BLOOD BANK Department INTRODUCTION Blood products used at Saint Michael s Hospital are obtained from the BloodCenter of Wisconsin. There is no charge for the blood, but there is a fee for testing and processing the blood component. The hospital does not require the family to replace the blood; however, if members of the family are willing and able to donate blood, they may do so during a BloodCenter of Wisconsin community blood drive or at the BloodCenter of Wisconsin Marshfield site. PATIENT AND SPECIMEN IDENTIFICATION Blood samples will not be drawn from any patient without positive identification. If a patient does not have a hospital armband, the technologist/phlebotomist will ask a responsible RN to identify the patient or have patient identify him/herself if able. After positive identification, the technologist/phlebotomist will attach a green Blood Bank wristband to the patient. DO NOT remove this band. These numbers are used in Blood Bank and by the nurse administering the blood, as positive identification of the patient and of the blood sample. PATIENT IN SURGERY OR KIDNEY UNIT A member of the surgical team or the hospital Kidney Unit may obtain a sample for blood bank. This person is responsible for the identification of the patient. The sample of blood should not be taken from an IV arm whenever possible. If taken from the IV arm, shut off the IV for 2 minutes before drawing; note on tube drawn below/above IV. At the patient s bedside, hand label the tube with the patient s complete name, Blood Bank ID number, date, time of drawing and initials of venipuncturist. Do NOT use nicknames or abbreviations. Lab tests performed before red blood cell transfusions include: ABO/Rho(D) Typing, Antibody Screening and Crossmatch. ORDERING BLOOD BANK TESTS OR BLOOD PRODUCTS Because the most common causes of fatal hemolytic transfusion reactions are the misidentification of the blood unit, the recipient, or recipient blood sample, we wish to reemphasize the following policy: NEVER cut off a Blood Bank armband or tape one to the bed. If an armband needs to be cut off, CALL THE LAB, and a technologist will cut the old band off, insert the old number into a new band and reband the patient. ONLY THE LAB MAY CUT OFF THE ARMBAND. In surgery, the anesthesiologist will take full responsibility for replacing an armband. If an armband is cut off by nursing personnel, THE PATIENT MUST BE REDRAWN AND RECROSSMATCHED.
If you have a question on this policy, please call Blood Bank or speak to Dr. Arnold, medical director. Order Blood Bank products in Meditech Order Entry category BB (see Test List in this manual). Answer the questions Quantity?, When is blood needed? and Been pregnant or transfused in last 3 months?. If manually requesting, include the recipient s full name, hospital identification number and date of birth on the All-Purpose Requisition. Leukoreduced red cells, fresh frozen plasma, and cryoprecipitate are routinely kept on hand in the blood bank. They may be obtained at any time. Fresh frozen plasma and cryoprecipitate must be thawed before being given. This takes 8 minutes for cryo and 14-18 minutes for FFP. Red cells must be crossmatched before being given. Give the Blood Bank advance notice if platelets, irradiated blood products, washed cells, frozen washed cells, or CMV negative cells are needed for a patient, since these must be prepared and obtained from the BloodCenter of Wisconsin in Marshfield or Milwaukee. All red cells and single donor platelets are leukoreduced.
For the following information also see Blood Product Administration under Ministry Saint Michael s Hospital - Policies and Procedures, Patient Care Policies and Procedures, 3 Skills-Procedures SIGNING OUT BLOOD A messenger (any hospital employee or PACE volunteer my be the messenger) must bring a stamped card bearing the patient s full name and Blood Bank wristband number to the Blood Bank; in cases of emergency or outpatients, a hand written slip will suffice. The messenger may NEVER take blood or blood products out of the Blood Bank refrigerator. A laboratory technologist obtains the blood or blood product and performs the sign-out procedure. The messenger and the laboratory technologist will: 1 Compare the patient s name and Blood Bank wristband number from the stamped or handwritten slip with the crossmatch card and with the issue/transfusion card. 2 Compare the ABO/Rh type and unit number of the blood product listed on the crossmatch card, the issue/transfusion card and the blood component. 3 Verify the patient ABO/Rh listed on the crossmatch card and the issue/transfusion card are identical. The patient ABO/Rh and unit ABO/Rh must be compatible. 4 Resolve any discrepancies found before the unit may be issued. 5 The messenger initials the issue card. The technologist initials the issue card and attaches the transfusion card to the blood bag. 6 The nursing person takes a biohazard bag to the floor for return of the blood bag and transfusion card. Personnel obtaining blood or blood products may obtain them for only one patient at a time. If blood is needed for two patients on the same floor, two trips to the Blood Bank must be made or two different personnel must come down. This is to prevent transfusion of blood to the wrong person. Transfuse the blood component immediately after leaving the Blood Bank. NEVER place it in a refrigerator on the nursing unit. If blood product is not to be given, return it to the Blood Bank immediately. Returned components are signed in in the same fashion they were signed out. Blood must be stored continuously between 1-6 degrees C. Blood out of the bank longer than 30 minutes must be returned but cannot be reissued. Blood, after being opened or partially used, should never be refrigerated to be given at a later date since there is a danger of contamination. In the event that the IV becomes inoperable, restart as quickly as possible to avoid contamination and needless waste of blood.
PREPARATION OF PATIENT Vital signs take pulse, blood pressure, temperature, and respiration and record as a baseline PRIOR to transfusion. If there are abnormal vital signs, consult the physician. IDENTIFICATION OF PATIENT AND BLOOD PRODUCTS To correctly identify the patient and the blood products, a clerical check of all blood products and of the patient MUST be done before beginning a transfusion or injection. It is ideal for two persons to carry out the steps listed below, thus crosschecking the information. The following information MUST be reviewed and found to be correct: 1 Physician order to transfuse. 2 Patient consent for administration of blood products. 3 Check the crossmatch card for the patient s name and BB wristband number with the transfusion card. They must match the transfusion card exactly. 4 Check the ABO group and Rh type on the blood container to be certain it matches the crossmatch card and the transfusion card. 5 Check the number on the label of the blood container to be certain it matches the crossmatch card and the transfusion card. 6 Check the patient s blood type on the crossmatch and transfusion card. They must match exactly. 7 Check to make sure the blood type of the blood product is compatible with the patient s. 8 Check the expiration date on the unit of blood/component and verify as acceptable. AT THE BEDSIDE 1 When possible, ask the patient to identify him/herself by stating and spelling his/her name. Never ask, Are you Mr.? 2 Check the name on the patient s hospital wristband against the information on the transfusion card and crossmatch card. They must match exactly. 3 Check the blood bank wristband number on the patient against the wristband number on the crossmatch card and on the transfusion card. They must match exactly. 4 The person who identifies that the correct blood product is being administered to the patient should then sign the transfusion card and the chart record. 5 The second person during the clerical check should sign the blood transfusion form (clerical check) stating that the above procedure has been completed and all information is correct. DO NOT BEGIN THE TRANSFUSION UNTIL ANY DISCREPANCY IN THE ABOVE INFORMATION IS RESOLVED. **Thoroughly mix the blood prior to hanging the bag for transfusion.
INFUSION OF BLOOD COMPONENT Administer blood components intravenously through a blood filter to remove blood clots and coagulant debris. The standard blood administration set incorporates a filter approximately 170 microns in diameter. Special white cell removal may also be used on products not pre-filtered. Most standard filters are designed to filter 2 4 units of blood, but if the 1 st unit required 4 hours for transfusion, the filter should not be reused. The blood infusion set should be changed after 4 hours. Needles or catheters used for blood transfusion should be large enough to allow appropriate flow rates, but not so large that they damage the vein. For the general population 18-20 gauge needles may be used. For pediatric patients or adults whose larger veins are inaccessible, blood can be infused through a 23-gauge, thin wall needle. STARTING THE TRANSFUSION AND INFUSION SOLUTIONS Use only Sodium Chloride USP (normal saline) solution suitable for use in the transfusion of blood products containing red blood cells, platelets, or leukocytes. In vivo hemolysis of red blood cells exposed to various IV solutions seems to be primarily dependent upon the amount of red blood cell swelling that occurs in vitro. Five percent dextrose in water is NOT satisfactory for filling or flushing blood administration sets because red blood cell clumping and swelling with subsequent hemolysis may occur. Lactated Ringer s solution also is unsatisfactory because calcium in the ringer s solution may cause the formation of clots. Great care must be taken to ensure that drugs which are toxic to blood components are not infused through the same administration set as the blood component. RATE OF INFUSION The rate of infusion depends upon the clinical condition of the patient and the product being transfused. In most administration sets, 15 drops equal 1 ml. Most patients who are not in congestive heart failure or in danger of fluid overload tolerate the infusion of one unit of red blood cells in no more than 1.5 to 2 hours, 40-60 drops/minute. Any transfusion should be completed in less than four hours because of the dangers of bacterial proliferation and red blood cell hemolysis at room temperature. NURSING CARE During the first 15 minutes, the rate of infusion of red blood cells should be very slow, approximately 2 ml per minute, except during urgent restoration of blood volume. This will minimize the volume of red blood cells infused if the patient experiences an immediate reaction. The patient should remain under direct observation for the first 15 minutes after the infusion begins and must be assessed periodically until an appropriate time after the transfusion is completed. After 15 minutes the rate of infusion can then be increased to that ordered by the physician. Vital signs (temperature, pulse, respirations, and blood pressure) should be obtained prior to the transfusion, 15 minutes after transfusion has begun, and prn until completion of transfusion. If a reaction occurs during transfusion, follow procedure for transfusion reaction. If no
reaction occurred and other intravenous therapy is ordered after the transfusion the infusion set should be changed before starting these drugs or solutions. COMPLETION OF TRANSFUSION When any transfusion is ended, complete the transfusion card. Place the blood bag in the biohazard bag and seal, place the completed transfusion card in the outer pouch and return to the lab. They may be sent in the tube system. UNIT TRANSFUSION CARD SAINT MICHAEL S HOSPITAL, Stevens Point, WI 54481 NAME ACCT# [Patient s type] [Patient s age/sex] [Location] WRISTBAND # [BB-######] [Specimen number] PATIENT MRI# [#######] BLOOD PRODUCT [Unit #] [Unit type] ISS BLOOD CEN SE WI Expires: [Date / Time] DATE: 1 VOLUME TRANSFUSED: 4 TIME TRANSFUSION BEGAN: 2 ENDED: 3 REACTION: 5 ***** SIGNATURES INCLUDE 1 st initial & COMPLETE LAST NAME) ***** UNIT STARTED BY: 6 (1 ST Initial & Complete Last Name) CLERICAL CHECK: 7 CONSENT FOR TRANSFUSION SIGNED? 8 YES N/A INITIALS: GREEN = PATIENT SPECIFIC INFO FROM COMPUTER Complete the card as follows: 1 Date 5 Reaction: no reaction Ǿ or nos/s: reaction, list symptoms 2 Time transfusion began 6 Unit started by (1 st initial and complete last name) 3 Time transfusion ended 7 Clerical check (1 st initial and complete last name) 4 Volume transfused 8 Consent for transfusion
TRANSFUSION REACTIONS Symptoms and signs of transfusion reactions may occur up to several hours after the transfusion. Continue to observe for reactions during this period of time. Signs and symptoms of transfusion reaction include the following: Chill Nausea Substernal pain Increase of pulse Edema of face Cyanosis Dyspnea Rash Shock Jaundice Vomiting Elevation of temperature Pain in lumbar Involuntary urination or defecation Hematuria Fall of blood pressure The nurse makes the decision as to whether a possible transfusion reaction has occurred. When a possible transfusion reaction does occur: 1 Stop transfusion of unit of blood, but continue saline to keep the vein open. 2 Inform the lab immediately so that a blood specimen can be drawn. 3 Notify patient s physician. 4 Fill out a transfusion reaction report form, and send to the lab. 5 Return the blood bag to the lab 6 The pathologist will determine if a urine or other ancillary testing is needed.