealthsask.ca/sites/SHA_forms/RQForms/RQHR%201163.pdf



http://rhdintranet/ceac/public/brochures/0235.pdf

HEALTH SERVICES

CODE B.1


2. Personal Protective Equipment (PPE) 3. Equipment for starting intravenous access (IV), if not already in progress (refer to appropriate

nursing procedure) 4. Appropriate blood component administration set: Pump #313406, Gravity #310813 5. Normal saline (N/S) IV Solution 6. IV Pump; if required

NOTE: All blood components administered to neonates and children MUST be infused on a pump and may require a special administration set. Check unit specific guidelines.

PROCEDURE 1. Verify Practitioner order on either PPO (Adult PP-601) or Physicians order sheet.

NOTE: For pediatrics, practitioner to determine volume of blood component per kg of

recipient body weight. Follow practitioner order for administration.

2. Ensure Consent/Refusal for Administration of Blood/Blood Components and or Plasma Protein Products completed by practitioner indicating client consent (Appendix 2a, 2b or 2c).

NURSING ALERT:

Informed Consent must be obtained by Practitioner as per Health Canada Blood Regulations (refer to reverse side of consent form for products requiring consent).

If consent not completed, notify Practitioner to obtain one of the following: o Informed Consent (can be in person or telephone consent with two witnesses) or o Order to hold transfusion until consent can be obtained or o Practitioner order that states “OK to proceed with transfusion without signed consent” and

MRP must gain consent within 24 hours.

RBC’s and platelets in non-urgent/non-bleeding inpatient settings should be transfused during daytime hours for client safety and transfused one unit at a time.

3. Ask client about previous transfusions and reactions and document. Provide CEAC document

0235 as required (Appendix 3). 4. Prime blood administration tubing set with N/S, ensuring fluid levels remain above filter at all

times. NOTE: Pediatrics will prime tubing with blood component.

HEALTH SERVICES

CODE B.1


NURSING ALERT:

N/S is the only IV solution that is compatible with most blood components. If using IV solution for flushing, N/S is utilized to prevent hemolysis of RBC’s. See Appendix 6 for exceptions.

A separate administration set must be used for different blood components.

5. Don PPE.

6. Ensure patent IV access.

NOTE: If central venous access device (CVAD) present, refer to appropriate procedure

for checking line patency (C.2, I.7, P.11, T.3): http://rhdintranet/np/Public/Procedures/C.2.pdf http://rhdintranet/np/Public/Procedures/I.7.pdf

http://rhdintranet/np/Public/Procedures/P.11.pdf http://rhdintranet/np/Public/Procedures/T.3.pdf

NOTE: For routine adult Red Blood Cells (RBC) administration, a 20-24 gauge IV is

sufficient. For rapid RBC transfusions in adults a 16-18 gauge is recommended.

For pediatric clients, use 22-24 gauge IV.

For all other blood components any size gauge IV is adequate. 7. Ensure pre-medication (if ordered), is administered prior to obtaining blood. 8. Obtain and document baseline vitals (T, HR, BP, R, SpO2) within 30 minutes prior to blood

administration.

NOTE: Notify practitioner of vital signs outside parameters prior to transfusion (i.e. increased temperature).

B. Obtaining Blood Component EQUIPMENT 1. Documents (see APPENDICES for sample transfusion forms):

Blood Bank Report (white, 8.5 x 11 sheet, computer generated, on chart) – Appendix 8

Request for Transfusions Services Requisition Appendix 7

Orange/Red TSIN Armband – Appendix 4

RQHR Patient Transfusion Notification Form – (Must use form RQHR 425 (10/18 Supplied by lab with 1st transfusion during current admission) Appendix 9

http://rhdintranet/np/Public/Procedures/I.7.pdf

http://rhdintranet/np/Public/Procedures/P.11.pdf

http://rhdintranet/np/Public/Procedures/T.3.pdf

HEALTH SERVICES

CODE B.1


NOTE: Obtaining blood products for rural facilities: follow flow chart for receipt and Transfusion of blood in rural facilities see Appendix 19. Ensure patient notification

obtained. RQHR 425 (10/18).

NURSING ALERT:

Blood must only be warmed by an approved blood warming apparatus when ordered by a practitioner. Serious hemolysis may occur with over-enthusiastic warming.

NEVER add or piggyback any medications to blood.

Avoid simultaneous administration of blood components as reaction would be indistinguishable to which blood component is responsible. Separate IV sites or CVAD lumens must be used if simultaneous administration is required in emergent situations.

Caution when simultaneously administering medications linked to hypersensitive reactions via another line or CVAD lumen, since distinction between medication related symptoms and transfusion reactions may be difficult.

PROCEDURE 1. Verify availability of product by checking Blood Bank Report or calling Transfusions

Department.

NOTE: If there is no Blood Bank Report on chart, call Transfusions Department and they will print one immediately. It is not necessary to have Donor Unit # on Blood Bank Report. A printed copy would not be required if a computer copy can be utilized in presence of client in room.

2. Complete pink Request for Transfusion Service requisition (Appendix 7) including stamp with

client’s addressograph, requested blood product and TSIN number if applicable.

3. Present completed requisition to staff in Transfusion Department.

NOTE: Any Saskatchewan Health Authority (SHA) employee certified to transport blood and blood components may obtain components from Transfusion Department. Certification entails yearly completion of Portering Blood and Blood Products E-quiz. Volunteers are not regarded as employees of SHA. A blood receipt check is performed with lab personnel. Check Transfusion Record Tag against blood bag label for blood type, unit # and TSIN # (TSIN # if applicable). Any discrepancies are to be resolved before leaving lab.

4. Sign transfusion record tag in lab upon receipt of blood component. 5. Obtain a Notification of Transfusion Form (RQHR form 425 (10/18)) from Transfusions

Department if first transfusion client has received on current admission.

HEALTH SERVICES

CODE B.1


6. Place Notification of Transfusion Form with discharge instructions or have client sign immediately if able. Ensure client signs and receives canary copy prior to discharge.

C. Preparation and Verification of Blood Component EQUIPMENT 1. Documents (see APPENDICES for sample transfusion forms):

Ordering of Red Blood Cells Adult PPO #PP-601 ( if giving Red Blood Cells) Appendix 1

Transfusion Blood Bank Report (white, 8.5 x 11 sheet, computer generated, on chart) – Appendix 8 or computer blood band report (i.e. SCM) at bedside

Transfusion Record Tag (two part tag that comes with blood product – pink on front, white on back) – Appendix 10

Blood Bag Label (white label attached to blood bag – Appendix 11

Autologous Blood Transfusion Tag (green, three part form: one part with unit of blood, one part given to client upon donation and one part kept with CBS) – Appendix 12a

Canadian Blood Services (CBS) Autologous Transfusion Notification for Units – Appendix 12b

Directed Donation Blood Tag (same as autologous report except pink) – Appendix 13 2. Blood component to be transfused

PROCEDURE

1. Inspect blood for bubbles, clots, abnormal color or clouding, and port and bag integrity.

NOTE: If a problem is noted, call Transfusions Department.

NURSING ALERT:

All blood components must be CHECKED AT BEDSIDE BY TWO INDIVIDUALS from the following designations: o registered nurse (RN) o registered psychiatric nurse (RPN) o licensed practical nurse (LPN) o nurse practitioner (NP) o medical doctor (MD) o perfusionist o nursing student – under supervision of instructor, RN/RPN/LPN A grad nurse (GN), Advanced Care Paramedic, or competent trained adult (for home infusion) may check blood only if checking with an RN/RPN/LPN. (See Policy #4.2.4 – Administration of blood products, in the RQHR Policy Manual.)

2. Check expiry date of blood component to be administered.

3. Verify at bedside, in presence of recipient, with two individuals, blood bank report, client’s

arm band, transfusion record tag and blood component label (referring to RQHR policy 0612), check for the following:

HEALTH SERVICES

CODE B.1


Client’s name, hospital identification number (HIN / MRN #), and date of birth (DOB)(on transfusion record tag, blood bank report and arm band).

Verbal validation by client/family stating name and DOB, if possible.

Red TSIN if applicable (on transfusion record tag, blood bank report and arm band).

ABO Group and Rh of client (found only on Transfusion Record Tag and Blood Bank Report, not contained on blood bag itself).

ABO Group, Rh OF DONOR and Donor unit # (found on Blood Bag Label and Transfusion Record Tag).

Specialized attributes if required (on blood bank report, transfusion record tag and blood product label) i.e. irradiated.

NOTE: ABO Group and Rh of donor is usually the same as client’s ABO Group and

Rh.

IF THERE IS ANY CONCERN, CALL TRANSFUSIONS DEPARTMENT.

NOTE: Donor unit number will only appear on Blood Bank Report if client has been crossmatched – it does not appear if clients have had type and screening done.

4. Sign Transfusion Record Tag by both individuals. 5. Detach top pink portion of Transfusion Record Tag and affix to Blood Bank Report or

addressographed Lab Reports Page (RQHR 321) in client chart using adhesive tab. White back portion of Transfusion Record Tag MUST remain attached to blood bag throughout entire transfusion process.

NOTE:

o Bedside Checks for CONTACT or CONTACT/DROPLET ISOLATION PRECAUTIONS: first checker is in client’s room with appropriate PPE. Second checker will not wear PPE and must stand within eyesight of client in room. They must remain at least one meter away from client and not be in contact with environment. Appropriate bedside checks are then performed verbally. Second checker keeps blood component initially and once checks are completed, signs Transfusion Record tag, then takes pink top copy and attaches it to Blood Bank report. Second checker hands blood component to

NURSING ALERT:

Verification check procedure must be done in full. Failure to verify both client’s and blood unit’s ABO, Rh, and donor unit # is a major cause of hemolytic transfusion reactions.

In event of a crisis situation for uncrossmatched units of blood, client’s ID bracelet shall be checked to verify name, DOB, and HIN / MRN # against uncrossmatched units of blood.

Operating room will follow work standard to confirm client’s identity before admitting into operating room suite. This will be essential to maintain a sterile environment and confirm client identification.

HEALTH SERVICES

CODE B.1


first checker to start infusion. Second checker will confirm pump settings. First checker will sign pink copy of the Transfusion Record tag fixed to the blood bank report in the chart once clean and outside client’s room.

o Bedside Checks for AIRBORNE and CONTACT PRECAUTIONS: first checker is in client’s room wearing PPE (including N-95 respirator, gown and gloves). Second checker will stay in anteroom with chart (blood bank report) and blood component wearing clean PPE (including N-95 respirator, gown and gloves). Second checker in anteroom will verbally communicate through window within sight of client. These two individuals will confirm and complete appropriate bedside checks. Once done, second checker signs Transfusion Record tag, then takes pink top copy and attaches it to Blood Bank report. Second checker will then enter client room to hand blood Component to first checker to start infusion. Second checker will confirm pump settings. Both staff will leave client room using appropriate infection control standards. First checker will then sign pink portion of Transfusion Record tag fixed to blood bank report in chart once clean, outside client’s room.

D. Commencing Blood Component

EQUIPMENT 1. Documents (see APPENDICES for sample transfusion forms):

Blood Components Administration Chart Appendix 6 2. PPE 3. Blood Component 4. Alcohol swabs 5. Prefilled N/S syringe 6. Pre-primed blood component administration set (see section A) 7. IV pump if required

PROCEDURE

1. Don PPE. 2. Attach blood administration tubing to IV access using aseptic technique. 3. Connect blood product to appropriate blood administration set spiking below eye level.

NOTE: Infuse or drain 15 mL of normal saline prime to ensure blood cells have reached the client prior to commencing infusion. Pediatrics prime tubing with blood component.

4. Commence infusion at 50 mL/hr for adults. Obtain independent double check of pump setting

following programing as for high alert medications.

NOTE: For Pediatrics infuse slowly at 1 mL/kg/hr, up to 50 mL/hr for the first 15 minutes.

HEALTH SERVICES

CODE B.1


NOTE: For Cryoprecipitate infusion rate see Blood Components Administration Chart Appendix 6.

NURSING ALERT:

Severe transfusion reactions commonly occur within first 15 minutes of exposure to blood and blood component.

Transfusion reactions may be due to: a) client allergy b) physiological reactions, i.e. febrile c) bacterial contamination d) blood group incompatibility

Transportation of a client should not occur during first 15 minutes of transfusion, except in emergency situation.

An RN, RPN, NP, LPN, MD or Paramedic MUST accompany clients on all transportation while blood component is infusing (i.e. tests/procedures, interfacility transfers etc.).

5. Document:

Date and time infusion commenced

Donor unit number and type of blood component

Infusion site

Rate of infusion

Vital Signs

6. Obtain vital signs (T, HR, BP, R, SpO2) and assess for signs of a transfusion reaction after 15 minutes and document.

7. Increase rate of infusion per practitioner’s orders if there are no signs of transfusion reaction.

NOTE: If no specific administration rate or time ordered by practitioner, refer to Blood

Administration Chart, Appendix 6.

NOTE: Pediatrics usual administration rate is 5 mL/kg/hr up to 150 mL/hr. NOTE: All blood and blood component infusions should be completed within 4 hours of

issue from Transfusions Department.

8. Document rate change. 9. Obtain vital signs (T, HR, BP, R, SpO2) every hour, PRN and upon completion of transfusion

and document accordingly. NOTE: If at 4 hours transfusion is not complete, discontinue infusion and see discard

instructions as per Section F.

HEALTH SERVICES

CODE B.1


Filtered tubing should be changed after every 4 units of blood, every 4 hours or if occluded whichever occurs first.

NURSING ALERT:

With each unit of blood or blood component, restart vital signs and follow rates. Decrease initial infusion rate as per protocol.

Flush tubing with N/S between consecutive units of blood if infusing multiple units of same products within 4 hour time limit using the same tubing. Exception: Platelets require new tubing with every unit infused.

E. Transfusion Reaction (Actual or Suspected) EQUIPMENT 1. Documents as required (see APPENDICES for sample transfusion forms):

Saskatchewan Hospitals Transfusion Adverse Event Report Form Appendix 15 http://rhdintranet/Transfusions/public/AdverseEvents/AdverseEventInformation.htm

Bedside transfusion reaction algorithm Appendix 14 http://rhdintranet/Transfusions/public/Resources/Bedside%20Transfusion%20Reaction%20Algorithm.pdf

2. N/S IV Solution 3. IV tubing Plumset # 313404 Gravity #313410 4. Oxygen tubing and Oxygen as required 5. Transfusions Blood Bank Report Appendix 8 6. Plastic Blood Product bag

NURSING ALERT:

Refer to bedside transfusion reaction algorithm (Appendix 14) for detailed list of reaction symptoms.

The following may be signs of a transfusion reaction: Early (first 1-2 hours): o Increased pulse o Hives or itching / allergic reaction o Temperature elevation >1°C o Hypo or hypertension o Chills o Dyspnea / hypoxemia

Later symptoms of a severe reaction (up to 6 hours): o Bleeding from mucous membranes o Back pain

http://rhdintranet/Transfusions/public/AdverseEvents/AdverseEventInformation.htm

http://rhdintranet/Transfusions/public/Resources/Bedside%20Transfusion%20Reaction%20Algorithm.pdf

http://rhdintranet/Transfusions/public/Resources/Bedside%20Transfusion%20Reaction%20Algorithm.pdf

HEALTH SERVICES

CODE B.1


PROCEDURE 1. STOP TRANSFUSION IMMEDIATELY AND DISCONNECT FROM CLIENT if a transfusion

reaction is suspected. Leave unit of blood and blood administration set intact with sterile cap on end of tubing until further instruction.

2. Maintain IV access with N/S in a NEW PRIMARY LINE to ensure no further blood/blood

component is administered. 3. Obtain vital signs (T, HR, BP, R, SpO2) and document in unit specific vital signs record.

NURSING ALERT:

Consider Calling Code Blue if severe reaction symptoms indicate.

4. Apply supplemental oxygen if required. 5. Re-check client identification and blood component. 6. Notify Practitioner and Transfusion Laboratory for further instruction. 7. Return residual blood component and tubing in plastic bag (clamped and capped) to transfusion

laboratory if discontinued.

8. Complete Saskatchewan Transfusion Adverse Event Report Form whenever client experiences a blood reaction or suspected reaction and document on health record. http://rhdintranet.rqhealth.ca/Transfusions/public/AdverseEvents/AdverseEventInformation.htm

9. Complete electronic confidential occurrence report (eCOR) if human error is the cause of

reaction. F. Following Transfusion EQUIPMENT 1. Client information:

CEAC 0235 Blood Transfusion Information, Inpatient. Appendix 3 http://rhdintranet/Transfusions/public/Forms/Forms.htm

CEAC 0689 Transfusion of Blood or Blood Products, Outpatient. Appendix 16 http://rhdintranet/Transfusions/public/Forms/Forms.htm

2. Plastic Blood Product bag 3. Alcohol swabs 4. N/S syringe flush (5-20 mL)

http://rhdintranet.rqhealth.ca/Transfusions/public/AdverseEvents/AdverseEventInformation.htm

http://rhdintranet/Transfusions/public/Forms/Forms.htm

http://rhdintranet/Transfusions/public/Forms/Forms.htm

HEALTH SERVICES

CODE B.1


PROCEDURE 1. Close clamp on blood bag side of administration set.

2. Open clamp on N/S side of administration set.

3. Flush administration tubing with N/S at current rate to clear remaining blood.

4. Discontinue blood administration infusion set.

5. Reattach to intravenous infusion or perform line maintenance according to IV access.

6. Remove spike from blood bag and discard tubing.

NOTE: Plug open port of blood bag with sample tubing attached to bag to prevent any

remaining blood from leaking out.

Place each empty blood bag in a separate securely sealed plastic bag, with white tag hanging outside of plastic bag. See Appendix 17.

7. Document completion of transfusion and volumes infused.

8. Provide CEAC documents as applicable.

9. Retain empty blood bag and white Transfusion Record Tag in designated area on unit for 12

hours post transfusion. See Appendix 17.

10. Remove white Transfusion Record Tag from blood bag 12 hours post transfusion if no reaction and send to Transfusions lab.

11. Discard empty blood bag into appropriate container.

HEALTH SERVICES

CODE B.1


REFERENCES American Association of Blood Banks (2014). Technical Manual, 18th Edition. Administration of Blood Components. Callum, JL., Pinkerton, Ph., & Lima, A.,(2016) Bloody Easy 4, Blood Transfusions, Blood

Alternatives and Transfusions Reactions Canadian Blood Services (2017). Circular of Information: For The Use of Human Blood and Blood

Components. Ottawa. Retrieved from http://www.blood.ca Canadian Blood Services (2017) Clinical Guide to Transfusion (online edition) Canadian Blood Services. Retrieved from:

https://professionaleducation.blood.ca/en/transfusion/clinical-guide/blood-administration https://professionaleducation.blood.ca/en/transfusion/clinical-guide/adverse-reactions

Canadian Society for Transfusion Medicine Standards, Version 4. April 2017. Caple, C., Schub, T. & Pravidkoff, D. (2017) Blood transfusion: Administering Red Blood Cells in

Adults. Retrieved from Nursing Reference Center http://web.b.ebscohost.com/nup/detail/detail?vid=3&sid=1915bb58-2cd9-4803-b8b4-2d0a2868adc4%40sessionmgr102&bdata=JnNpdGU9bnVwLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=T706674&db=nup

Infusion Therapy (2016) Standards of Practice from Art and Science of Infusion Nursing (online

edition)

Lima, A. (2015) Bloody Easy Blood Administration Version 2 Ontario Regional Blood Coordinating Network

Regina Qu’Appelle Health Region. Laboratory Services Manual and Test Compendium (2016). Saskatoon Health Region 2015 Blood, Blood components & Plasma Protein - Administration of.

Policies and Procedures Revised by: Kelly Atkinson, CNE, Lisa Roland, CNE, Paula VanVliet, Inter-regional Transfusions

Safety Manager, Robin Lawrence, Transfusion Supervisor, Dr. T. Alport, Transfusions Medical Section Head, Kateri Singer, Director Regional Infection Prevention and Control.

Date: November 2018 (RQHR Form # on page 7 corrected 23Jan20)

(3Feb21 – All links updated under Equipment bullet 2 (page 2), Appendices 2a, 2b, 2c & 15 updated) Approved by: Date:

20Dec18

http://www.blood.ca/

https://professionaleducation.blood.ca/en/transfusion/clinical-guide/blood-administration

https://professionaleducation.blood.ca/en/transfusion/clinical-guide/adverse-reactions

http://web.b.ebscohost.com/nup/detail/detail?vid=3&sid=1915bb58-2cd9-4803-b8b4-2d0a2868adc4%40sessionmgr102&bdata=JnNpdGU9bnVwLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=T706674&db=nup



HEALTH SERVICES

CODE B.1


Appendix 1

HEALTH SERVICES

CODE B.1


Appendix 1

HEALTH SERVICES

CODE B.1


Appendix 2a

HEALTH SERVICES

CODE B.1


Appendix 2a

HEALTH SERVICES

CODE B.1


Appendix 2b

HEALTH SERVICES

CODE B.1


Appendix 2b

HEALTH SERVICES

CODE B.1


Appendix 2c

HEALTH SERVICES

CODE B.1


Appendix 2c

HEALTH SERVICES

CODE B.1


Appendix 3

HEALTH SERVICES

CODE B.1


Appendix 3

HEALTH SERVICES

CODE B.1


Appendix 4

Transfusion Services Identification Number (TSIN):

MRN / HIN # is assigned only upon admission to hospital system. If clients have their cross match done as an outpatient, the TSIN is a unique number that maintains continuity of identification from time of collection.

For outpatients and clients transferred between SHA facilities the TSIN will be displayed as a number on the armband.

TSIN’s WILL NOT APPEAR FOR EVERY CLIENT.

If the client is cross matched while they are an inpatient, they will not have a TSIN blood component armband.

If the client may be transferred to another facility, ask the lab to put a TSIN blood component armband on the client at the time of cross match.

The blood component armband must not be removed. If the armband is removed for any reason, the client must be re-cross matched.

TRANSFUSION SERVICES IDENTIFICATION NUMBER (TSIN)

Code: B.1 Revised: Sept 2014

HEALTH SERVICES

CODE B.1


BLOOD AND BLOOD PRODUCTS ADMINISTRATION CHECKLIST

**Refer to Applicable Nursing Procedures (B.1, B.1.1, B.1.2, B.1.3, B.1.6)**

1 Practitioner Order Verified

2

Consent for Administration of Blood/Blood Components Signed

Yes – Proceed to #3 No – Was the Practitioner notified to obtain informed

consent or have a Practitioner Order that states: “Ok

to proceed with transfusion without signed consent”.

MRP must obtain consent within 24 hours.

3 Client Education Completed

Yes

No – Record reason in notes

4 Patient Identity Confirmed (3 Client Identifiers)

ID band (name, HIN/MRN# and DOB)

Verbal confirmation (Name and DOB)

5

Crossmatch Results (Required for blood components i.e RBC, Cryoprecipitate, Plasma, Platelets)

On chart Using uncrossmatched blood (practitioner’s signature

required)

6 IV in place, IV Fluid

0.9% Sodium Chloride

7 Baseline Vital Signs (T, P, R, B, SpO2)

Recorded within 30 minutes prior to initiation

8 Premeds

Ordered

Administered

N/A

9 Visual Inspection/Expiry Acceptable (If not acceptable, return to Transfusions Department)

10

Verbal Validation (Blood Unit Label, Blood Bank Report, Transfusion Record Tag & Patient Armband) - Done at

bedside by 2 appropriate designates) Note: It is not necessary to have Donor Unit # on Blood Bank Report

Name and Date of Birth

MRN/HIN and/or Transfusion Services Identification Number (TSIN)

Client ABO and Rh (required for blood components)

Unit ABO and Rh (required for blood components)

Specialized requests have been followed if required (i.e. irradiated)

Unit # (verify Transfusion Record Tag and Blood Unit Label)

2 signatures on tag

For ARO isolation refer to nursing procedure.

11 Final Verification

Transfusion Record tag verified with armband

12

Documentation

Transfusion initiated within 30 minutes of issue

Vital Signs (T, P, R, BP SpO2)

15 minutes

Every hour and PRN

Upon completion

Infused within 4 hours of issue

Pink copy of transfusion record tag affixed on chart

13

Transfusion Reaction (Algorithm Appendix 14)

Adverse Reaction Noted – See Below No Adverse Reaction

Transfusion stopped immediately

IV patency maintained with compatible fluid

Practitioner notified

Vitals signs taken every 15 minutes or more frequently as condition indicates

Client identification And blood components re-checked

Transfusion Service/Lab notified

SK Transfusion Adverse Event Report form completed

14

Following Transfusion

Retain empty blood bag and white Transfusion Record Tag in designated area on ward for 12 hours post transfusion.

Remove white Transfusion Record Tag from blood bag after 12 hours and send to Transfusions Department

Discard empty blood bag after 12 hours into appropriate container

15 Notification of Blood and Blood Products (RQHR #425)

Appendix 5

HEALTH SERVICES

CODE B.1


Appendix 6 Blood Component Administration Chart

HEALTH SERVICES

CODE B.1


Appendix 7

Request for Transfusion Services Requisition

HEALTH SERVICES

CODE B.1


Appendix 8

HEALTH SERVICES

CODE B.1


Appendix 9

HEALTH SERVICES

CODE B.1


Appendix 10

HEALTH SERVICES

CODE B.1


Appendix 11

SAMPLE BLOOD BAG WITH LABEL


HEALTH SERVICES

CODE B.1


Appendix 12a

Autologous Blood is blood donated by the client for use in his / her own surgery.

The Canadian Blood Services (CBS) has a green three part tag for autologous blood donations (see next page).

The top part of the tag is kept with the blood.

The middle portion is given to the client.

The bottom portion is on the transfer pack for the plasma.

The Transfusion Department receives the blood just prior to the proposed surgery date.

The blood bag will have the top portion of the green tag from the CBS as well as a Transfusion Record tag (see page 14).

On admission, the client is to present their part of the green tag and a Notification from CBS to nursing personnel.

When checking the blood, verify that the blood bag tag matches the bottom part of the tag provided by the client.

The client’s portion of the tag is to be stapled to the Notification from CBS and inserted under the Laboratory / Transfusions section on the client’s chart.

Clients who have provided an autologous blood donation must be provided with that donation if a transfusion is required. Failure to comply with the client’s request may result in litigation.

Accurate surgery date is imperative since autologous donations expire after 42 days.

Procedure for accessing blood is the same as per homologous donation.

Procedure for transfusing blood is the same as per homologous donation.

AUTOLOGOUS BLOOD DONATION


HEALTH SERVICES

CODE B.1


Appendix 12b


HEALTH SERVICES

CODE B.1


Appendix 12c

AUTOLOGOUS BLOOD DONATION TAG

HEALTH SERVICES

CODE B.1


Appendix 13

A Directed Blood Donation is blood donated by a parent for use by their child, 18 years or younger. Procedure is the same as for autologous donation

except the three part blood tear-off tag is pink in color.


DIRECTED TRANSFUSION TAG DONATION

HEALTH SERVICES

CODE B.1


Appendix 14

Code: B.1 Revised:

HEALTH SERVICES

CODE B.1


Appendix 15

HEALTH SERVICES

CODE B.1


Appendix 15

HEALTH SERVICES

CODE B.1


Appendix 16

HEALTH SERVICES

CODE B.1


Appendix 17

Empty Blood Bag with Tag in Plastic Blood Bag for Safe Storage in Designated Area on Unit

HEALTH SERVICES

CODE B.1


Massive Transfusion Protocol (MTP) Nursing Guidelines

Criteria for Activation

≥ 4 packed red cells transfused in ≤ 1 hour with uncontrolled bleeding and /or request by Code Blue Captain, Trauma Team Leader or Anesthesiologist when clinically necessary.

Physician determines MTP activation is required. The physician activating the MTP will be Contact Physician for the duration of the MTP. If the Contact Physician is not the MRP, then physician-to-physician communication about the activation should occur at a clinically appropriate time.

The Charge RN for the identified unit will be the Team Contact.

Team Contact notifies Transfusions Department (Regina General Hospital #4474, Pasqua Hospital #2227) to activate MTP

Provide patient name, MRN, gender, care team site, and location Transfusions Department is responsible for overhead page of MTP activation.

Team Contact will:

Be provided with an MTP companion phone and Team Contact red vest (red badge in ORs) with the delivery of the initial MTP box of blood products.

Carry the companion phone at all times during the MTP.

Don Red Vest (or badge) so that they will easily be identified by all members of the health care team.

Code Blue team responds to MTP activations per RQHR Code Blue policy.

MTP documentation to be done on Unit Specific Nursing Flow Sheets, Nursing Notes, Trauma Record, Operating Room Record and/or Code Blue Record

Emergency Department team member will bring and manage Belmont Rapid Infuser

Dedicated MTP Transport staff (identified by Transfusions) is responsible for transporting initial “MTP Package”, “MTP Bloodwork” and all “MTP Boxes” to and from lab per protocol.

The initial MTP “Box 1A” (4 pRBC) will be delivered immediately to the identified unit. “Box 1B” (1 platelet + 4 plasma) will be delivered ASAP (within 20-25 minutes). Refer to algorithm. Subsequent MTP Boxes can be delivered every 30 minutes as required by the Physician Lead. Transfusions will communicate with Team Contact prior to sending all subsequent MTP boxes to ensure readiness.

Team Contact will: Ensure patient Vital Signs every 15 minutes (BP, HR, RR, SPO2, and Temp) and appropriate blood

work is collected using provided MTP requisitions every 30-60 minutes as ordered. Remain with patient until MTP discontinued or patient transferred to appropriate care location Contact Transfusions at 6562 (dedicated MTP line) of any change in care team location or contact # Contact Transfusions at 6562 as soon as MTP is discontinued. Ensure MTP companion phone, pager, red vest is returned to Transfusions. Ensure any unused blood products are returned to Transfusions as soon as possible.

NURSING ALERT:

DO NOT remove patient identification bands at any time during MTP

Warming methods to achieve normothermic patient temperature (Bair Hugger®, warm blankets, increasing

room temperature, etc…)

Refer to Massive Transfusion Protocol Algorithm for specific details of above protocol highlights Nov 6, 2018

Appendix 18a

HEALTH SERVICES

CODE B.1


Appendix 18b

HEALTH SERVICES

CODE B.1


Appendix 19

FLOWCHART FOR RECEIPT AND TRANSFUSION OF BLOOD IN RURAL FACILITIES

Blood Product sent in Transport boxes1 unit/box and each box will contain all informationEach box has the following:1. Tamper-proof tie2. Human Blood For Transfusion card3. Envelope with issue voucher

Upon receipt of storage box(es) 1. Tamper-proof tie intact? 2. Human Blood for Transfusion card shipping/storage time is valid?

Yes No

Open Envelope with Issue Voucher 1. Acknowledge on issue voucher that Tamper-proof tie on shipping container intact.

Do Not TransfuseContact Transfusions

RGH Immediately306-766-4474

Ready to transfuse patient?

NoYes

Open Storage box (1 at a time when transfusion ready to start)1. Record on Issue Voucher Visual Inspection2. Inside storage box Patient’s report and Notification of Administration of Blood and Blood Products form3. Place report on patient chart4. Follow instructions for transfusing in RQHR nursing procedure5. Prior to starting transfusion, perform visual inspection and record on RQHR Blood/Blood Product issue voucher6. Following patient identification at bedside by two individuals as outlined in nursing procedure, sign Transfusions record tag (both individuals checking blood products must sign tag.)7. Remove pink portion of Transfusion Record “tag” and apply to patient’s chart8. Complete documentation required in nursing procedure and complete RQHR Blood/Blood Product’s issue voucher

Leave sealed storage box at Room Temperature until ready to transfuse up to time valid on Human Blood for Transfusion Card

Transfuse Patient using RQHR nursing procedure B.1

Following transfusion of each unit of blood, follow steps listed in Nursing

Section of RQHR Blood issue Voucher for Rural Facilities