8.3 FRESH FROZEN PLASMA (FFP)
FFP is likely to be appropriate for:
· Single factor deficiency & bleeding or invasive procedure planned, and where no specific factor replacement available
· Warfarin effect: In presence of life threatening bleeding. Use in addition to Vitamin K dependent concentrates
· Acute DIC: Indicated where there is bleeding and abnormal coagulation. Not indicated for chronic DIC
· TTP: Accepted treatment; replacement therapy for plasma exchange
· Following massive transfusion or cardiac bypass: May be appropriate in the presence of bleeding and abnormal coagulation
· Liver disease: May be appropriate in the presence of bleeding and abnormal coagulation. Abnormal coagulation usually defined as greater (>) than 1.5 times normal range.
Summary of Transfusion Guidelines (NHMRC/ASBT 2002)
NB: FFP is frequently used inappropriately
· Rh group doesnt matter
· Where group unknown use AB plasma
To ensure the safe and effective transfusion of FFP, in the appropriate amount at the appropriate time where the benefits of the transfusion out weigh the potential risks.
PERSONNEL ABLE TO PERFOM
Registered Nurse + another RN or EN
FFP is stored frozen in the blood bank and will be defrosted on request.
Defrosting takes about 20 minutes.
· ABO group needs to be known 1 x EDTA sample (Correct labeling criteria applies to both sample and request form)
· Coagulation profile result and diagnosis MUST be available when ordering FFP
· Normally maximum of 2 units FFP will be released at one time
EQUIPMENT IV Therapy Chart (ordered for number of units, rate)
Standard blood administration set (inclusive of filter 170-200 microns)
IV giving set
Ensure integrity of vein with IV in situ before retrieving component from approved storage Collection of blood products 4.2
Ensure IV line (approved for blood administration) is primed with normal saline / component.
Perform integrity check of component 6.2 Component Integrity Check
Perform vital bedside identity check 6.1 Positive Patient Identity Check
Any discrepancy - STOP contact the transfusion service provider immediately
· FFP units are defrosted in blood bank immediately prior to use (it takes 15-20 mins)
· Transfuse via standard blood giving set (incorporating a 170-200micron filter)
· Invert component gently before transfusion and check integrity eg: look for turbidity, clots
· For first 15 minutes rate should be no more than 5mls/min unless otherwise indicated
· Transfuse each unit over 30 mins 1 hour unless otherwise clinically indicated
· Usual therapeutic dose: 10-15mL/kg. Order in number of units
· Baseline TPR and BP at commencement of each unit
· Repeat 15 minutes after commencement
· On completion or hourly (which ever comes first)
· FFP is usually transfused as quickly as is tolerated (30 minutes) < 4 hours
The nurse must remain with the patient throughout the transfusion
· Reactions are usually allergic in nature
· Fluid overload can occur with larger volumes of FFP, a strict fluid balance record must be maintained