Good Transfusion Practices

Dr Norris Naim Pusat Darah Negara

Transfusion Safety Workshop:

What is blood for?

Purpose of blood transfusion
Safe patient life, improve patient recovery

Improve O2 carrying capacity

Red cells (PC, BCPPC, WB)

Stops bleeding, improve hemostasis

Platelets, FFP, Cryoprecipitate, factor concentrates

 Transfusion process
From vein-to-vein (donor to patient)

Good Transfusion Practice

Transfusion that is just, indicated and clinically sound with patient best interest at heart Transfusion of appropriate type and volume of blood and components

Transfusion of blood and components that are of good quality

Transfusion that is performed according to procedures that minimise errors and mistakes that would harm the patient

Good Transfusion Practice

Patient safety is a priority in blood transfusion

It involves correct patient identification:

when taking pre-transfusion sample When transfusing blood to patient

Also involves patient monitoring during and after transfusion for any adverse reactions

Do it right from the beginning Taking pre-transfusion sample

Must follow procedure (no exception)
Identify patient: by name, IC ask patient, relatives, check wristband Dont use bed numbers Label sample at bedside: do not label away from the patient, do not leave the sample unlabeled and unattended even for a while Use hand written labels: dont use pre-printed labels

 Sampling and labeling must be performed on one patient at a time

Label the sample immediately do not delay Dont allow yourself to be distracted

Those who take the sample, must label it and must initial the label

Do it yourself dont ask others for help

Filling in the form If you take the sample and label it, write your name as the person who did it

 Make sure
Proper diagnosis is written Indication for transfusion is filled (eg type of surgery). Avoid using vague reasons (eg for op, surgery, for intervention) Date and time blood is required is written (for GXM request)

 Avoid calling the Blood Bank unnecessarily just to confirm blood

What is confirm blood?
?Sample received by BB ?Blood ready for collection

Use of dispatch book helps you keep track of the sample sent
Record the samples sent, who received it and what time its received at Blood Bank

 When to collect the blood for transfusion

Collect when and only when blood is needed for transfusion

Non-urgent transfusion: XM blood can be collected after 2 hours after BB receive the sample or as written on request form

Pre-transfusion Testing

Except for a few, all non-emergency requests should be treated as GSH Tests performed:
ABO and RhD grouping, antibody screening

Antibody positive cases

Ward will be informed. Need to send extra sample (10cc EDTA) for antibody identification To d/w BB MO on duty All antibody cases will be crossmatched

 Rh negative cases:
Ward will be informed. To d/w BB MO on duty Ability of BB to supply Rh neg blood depends on stock May need to call in donors; thus delay in supply

Platelet and plasma request

New patient: fresh sample for ABO and RhD grouping Known patient: attach copy of previous request form (had at least 2 previous transfusions)

 Emergency XM
For cases that require immediate transfusion but no sample was sent to BB earlier

Request for XM just to get blood to OT with patient, is NOT Emergency XM Emergency XM is not as safe as a full complete crossmatch
Blood is supplied after ABO and RhD grouping, and quick crossmatching at RT

 Emergency XM (cont)
Antibody screening only performed after blood is issued out
chance of supplied blood causing reaction to patients is higher than normal

Should only be requested when transfusion is necessary and require immediately

If probability of transfusion is minimal or transfusion is to be performed later, full crossmatch should be requested instead.

 Collecting Blood
Bring along written document of the patients details, blood component needed and number of unit needed When urgent transfusion is needed, save time by calling blood bank to prepare the blood while PPK/porter is sent to collect the blood
Before taking blood back to ward, check details on request form against that on PPDK1 card and blood bag

 Blood should be taken back immediately to the ward

Red cells and Plasma products: icecontaining box Platelets: ice-free box

Blood must only be collected when its going to be transfused

The shorter the period the blood is outside the BB, the better

Checking the blood at the ward Checking of blood

ensure the blood collected is for the patient intended (tallying info bw blood, form and PPDK card) can be performed by SN

DO NOT sign the PPDK card yet

may initial the card and request form as indication that checks have been made

 Transfuse blood as soon as it arrived

Red cell units that are not to be transfused yet, must be stored in blood fridge Keep record of movement of the red cell units in and out of the fridge Plasma and platelet
transfuse as soon as possible MUST NOT be stored in fridge

Transfusion of Blood
Plasma and platelet: immediately after it arrive to the ward

Red cell transfusion

DO NOT warm the blood (ie. blood warmer, run under tap water) Take out of blood fridge for 15 minutes before transfusion Use administration set: 1 set per 2 units Each unit should not be more than 4 hours to complete Do not add in any other fluid or medicine through the same iv line (except normal saline)

Before transfusion:
Check blood JUST BEFORE the transfusion at bedside, by two staffs (doctor and SN) Document the checking in the checklist form Ensure patient is the right pt check blood bag against request form, PPDK card, patients wrist band/patient ID, asking patient Check each unit the same way before each of the unit being transfused

THEY MAY LOOK THE SAME, BUT NOT NECESSARILY THE SAME

Not Vigilant Enough

Patient Monitoring
Vital signs (BP, HR, Temp) must be taken before transfusion of each unit Monitoring must be close for first 15 minutes, then every half to one hour (if no complication)

Avoid transfusion in the evening especially for pts in rooms, unless in emergency Document the details of the transfusion (vital signs, blood units transfused, any reactions)

Completion of transfusion
Complete the PPDK card only after transfusion is finished

Fill in the necessary details and sign the card (by doctor or staff nurse) Return the card with the used blood bag to BB

Transfusion Reactions
Stop transfusion if patient show any reaction Investigate all reactions Return all used blood bag to BB empty or not, and any unused blood units Should patient needs the transfusion, make a fresh request