BLOOD BANK SPECIMEN COLLECTION PROCEDURE

Transcription

1 BLOOD BANK SPECIMEN COLLECTION PROCEDURE INTRODUCTION Scientific and technical advances in blood group serology have made the transfusion of blood a relatively safe procedure, but serious adverse effects of transfusion still result because of human errors. The collection of a properly labeled blood sample from a properly identified patient is critical for a safe blood transfusion. The individual who collects the blood sample must identify the patient in a positive manner prior to collecting the specimen. Only personnel who understand the importance of blood bank protocols and adhere to them should be allowed to collect patient samples. Failure to provide adequate concentration and attention to this task endangers the life of the patient. The Altoona Regional Health System utilizes the Hollister Ident-A-Band recipient identification system to ensure that patients who are potential blood or blood component recipients are properly identified. The system consists of a numbered Hollister R-sheet and a red patient identification wristband. These products are available upon request from the blood bank. The Hollister Ident-A-Band system is required at the time of specimen collection. Specimens must be collected no more than 3 days before the anticipated blood need. The entire Hollister identification process must be repeated every three days if blood needs continue. The only exceptions to these guidelines are predeposited autologous donations and pre-admission patients that provide the preadmission nurse with a history of no transfusions or pregnancies with in the last three months. A Hollister R-sheet MUST accompany the following requests: 1. Type and Crossmatch requests when red blood cells or blood components are definitely needed for transfusion or surgery. 2. Type and Screen requests when blood products may be needed for transfusion or surgery. Once a normal type and screen is completed, any requests for red blood cells will be available in approximately 15 minutes after the blood bank is notified. If a clinically significant unexpected antibody is detected in the Type and Screen procedure, it is the Blood Bank s policy to crossmatch and provide two units of compatible red blood cells for the patient. 3. Draw and Hold requests are to be used when an extra tube will be collected and held in the Blood Bank for future testing if specific orders become necessary. This order is most often used internally for Labor Room patients and Trauma patients. It is also used frequently (pending H&H results) for Medial Outpatients collected by BMA Oncology, the Outpatient Clinics, or Home Nursing Agencies. Blood Bank Specimen Collection Page 1 of 7

2 4. The Hollister R-band should also be used for any Blood Bank request, even ABO and Rh testing, when the patient will be coming to or remaining in the facility for the purpose of treatment, diagnostic testing or surgery (e.g. D&E,). The Hollister Ident- A-band system is not indicated for prenatal testing including antenatal Rh immune globulin testing. INITIATING A BLOOD BANK REQUEST 1. From an online facility, place the appropriate orders into the computer using the test codes provided. From an off-site facility, complete one of the Altoona Regional Health System Laboratory Test Request Forms provided. Special Instructions are included at the end of this section for requesting autologous and directed donations. 2. If the Hollister Ident-A-Band system is to be used, the Hollister R-sheet is to be completed in the following manner: (See Figure 1). Specimen Tube Label - Top Right: Patient s full name including middle initial Patient s own Social Security Number (Not Spouse s or Medicare Number) Patient s Date of Birth Name of requesting physician Date and Time of specimen collection Phlebotomist s initials Blank Left Side of R-sheet: Patient s full name including middle initial (specimen label may be attached) Date of Specimen collection Chart Record Lower Left: Do Not Remove: This is for Blood Bank uses only. R Numbers are only to be placed on specimen tubes. Do not remove R Numbers to be placed on the patient s chart. The R Number must not be documented on the chart in order to avoid potential misidentification errors. Patient Armband Insert Bottom: Patient s full name including middle initial Date and Time of specimen collection Phlebotomist s initials NO OTHER IDENTIFIYING NUMBERS SHOULD BE INCLUDED ON THE PATIENT S HOLLISTER ARMBAND. Blood Bank Specimen Collection Page 2 of 7

3 BLOOD BANK SPECIMEN COLLECTION Patient identification and specimen labeling are the two most crucial steps in pretransfusion testing. A venipuncture must not be performed if there are any identification discrepancies (Name, Social Security Number, Medical Record Number, Date of Birth, etc.) between the physician s order, laboratory test request label, R-sheet or patient armband. 1. The individual who will be collecting the specimen must unmistakably identify the patient. The following procedure must be followed in order to do so: A. Ask the patient to state his or her full name, including middle initial. Never ask the patient to agree to a certain name. (e.g.: Are you Mr.? ) B. Confirm the Patient Identity using at least 2 unique identifiers. Inpatients Compare the hospital wristband information (name, medical record number, social security number, date of birth) with the order information on the label. If possible, ask the patient to state their social security number (or date of birth in the absence of a SS#) to ensure that the admission data is correct. The identifying numbers should be documented on the R-sheet as well as on the patient tube. Never use room numbers or bed labels as a source of patient identification. Outpatients and Physician Office Patients Ask the patient to state his or her own social security number or to provide documentation. Do Not Use the spouse s social security number or a Medicare number. If the patient does not have a social security number, you can substitute their date of birth. The identifying numbers should be documented on the R-sheet as well as on the patient tube. C. Please Note: If an emergent situation exists where the identity of a patient is unknown, a minimum of the Hollister R-Number and a Trauma Color alias will suffice as two unique identifiers until other name and number information becomes available. In Trauma or Massive Transfusion Protocol (MTP) situations, group O Positive or O Negative blood may be transfused without prior patient identification or specimen collection, but every attempt must be made to get a sample to the Blood Bank as soon as possible for determination of ABO/Rh, antibody screening, and compatibility testing. 2. After patient identity has been verified, remove the patient armband insert from the bottom of the R-sheet. It should be completed with the patient s full name, date and time of collection and phlebotomist s initials. NO OTHER identifying numbers (SS#, DOB, etc.) should be included on the Hollister armband. Insert the labeled band into the red plastic armband provided. Secure the red armband around the patient s wrist. Please make sure all information is visible before Blood Bank Specimen Collection Page 3 of 7

4 attaching the armband. Allow sufficient room in the armband for comfortable movement and possible swelling of the wrist, but snug enough to prevent removal or accidental loss. NOTE: The patient should be instructed not to remove the armband until discharge from the hospital. If the armband is removed prior to transfusion or surgery, the entire process must be repeated. 3. Perform the phlebotomy according to general specimen collection techniques. Collect one 10-mL K-2 EDTA purple top tube. Other acceptable specimens include a 10 ml plain red top tube along with the 5 ml EDTA tube. If difficult phlebotomies or pediatric patients necessitate the use of smaller tubes, an absolute minimum of one 5 ml or two 3 ml EDTA lavender top tubes should be collected. Each tube submitted must be labeled with a Hollister R-number, name, and second identifying number. Do not use microtainers for blood bank specimens without consulting the blood bank before collection. 4. All tubes must be completely labeled as follows before leaving the patient s bedside or exiting from the phlebotomy area: A. The specimen tube label from the top right hand side of the R-sheet should be placed on one of the 10 ml purple top tube in such a way that all of the information on the label is clearly visible and a long narrow window is created down the length of the tube. This window is necessary to enable visible examination of the tube s contents. This label must contain the information specified in the above section Initiating a Blood Bank Request. B. All tubes should be labeled with a minimum of the patient s full name, a second unique identifying number, date and time of collection and phlebotomist s initials. They must also have a Hollister R number sticker attached to each specimen. Please use any of the three stickers in the vertical row above the chart record sticker on the left side of the Hollister R-sheet. C. If pediatric tubes are used, each tube must be labeled with all of the above information including a Hollister R number sticker. If collection of microtainers has been approved by the blood bank, they may be placed into an empty 10 ml red top tube and the necessary labels placed on the larger tube. D. Please Note: Improperly labeled tubes will not be accepted by the Blood Bank for pretransfusion testing. Incompletely or inaccurately labeled tubes will never be returned to the phlebotomist or collection area for completion or correction once they have been submitted. In such cases the R-sheet, patient identification process, and the phlebotomy must all be repeated. The same applies if the patient armband has not been applied or has been removed. 5. All blood bank specimens should remain at room temperature in the original tubes until they can be delivered to the blood bank. They should not be centrifuged to Blood Bank Specimen Collection Page 4 of 7

5 separate serum or plasma. Specimens should not be refrigerated. The patient samples and all paperwork, including the R-sheet, should be transported to the blood bank as soon as possible. The date and time of specimen arrival will be documented by computer verification when the specimen is received in the lab. CRITERIA FOR SPECIMEN REJECTION Specimens received unlabeled or improperly labeled. No specimens will be accepted unless the Hollister Ident-A-Band patient identification and specimen labeling process is completed exactly as described in the previous sections. The Blood Bank staff or members of the phlebotomy team may not, under any circumstances, complete labeling after the blood samples are received in the laboratory. All specimen labeling must be performed at the patient s bedside at the time of collection. Illegible forms or labels are unacceptable. Specimens not received in the Laboratory within 8 hours of collection. Specimens for pretransfusion testing should be processed as soon as possible to ensure accurate ABO and Rh typing and optimal antibody detection. Unacceptable tube received. K-2 EDTA is the preferred specimen for pretransfusion testing. Serum or K-3 EDTA may be acceptable. Specimens which are hemolyzed. Hemolyzed specimens may contain enough soluble material or cellular stroma to interfere with typing reactions, detection of clinically significant antibodies or compatibility testing by acting to neutralize antibodies. Free serum hemoglobin may also mask antibody-induced hemolysis. Quantity not sufficient for testing (QNS). Generally, a minimum of 6 ml of whole blood yielding at least 3 ml of serum is required to provide adequate specimen volume for antibody detection and compatibility testing. (See Specimen Collection Section above for preferred specimen volumes.) Some testing may be performed on smaller specimens, but could result in delays should large numbers of units become necessary or a clinically significant antibody is detected. Samples diluted with IV fluids. Whether collected from a phlebotomy site above an IV line, or syringe pulled from an infusion line, residual IV fluids can interfere with serologic testing. The serum dilution will result in less sensitive antibody detection. Some contaminant fluids may also result in spontaneous agglutination providing false positive results. Specimens lacking two (2) unique identifiers. The specimen must include the Hollister R-number and at least one other unique identifier such as Trauma Color, Name, Date of Birth, Social Security Number, Medical Record Number, etc. Blood Bank Specimen Collection Page 5 of 7

6 SUMMARY OF COMMON BLOOD PRODUCTS Component Red Blood Cells Plasma Platelets And Platelet Apheresis Cryoprecipitated AHF Factor Concentrates (Factors VIIa, VIII, IX, and vwf available) Major Indications Symptomatic anemia Deficit of labile and stable plasma coagulation s, TTP Bleeding from platelet dysfunction abnormality or thrombocytopenia Hypofibrinogenemia, von Willebrand s disease, Factor XIII deficiency Hemophilia A Treat specific coagulation deficiency Function Restoration of oxygen carrying capacity Source of labile and stable plasma coagulation s Provide adequate hemostasis Provides Factor VIII, Fibrinogen, Factor XIII, And vwf Provides specific coagulation Not Indicated Pharmacologically treatable anemia, Coagulation deficiencies Conditions responsive to volume replacement Plasma coagulation deficiencies, ITP Conditions not deficient in specific Conditions not deficient in specific Blood Bank Specimen Collection Page 6 of 7

7 AUTOLOGOUS AND DIRECTED DONOR INFORMATION Autologous Donation refers to the removal of blood or blood products from a donor or patient for subsequent re-infusion. The use of preoperative pre-deposited autologous blood can significantly reduce or completely eliminate allogeneic blood exposures. This procedure is used most often in orthopedic, vascular urologic and cardiac surgery. For procedures in which the likelihood of transfusion is remote, the use of preoperative predeposited autologous blood is not indicated. Advantages of autologous donation include: 1. Prevention of transfusion - transmitted disease 2. Prevention of alloimmunization 3. Reduction in adverse events during a transfusion (GVHD, etc,) 4. Supplement area blood supplies 5. Stimulate erythropoiesis 6. Source of blood for patients with multiple alloantibodies Disadvantages of Autologous Donations include: 1. Outdating and discard of unused units of blood 2. Increased cost and complexity of services 3. Donor reactions Directed Donation allows potential blood component recipient to select the donors to be used for anticipated transfusion events. The donor criteria are identical to homologous donations, except for the fact that all of the potential directed donors selected must be ABO and Rh compatible with the intended recipient. All Autologous and Directed donations are arranged and collected by the Alleghenies Region of the American Red Cross. Arrangement for Autologous and Directed donations may be made by contacting the American Red Cross at All of the blood components are collected and forwarded to Altoona Regional prior to the date of the anticipated product need. REFERENCES Technical Manual, American Association of Blood Banks, Bethesda, MD, 15 th Edition, Blood Bank Specimen Collection Page 7 of 7