8. 1 PACKED CELLS
Red cells are indicated for the treatment of clinically significant anaemia with symptomatic deficit of oxygen carrying capacity and for the replacement of traumatic or surgical blood loss.
The decision to transfuse red cells should be based on the clinical assessment of the patient, the patient’s haemoglobin level and their response to any previous transfusion.
Summary of Transfusion Guidelines (NHMRC/ASBT 2002)
To ensure the safe and effective transfusion of red cells, 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
IV Therapy Chart (ordered for number of units, rate)
Standard blood administration set (inclusive of 170-200 micron filter)
IV giving set
Optional: (if ordered by Doctor)
6.6 Infusion Devices
6.7 Blood Warmer
3.0 Sample collection – Crossmatching
· ABO group needs to be known – 1 x EDTA sample (Correct labeling criteria applies to both sample and request form)
· Hb should be known prior to ordering
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 or blood component.
Perform integrity check of component – Component Integrity Check 6.2
Perform vital bedside identity check – Positive Patient Identity Check 6.1
Any discrepancy - STOP – contact the transfusion service provider immediately
· 18-20 size gauge needle is recommended for adults. (Smaller gauge devices can be used but restrict the flow rate of the transfusion and result in a much longer time to infuse.)
· 22-24G or larger is recommended for paediatric patients (where blood is being administered by syringe to small infants or neonates the blood shall be drawn into the syringe via a 170-200 micron filter)
· Blood may be given through a central venous line if patient requires high volume transfusion
Use a standard blood administration set which includes a filter 170-200 microns.
Optimally, the blood administration set should be connected directly to the IV access site.
Piggybacking into an existing line increases the risk of contamination, as well as the possibility that an incompatible IV fluid may be infused together with the blood component
· Gently mix red cells prior to spiking bag
· For first 15 minutes rate should be no more than 5mls/min, unless otherwise clinically indicated
· Transfuse over 1-2 hours (unless otherwise clinically indicated) always < 4 hours
NB: Administration set may be used for administration of up to 2 units red cells but MUST be changed every 8 hours
· After completion of transfusion discard empty donor pack – however retain for up to 48 hours in case of a delayed transfusion reaction
· Document transfusion in patients notes - Documentation 7.0
· Record baseline TPR & BP prior to commencement of transfusion of each component.
· Repeat 15 minutes after commencement of each unit.
· Then, hourly and on completion of each unit.
Closely observe the patient for the first 15 minutes of transfusion; this is when a severe reaction is most likely to occur.
Instruct patient to report immediately any adverse effects.
A unit may be interrupted during a transfusion, however, if recommenced transfusion MUST be completed < 4 hours of removal of red cells from approved storage.
An accurate fluid balance chart must be maintained
Each unit of packed cells is approx 250ml / each unit of autologous blood contains approx. 450 ml
· Record urinalysis
· Check cannula site with observations
· 9.2 Irradiated
· 9.3 CMV negative
· 9.4 Washed Cells