The transfusion of blood components in the out of hospital setting can be done safely for patients with a variety of chronic disorders.
The ordering physician shall be responsible for initial patient instructions regarding the need for and risks associated with transfusion of a blood component. The nurse is responsible for patient education which includes reinforcement of physician instructions, review of signs and symptoms of potential adverse reactions and the emergency measures that shall be instituted should adverse reactions occur.
1. Requests for blood products must contain the patient's name, social security number and date of birth. The request also must contain the blood product to be infused, the planned date of infusion and the ordering physician.
Note: Requests for Platelets do not require a crossmatch. No blood specimen is necessary for the transfusion of this product.
Note: Requests for Fresh Frozen Plasma do not require a crossmatch, but it is necessary to give ABO group compatible product. Properly identified blood specimens will be required to verify the patient ABO group.
2. Blood specimens for ABO group, Rh type, Antibody Screen and Crossmatch are drawn by the transfusion nurse.
A. Identify the patient. The Typenex band is used for identification. Refer to “Blood Recipient Identification, Emergency and Outpatient; Typenex” operational policy.
1. Write the date, time and initials of the person drawing the blood, patient name and patient Social Security Number on the self-sticking red label of the identification band.
2. Remove the protective white backing from the end of the band of numbers to expose the adhesive surface.
3. Wrap the band once around the patient's wrist or ankle, number side out.
4. Firmly close the clip. The band becomes tamper-proof when the clip is closed.
B. Perform the venipuncture using the established nursing procedure.
A purple-top vacutainer (EDTA tube) and a 7 - 15 ml red-top vacutainer (clot tube) filled with blood are the acceptable specimens. If possible, the specimens will be obtained prior to heparinization. The specimens must be obtained no more than 3 days prior to the time of the intended transfusion.
C. Label the tubes.
1. Peel the self-sticking red label from the identification band and press it onto one of the tubes to be used for the blood bank tests. Use the small red stickers for any other tubes collected.
Label all tubes with the patient name, social security number, date and time of collection and initials of the person collecting and labeling the specimens.
2. A Blood Bank specimen must be accompanied by a manual transcription of the patient’s medical record number or the unique identifier (Typenex number) transcribed from the patient armband onto any patient identifying document, i.e., stamped label for the tube, test requisition, stamped 3x5 card.
3. Double check to make sure that the patient ID letter and number sequence is the same on the patient band, the specimen tubes, and the patient ID document. Deliver the blood specimens and the paper work to the testing facility (hospital transfusion service).
Note: If the information on the paper work does not match the information on the tubes exactly, the blood bank tech cannot accept the specimen for compatibility testing.
Warning: Do not remove the TYPENEX band . It will remain on the patient until the end of the transfusion(s) initiated by this request.
4. The doctor’s written order for the transfusion must accompany all patients lab orders from the transfusing agency (e.g.: Tri-State Dialysis). This is for the patient’s hospital medical record.
3. Compatibility testing is done by established procedures. Should an incompatibility be found which would delay transfusion, the laboratory will immediately call the transfusing agency.
4. The blood component is signed out according to the blood sign-out policy (see “Product Issue or Return; Inventory Module” policy or Procurement from the Laboratory Nursing policy).
5. The blood component is transported to the transfusing location in an insulated container and kept in this container until transfused.
A. A container provided by the blood supplier or a cooler provided by the transfusing agency is used for transport of the blood products.
B. Red blood cells are packed for shipment as follows:
1. The blood is packed in a cooler.
2. Wet ice, (a combination of ¾ cube or crushed ice and ¼ cold water) in plastic bags are placed in the shipping containers to maintain storage temperature during shipment. Sufficient quantities of ice should be added to the bag depending on the outside temperature.
3. Paper towels are placed between the blood and the bag of ice.
C. Blood products stored at room temperature (platelets and granulocytes) are packed for shipment as follows:
1. Pack the platelets or granulocytes in a cooler provided by the blood supplier.
2. Include a room temperature refrigerant pack to protect the product from extreme temperatures.
6. The transfusionist and a witness check the patient and unit identification at the patient’s bedside and document these steps on the product ID tag.
7. The blood component is then transfused according to the nursing policies.
A. Refer to the nursing policy for recognition of Transfusion Reactions.
B. Should a reaction occur:
1. Stop the transfusion without disconnecting the IV. Give normal saline to keep the line open.
2. Contact the ordering physician immediately.
3. If the physician concludes that the reaction requires a transfusion reaction work-up, phone the testing facility and speak to a blood bank tech.
4. Complete a Transfusion Reaction Report form. Include a UCL OP Requisition with Transfusion Reaction Workup (write in) ordered.
6. Collect blood from the patient and label the tubes (refer to II.2.B-C.). Use the same Typenex number to label these tubes. The current date and time must be documented on each tube collected.
7. Collect the next two urine voidings if possible. Take special notice to document and label times of collection.
8. Disconnect the transfusion set and send the blood bag as well as the attached transfusion set to the testing facility. Place the blood bag and transfusion set into a red plastic bag. The transfusion request form should be sticking out of the bag to protect it from blood leakage.
9. Deliver all items, specimens and paperwork to the testing facility as soon as possible.
8. Document the date and time the transfusion is completed on the product ID tag.
9. If a blood supplier provided cooler is used, return it to the testing facility.
10. Notify the testing facility if the patient develops post transfusion (within six months of transfusion) infections of viral hepatitis, HTLV-I or HIV.
1. Fenwal TYPENEX package instructions.
2. AABB Standards for Blood Banks and Transfusion Services; current edition.
3. AABB Technical Manual; current edition.
i. 7/96 M Burger
ii. 4/98 S Rodriguez (Revised: Added II.1. and clot tube to II.2.B.)
iii. October 2003 M. Burger (Revised: II.2.B.,C.2.,C.4., II.5.A-C., II.6., II.7.B.4., II.8.)
iv. July 2006 M. Burger (Revised: II.2.C.2-3; tranfusion request form dc’d)
Interim Review: May 2010 J. Klein (no changes)