Blood Transfusion Learning

Pack Check:
a learning resource for

checking a blood component
pack before transfusion
© 2012. Australian Red Cross Blood Service. All rights reserved.
Pack Check Learning Resource: contents
Introduction 3 Scenario 4
Session plan 4 Patient case: cryoprecipitate 23
Pre- and post-test: educator’s resource 5 Blood product prescription 24
Example of a blood pack 6 Cryoprecipitate pack 25
Blood component labelling 7 Additional learning answers 26
Example of blood component labelling 8 Scenario 5
Check of the blood pack prior to transfusion 9 Patient case: red cells 27
Scenario 1 Blood product prescription 28
Patient case: fresh frozen plasma 11 Red cell pack 29
Blood product prescription 12 Additional learning answers 30
Fresh Frozen Plasma pack 13 Blood transfusion: further learning questions 31
Additional learning answers 14 Blood transfusion: further learning answers 32
Scenario 2 Create your own scenario
Patient case: red cells 15 Patient identification band 34
Blood product prescription 16 Blood product prescription 35
Red cell pack 17 Red cell pack 36
Additional learning answers 18
Scenario 3
Patient case: platelets 19
Blood product prescription 20
Platelet pack 21
Additional learning answers 22
Page of 36
Introduction
The Australian Red Cross Blood Service designed this

face-to-face learning resource to assist in the teaching of
checking a blood component pack prior to a transfusion.
It is suitable for Registered and Enrolled Nurses and
medical students.
This resource has educator notes and five learning scenarios
encompassing the fresh components produced by the Blood
Service. The information in this package is based on the
2011 Australian New Zealand Society of Blood Transfusion
and Royal College of Nursing Australia Guidelines for the
Administration of Blood Products and the National Blood
Authority Patient Blood Management Guidelines.
Each scenario contains:
1. A patient case study
2. Corresponding transfusion prescription
3. Images of the component to be checked
4. Questions and answers for the learner to practice the
pack check process
5. Additional learning questions and answers have been
included. These scenarios can be laminated for re use
if desired.
FURTHER RESOURCES
n Visit www.transfusion.com.au for more information

on blood components, transfsuion and to access
iTRANSFUSE Online Learning.
n Transfusion information for patients can be found at
www.mytransfusion.com.au
n For BloodSafe eLearning packages and Flippin’ Blood
visit www.health.sa.gov.au
n For any queries or feedback about this package,
please email itransfuse@redcrossblood.org.au
Page of 36
Session plan
1. Introduce the activity. 11. Distribute the handout ‘Blood transfusion further
learning.’ Pairs can discuss answers between
2. Complete the pre-test using the example of a blood themselves but all individuals should record their
collection pack on page 6. own answers.
3. Ask for any feedback on the pre-test activity. 12. Discuss answers with the whole group, checking
4. Using the handout ‘Blood component labelling’, for understanding.
talk through the points with the group, allowing the 13. Repeat ‘Can you find?’ activity as a post-assessment.
opportunity to read and ask questions.
14. Ask for any feedback about how the group feels they
5. Distribute the handout ‘Check of the blood pack prior have improved from the pre-test.
to transfusion.’ Talk through the points with the group,
allowing the opportunity to read and ask questions.
6. Divide the group into pairs.
7. Distribute a ‘Scenario’ handout.
8. In pairs, the group needs to check the blood

component pack against the written order and
patient information. At the end of this exercise, each
individual will complete the additional learning
questions located at the bottom of the scenario page.
9. Go through answers to the scenario with the entire

group, checking that the scenario was completed and
understood by all. The diagnosis of the patient and
why it was an appropriate treatment option can also
be discussed.
10. Complete additional scenarios as required.
Page of 36
Pre- and post-test: educator’s resource
n Discussion points before beginning this exercise:

– Check should happen at the patient side
– Consent should be given and documented before commencing
– The individual should have an understanding of their roles and responsibilities in undertaking the checking
of the blood pack. Further information can be found in the ANZSBT RCNA Administration Guidelines.
n Each student is to have in front of them a picture of a blood collection pack found on page 6.
n Using the picture, ask the students to locate the following:
Locate the following on the Blood Component Label

Pre-test Post-test
Patient name and date of birth
Product type
Special requirements if required
Blood Group
Blood donation/batch number
Expiry date and time
n Ask for a show of hands to indicate correct answers.
n In the box provided, keep a record of how many students could locate the information.
n Use this as a pre- and post-test to determine the students’ understanding.
Page of 36
Example of a blood pack
JOHN
RED CELLS
CITIZEN
123456 01-01-1999 8283172
WARD XYZ 0 RhD Positive 0 RhD Positive
25-10-2010 29-11-2010 23.59 COMPATIBLE
CMV NEGATIVE
Page of 36
Blood component labelling
The following information will be physically printed on The label will have the following additional information
the labels: printed:
n Donation number codes. This number links the blood
component to the donor. Collected and processed by
Australian Red Cross
n The expiry date. All components will have an expiry
Blood Service
date. After this date, the components are not suitable
For more information
for use. The expiry date varies with the component,
Telephone: 1300 13 60 13
anticoagulant, additive and method of preparation.
Donation tested and non-reactive for
n Collection date. Platelet pools will have the
specified markers for HIV 1&2,
preparation date. The expiry date is calculated from
hepatitis B&C, HTLV and syphilis.
the earliest collection date of components in the pool.
TRANSFUSION INSTRUCTIONS
n Blood group. (ABO and Rh D) in text and barcode 1. PROPERLY IDENTIFY INTENDED RECIPIENT.
format. Barcode format is for use by the transfusion lab. 2. DO NOT USE IF CONTENTS SHOW VISIBLE SIGNS OF
n Component name in text and barcode format. DETERIORATION.
n Component volume in mL WARNING
n Storage temperature. This differs depending on THIS PRODUCT MAY TRANSMIT INFECTIOUS AGENTS.
the blood component. Red cells are stored SEE CIRCULAR OF INFORMATION FOR CAUTIONS AND
between 2–6 degrees celsius, platelets between INSTRUCTIONS.
20 and 24 degrees celsius and fresh frozen plasma,
cryoprecipitate and cryodepleted plasma at
minus 25 degrees celsius or below.
n Modifiers such as CMV and irradiation status.
In some circumstances it is not just the blood group
that is important when selecting appropriate blood
for transfusion. Sometimes extra requirements need
to be taken into consideration. CMV negative blood
may be requested for a CMV negative patient with
a weakened immune system or who is undergoing
an organ transplant, and also in pregnant patients
who have not previously been in contact with CMV.
Irradiated blood components may be requested
to prevent transfusion-associated graft versus
host disease.
n Phenotype results if applicable. A portion of
the population have additional antibodies that
need further matching to find a compatible
blood component.
Note: Phenotype results are advisory only.
Page of 36
Example of blood component labelling
JOHN
RED CELLS
CITIZEN
123456 01-01-1999 8283172
WARD XYZ 0 RhD Positive 0 RhD Positive
25-10-2010 29-11-2010 23.59 COMPATIBLE

CMV NEGATIVE
Page of 36
Check of the blood pack prior to transfusion
Transfusion should only occur in a clinical area where n If a patient is unable to state these details,
observation and advanced life support equipment verify the patient’s identity with the next of
is available. kin/spouse/carer if present
1. Prepare your patient n If the transfusion is occurring in an operating
n ALL patients should be wearing patient theatre where the patient is unconscious,
identification bands identification is by two qualified persons
checking the patient’s wrist band.
n Ensure written consent has been obtained from
the patient 4. Ensure right patient
n Ensure that, where possible, the procedure has Ensure the medical prescription, patient identification
been explained to the patient and they are aware band and patient compatibility label are identical and
of potential symptoms of a transfusion reaction correct for:
and that they need to inform staff immediately if n Patient’s surname
they feel unwell
n Patient’s first name(s)
n Assess for any pre-existing conditions such as
n Date of birth
fever or rash that could be later confused with a
transfusion-related reaction. n Medical record number.
n Assess and record baseline observations; 5. Ensure right product

temperature, pulse, respirations and Ensure the medical prescription, blood component
blood pressure label, patient compatibility labels and the component
n Ensure suitable IV access type are identical and correct for:
n Ensure blood collection or request form has n The product to be transfused
been completed. n Any special requirements.
2. Check Medical Officer prescription for the following: 6. Ensure right pack
n Medication that is relevant to the transfusion Ensure the blood component label and patient
such as pre-medication or diuretics compatibility labels are identical and correct for:
n Any special transfusion requirements such as n Blood group of patient
CMV negative or irradiated products. n Blood group of donor
3. Positively identify the patient n Blood donation number
n This must be performed at the patient’s bedside n Expiry date and time.
n One of the two qualified persons must be a If the blood group of the blood pack and the patient
registered nurse or a medical officer are not identical, the transfusion service provider
must make a specific comment to indicate that it is
n Ensure patient is positively identified by asking
compatible (or the most suitable available).
the patient to state and spell their full name and
date of birth
n Ensure this matches the patient details on their
identification band continued on the following page
Page of 36
Check of the blood pack prior to transfusion
continued from the previous page
7. Documentation
Ensure that the following is documented on the
medical prescription and the blood transfusion
administration record:
n Date and time of commencement
n Two checking names and signatures
n Ensure the second peel off patient compatibility
label from the blood product is attached to the
blood transfusion administration record if the
unit is used
n If there is not a second peel off label, ensure
the donation number and product type is
manually recorded on the blood transfusion
administration record.
One of the people involved in the checking process must

spike and connect the product to the patient without delay.
REMEMBER: RIGHT patient, RIGHT pack, RIGHT paperwork!
Page 10 of 36
Scenario 1: fresh frozen plasma
May June is a 67-year-old female who suffers from

hypertension, poorly controlled type 2 diabetes and
has a family history of heart disease. May June often
experiences chest pain and, after investigations by her
doctor, has been diagnosed with coronary artery disease.
May June’s doctor initially treats her condition with aspirin
and warfarin to prevent platelet clumping and blood
clotting in her narrowed arteries. However, her chest pain
exacerbates and she is admitted to hospital. May June has
to undergo urgent coronary artery bypass graft surgery
on advice from the cardiologist, as she has significant
narrowing in multiple arteries.
There was no time to give Vitamin K to reverse the warfarin.
During her surgery there was some extra bleeding. As part of
her treatment, May June requires a transfusion of four units
of Fresh Frozen Plasma to help reverse the warfarin effect.
Activity
JU N
With a partner, check May June’s blood product pack. M ay E
Use the appropriate documentation to ensure it matches the Fem 389 3 0 3
ale 31.07.1943
component to be transfused.
Additional learning
1. What is Fresh Frozen Plasma (FFP)?
2. What are the clinical uses of FFP?
3. What are the minimum observations when

transfusing FFP?
4. What signs and symptoms are being looked for during

the observations?
5. What is the compatible intravenous solution for FFP?
6. What other blood components do you think May June

may need?
Page 11 of 36
Page 12 of 36
MAY
FRESH FROZEN PLASMA
JUNE
389303 31-07-1943 8274830
CORONARY 0 RhD Positive 0 RhD Positive

CARE
15-12-2010 20-12-2010 23:59 COMPATIBLE
Page 13 of 36
Scenario 1: additional learning answers
1. What is Fresh Frozen Plasma (FFP)? 4. What signs and symptoms are being looked for
during the observations?
An unconcentrated form of blood plasma containing
all of the clotting factors except platelets. Observations are regularly taken throughout a
transfusion to monitor the patient for signs of a
2. What are the clinical uses of FFP? transfusion reaction. Signs of a patient experiencing a
reaction can include:
FFP is indicated for patients with a coagulopathy who
are bleeding or at risk of bleeding where a specific n Increase in temperature
therapy such as vitamin K or factor concentrate is not n Increase in pulse
appropriate or unavailable. FFP may be indicated in n Drop in blood pressure
bleeding patients who require replacement of plasma n Shortness of breath
coagulation factors such as in massive transfusion,
n Allergic reaction (eg. Itching or hives).
cardiac bypass, liver disease or acute disseminated
intravascular coagulation. It may also be used for
patients with thrombotic thrombocytopenic purpura 5. What is the compatible intravenous solution for FFP?
(TTP) and in cases of warfarin overdose with life Normal Saline (0.9% NaCl Solution)
threatening bleeding.
6. What other blood components do you think May June
3. What are the minimum observations when might need?
transfusing FFP? n Platelets – to counteract the affects of her
n The patient must be observed closely for the first asprin medication
15 minutes of each pack n Red cells – if there is significant blood loss.
n Temperature, pulse, respirations and blood
pressure must be taken prior to commencement,
15 minutes after commencing administration
of the blood product, and on completion of
each pack
n Monitor patient closely during and after
transfusion for signs of reaction
n The need for more frequent observations will
depend on the patient’s clinical status
n Check hospital policy for additional observations.
Page 14 of 36
Scenario 2: red cells
Mable-Lee Marburld, aged 64, was experiencing difficulty

walking and performing everyday activities. She was
initially examined by her local GP, who referred her to
an orthopaedic surgeon. Advanced osteoarthritis was
diagnosed and surgery planned to perform a total hip
replacement. Her medications included Warfarin for atrial
fibrillation and a fish oil supplement.
Post-surgery, Mable-Lee had a haemoglobin count of 80g/L
and was experiencing ongoing blood loss, shortness of
breath and associated chest pain. The decision was made
to transfuse Mable-Lee one unit of red cells, following which
she would be reassessed to identify the need for further
blood products.
Activity
With a partner, check Mable-Lee Marburld’s blood
product pack. MA
Ma RBURLD
ble-L
Use the appropriate documentation to ensure it matches the Fe
m al
ee 590 4 3 2 6 8
product to be transfused. e 27.0
8.1946
Additional learning
1. What are red blood cells?
2. What are the clinical uses of red cells?
3. What are the minimum observations required when

transfusing red cells?

the observations?
5. What are the compatible intravenous solutions for

red cells?
6. Why has Mable-Lee been ordered Frusemide

post-transfusion?
Page 15 of 36
Page 16 of 36
MABLE-LEE
RED CELLS
Marburld
59043268 27-08-1946 8283172
South 5 0 RhD Positive 0 RhD Positive
20-10-2010 29-11-2010 23:59 COMPATIBLE
Page 17 of 36
1. What are red blood cells? 4. What signs and symptoms are being looked for
Red blood cells are the major cellular element of the
circulating blood and give blood its colour. The main Observations are regularly taken throughout a
function of these cells is to transport oxygen from the transfusion to monitor the patient for signs of a
lungs to all the cells in the body. transfusion reaction. Signs of a patient experiencing
a reaction can include:
2. What are the clinical uses of red blood cells? n Increase in temperature
Red cells are transfused to treat people: n Increase in pulse
n With severe anaemia n Drop in blood pressure
n Whose red cells do not function adequately n Shortness of breath
n Who experience severe bleeding n Allergic reaction (eg. itching or hives).
(e.g. from trauma or surgery).
5. What are the compatible intravenous solutions
3. What are the minimal observations when transfusing for red cells?
red cells? n Normal Saline (0.9% NaCl Solution)
n The patient must be observed closely for the first n Albumin 4%
15 minutes of every pack n ABO compatible plasma.
pressure must be taken prior to commencement, 6. Why has Mable-Lee been ordered Frusemide
15 minutes after commencing administration of post-transfusion?
the blood product, and on completion of each
red cell pack After transfusion, some patients have transfusion
associated circulatory overload (TACO). Diuretics are
given to manage patients at risk of this. Mable-Lee
has a cardiac condition which puts her at risk of TACO.
Page 18 of 36
Scenario 3: platelets
Cullen Grahame-McGover is a 20-year-old male who

presented with a history of upper respiratory tract
infections and more recently palor, bone pain, fatigue
and dizziness. Tests conclude the diagnosis to be acute
myeloid leukaemia. A gastrointestinal haemorrhage has
also been found.
Important parts of Cullen’s care are platelet transfusions to
maintain a platelet count greater than 10,000 cells/uL. This
decreases the risk and occurrence of bleeding complications
associated with leukaemia and chemotherapy.
Activity
With a partner, check Cullen Grahame-McGover’s blood
component pack.
Use the appropriate documentation to ensure it matches the
product to be transfused.
GR
A
Cul HAME-McGOVER
len
Additional learning Ma
le 0
1 .08.1990
509 268
1. What are platelets?
2. What are the clinical uses of platelets?
3. What are the minimum observations when transfusing

platelets?

the observations?
5. If a transfusion reaction does occur with platelet

products, what should be considered?
6. What is the compatible intravenous solution for

platelets?
7. Why does Cullen require irradiated platelets?
Page 19 of 36
Page 20 of 36
CULLEN
Platelets
Grahame-McGover
509268 01-08-1990 8304430
East 3 A RhD Positive A RhD Positive
23-10-2010 27-10-2010 23:59 COMPATIBLE
Irradiated
Page 21 of 36
1. What are platelets? 4. What signs and symptoms are being looked for
Platelets are small disc-shaped fragments from
a cell called a megakaryocyte. Platelets play a crucial Observations are regularly taken throughout a
role in blood clotting and repairing damaged body transfusion to monitor the patient for signs of a
tissue. Activated platelets clump together to make transfusion reaction. Signs of a patient experiencing a
a plug which clotting factors then bind to in order to reaction can include:
form a clot. n Increase in temperature
n Increase in pulse
2. What are the clinical uses of platelets?
n Drop in blood pressure
Platelet transfusions are commonly used in patients n Shortness of breath
with a low platelet count or non-functioning platelets
n Allergic reaction (eg. itching or hives).
who are bleeding or at risk of bleeding. This may
occur during:
5. If a transfusion reaction does occur with platelet
n High dose chemotherapy
products, what should be considered?
n Bone marrow transplantation
Bacterial contamination. This is because platelets are
n Major surgery while on platelet inhibiting drugs
not refrigerated and are kept between 20–24 degrees
n Liver disease requiring surgery celsius. This means that they are at an increased risk
n Severe trauma of bacterial growth and hence have a short shelf life of
n Leukaemia and bone marrow cancers. five days.
3. What are the minimum observations when 6. What is the compatible intravenous solution for
transfusing platelets? platelets?
n The patient must be observed closely for the first Normal Saline (0.9% NaCl Solution).
15 minutes of each pack
n Temperature, pulse, respirations and blood 7. Why does Cullen require irradiated platelets?
pressure must be taken prior to commencement Irradiation of cellular blood components inactivates
and on completion of each platelet pack donor lymphocytes (a type of white cell), which can
n Monitor patient closely during and after reproduce and grow in the recipient. The engraftment
transfusion for signs of reactions of donor lymphocytes can cause an almost universally
n The need for more frequent observations will fatal disease called transfusion-associated graft
depend on the patient’s clinical status versus host disease (TA-GVHD) in some recipients.
n Check hospital policy for additional observations. Cullen is at particular risk of developing TA-GVHD as
he has a weakened immune system as a result of his
condition acute myeloid leukaemia.
Page 22 of 36
Scenario 4: cryoprecipitate
Vladislav Yordanyotou is a 33-year-old male admitted

to the emergency department following a motor vehicle
accident (MVA) on his way home from work. He is
conscious and able to speak with the doctors. His medical
history includes liver disease secondary to chronic
hepatitis, hypertension and gastro-oesophageal reflux
disease (GORD).
Severe internal bleeding from the trauma complicated by
the presence of liver disease has been determined, and
he is rushed to surgery to find the cause. Cryoprecipitate
is transfused as part of his critical bleeding/massive
transfusion management.
Activity
With a partner, check Vladislav Yordanyotou blood
component pack.
Use the appropriate documentation to ensure it matches the YO
R
product to be transfused. Vla DANYOTO
disla U
7
M ale
v
20.09 3 89 30 3 4
.1977
Additional learning
1. What is a critical bleeding/massive transfusion pack?
2. What is cryoprecipitate?
3. What are the clinical uses of cryoprecipitate?
4. What are the minimum observations when transfusing

cryoprecipitate?

the observations?
6. What is the compatible intravenous solution for

cryoprecipitate?
Page 23 of 36
Page 24 of 36
Vladislav
Cryoprecipitate
Yordanyotou
38930347 20-09-1977 9114290
Trauma 1 AB RhD Negative AB RhD Negative
10-08-2010 10-08-2010 23:59 COMPATIBLE
Page 25 of 36
1. What is a critical bleeding/massive transfusion 5. What signs and symptoms are being looked for
pack? during the observations?
In trauma situations where large blood volumes Observations are regularly taken throughout a
are lost, multiple blood components are required transfusion to monitor the patient for signs of a
for transfusion to address not just volume loss but transfusion reaction. Signs of a patient experiencing a
also the resulting coagulpathy. A critical bleeding reaction can include:
pack contains blood components such as red cells, n Increase in temperature
fresh frozen plasma, platelets, and in some cases,
n Increase in pulse
cryoprecipitate.
2. What is cryoprecipitate? n Shortness of breath
Cryoprecipitate is a concentrated blood component
made from fresh frozen plasma. This component
contains most of the clotting factors including factor 6. What is the compatible intravenous solution for
VIII, fibrinogen, factor XIII, von Willebrand factor and cryoprecipitate?
fibronectin. Fibrinogen, in particular, is important in Normal Saline (0.9% NaCl Solution).
the blood clotting process and can be thought of as
the “glue” that binds the clot together.
3. What are the clinical uses of cryoprecipitate?

Cryoprecipitate is indicated for the treatment of
fibrinogen deficiency or dysfibrinogenaemia (poorly
functioning fibrinogen) when there is clinical bleeding,
an invasive procedure, trauma or disseminated
intravascular coagulation.

transfusing cryoprecipitate?
n The patient must be observed closely for the first
15 minutes of the transfusion
pressure must be taken prior to commencing
and on completion of the transfused dose
Page 26 of 36
Vasos Papadopoulos is a 43-year-old male with

thalassaemia major. This condition results in severe
anaemia requiring regular red cell transfusions,
approximately every three to four weeks.
Activity
With a partner, check Vasos Papadopoulos blood
product pack.
Use the appropriate documentation to ensure it matches the
product to be transfused.
Additional learning
1. What is thalassaemia major?
2. What is the indication for a person with thalassaemia PAP

A
major requiring frequent red cell transfusions? Vas DOPOULOS
os
Ma
le 0
8
463 921
.06.1968
3. What are the clinical uses of red cells?
4. What are the minimum observations required when


the observations?
6. What are the compatible intravenous solutions

for red cells?
Page 27 of 36
Page 28 of 36
Vasos
RED CELLS
Papadopoulos
463921 08-06-1968 8283172
HDC 0 RhD Positive 0 RhD Positive
25-10-2010 29-11-2010 23:59 COMPATIBLE
RIRI C+E- c-e+ Cw- K-
Page 29 of 36
1. What is thalassaemia major? 5. What signs and symptoms are being looked for
Thalassaemia is an inherited blood disorder that
affects haemoglobin production. Haemoglobin is the Observations are regularly taken throughout a
oxygen carrying molecule found in red blood cells. The transfusion to monitor the patient for signs of a
red blood cells of a person with thalassaemia major transfusion reaction. Signs of a patient experiencing a
can only survive a few weeks compared to normal red reaction can include:
cells that survive for approximately four months. n Increase in temperature
n Increase in pulse
2. What is the indication for a person with
thalassaemia major requiring frequent red cell
transfusions? n Shortness of breath
Red cell transfusions for those with thalassaemia
major are individualised to fit in with the patient’s
lifestyle. This means they may be transfused when 6. What are the compatible intravenous solutions for
they are symptomatic or they may have a regular red cells?
appointment they attend. n Normal Saline (0.9% NaCl Solution)
n Albumin 4%
3. What are the clinical uses of red blood cells? n ABO compatible plasma.
Red cells are transfused to treat people:
n With severe anaemia
n Whose red cells do not function adequately
n Who experience severe bleeding (e.g. from
trauma or surgery).

pressure must be taken prior to commencement,
15 minutes after commencing administration of
the blood product, and on completion of each
red cell pack
n The patient must be observed closely for signs of
reaction for the first 15 minutes of every pack
Page 30 of 36
Blood transfusions: further learning
1. What should you prime your IV line with prior to

administering blood components?
2. Can a pump be used for all blood components?
3. Can medications be given concurrently with

a blood transfusion?
4. How is bolus medication administered?
5. When should a blood warmer be used?
6. Who can perform the pack check?
7. Why should non-urgent transfusions be

avoided overnight?
8. What visual checks should be performed on the

pack prior to transfusion?
9. Why is only one unit of blood released for use at a time

for non-urgent transfusions?
10. Do you have to flush blood lines at the end

of a transfusion? Why or why not?
Page 31 of 36
Blood transfusions: further learning answers
1. What should you prime your IV line with prior to 6. Who can perform the pack check?
administering blood components?
This must be performed at the bedside by two clinical
The new standard blood administration set should be staff, one of whom is required to be a registered nurse
primed with normal saline or the blood component or a medical officer. A registered nurse or medical
as per local policy. Priming with other solutions officer is required because it is their role to assess
may interfere with the anticoagulant additive or whether or not the patient is fit to have a transfusion
blood component. at that time and in the manner prescribed. Both of
the staff performing the check must sign the blood
2. Can a pump be used for all blood components? prescription order.
Yes, provided the pump has been certified as safe to
7. Why should non-urgent transfusions be avoided
administer blood components. The pump must also not
overnight?
damage the components and must have the correct IV
giving set with an incorporated blood filter. If it is not an emergency situation, transfusions
should be avoided overnight. Serious Hazards of
3. Can medications be given concurrently with Transfusion (SHOT) data from the UK shows that more
a blood transfusion? adverse events occur if a transfusion is performed
during the night. There are generally less staff on duty
Medications should not be given concurrently in the
overnight, making it more difficult for the patient to
same IV as a blood component during transfusion.
be closely monitored and to recognise and manage
transfusion reactions. The patient also experiences
4. How is bolus medication administered?
interrupted sleep.
If medications need to be given through the IV line, the
transfusion should be stopped, the line flushed with
normal saline, medication administered and the line
again flushed with normal saline. The transfusion can
recommence at this point. Alternatively a second IV
access could be used.
5. When should a blood warmer be used?

Blood components may be warmed during, or just prior
to transfusion, if clinically indicated. Only designated
blood warming devices should be used and these must
be operated strictly according to the manufacturer’s
instructions. A blood warmer can be used for:
n Patients with clinically significant cold
agglutinins
n Adults receiving an infusion of blood at a rate
greater than 50ml/kg/hr
n Infants undergoing an exchange transfusion. continued on the following page
Page 32 of 36
Blood transfusions: further learning answers
continued from the previous page
8. What visual checks should be performed on the 10. Do you have to flush blood lines at the end of a
pack prior to transfusion? transfusion? Why or why not?
Ensure the following information on the blood It is not necessary to flush between packs if another
component pack is correct and matches the patient component of the same type is to be administered.
details: At the end of the transfusion, flushing with normal saline
n Patient’s first name(s) and surname ensures the patient receives all of the intended product.
However, individual circumstances should be taken into
n Date of birth and/or Medical Record Number
consideration – especially in cases involving paediatric
n Blood group patients or patients at risk of fluid overload.
n Blood donation/Batch number.
Other information to be visually checked includes:
n Expiry date and time of blood component
n Component type
n Special requirements if required.
Once this has been completed, check the blood
component for any signs of damage or leakage,
discolouration, turbidity, presence of clots and
evidence of haemolysis in the pack or tube segments.
If you find any, or you are unsure, talk to the service
provider immediately.
9. Why is only one unit of blood released for use at a

time for non-urgent transfusions?
This prevents unnecessary wastage. If more than
one unit is released at a time, it may be sitting at
room temperature for too long and thus have to
be discarded. Warm blood is an ideal medium for
bacterial growth.
Page 33 of 36
Create your own scenario:
patient identification band
Page 34 of 36
Create your own scenario:
blood product prescription
Page 35 of 36
Create your own scenario: red cell pack
Page 36 of 36

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Blood Transfusion Learning

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Pack Check:

a learning resource for

The Australian Red Cross Blood Service designed this

n Visit www.transfusion.com.au for more information

6. Divide the group into pairs.

7. Distribute a ‘Scenario’ handout.

8. In pairs, the group needs to check the blood

9. Go through answers to the scenario with the entire

10. Complete additional scenarios as required.

n Discussion points before beginning this exercise:

n Using the picture, ask the students to locate the following:

Locate the following on the Blood Component Label

Patient name and date of birth

Special requirements if required

Blood donation/batch number

Expiry date and time

n Ask for a show of hands to indicate correct answers.

n Use this as a pre- and post-test to determine the students’ understanding.

WARD XYZ 0 RhD Positive 0 RhD Positive

25-10-2010 29-11-2010 23.59 COMPATIBLE

WARD XYZ 0 RhD Positive 0 RhD Positive

25-10-2010 29-11-2010 23.59 COMPATIBLE

n Assess and record baseline observations; 5. Ensure right product

3. Positively identify the patient n Blood donation number

continued from the previous page

One of the people involved in the checking process must

REMEMBER: RIGHT patient, RIGHT pack, RIGHT paperwork!

May June is a 67-year-old female who suffers from

2. What are the clinical uses of FFP?

3. What are the minimum observations when

4. What signs and symptoms are being looked for during

5. What is the compatible intravenous solution for FFP?

6. What other blood components do you think May June

REMEMBER: RIGHT patient, RIGHT pack, RIGHT paperwork!

CORONARY 0 RhD Positive 0 RhD Positive

15-12-2010 20-12-2010 23:59 COMPATIBLE

Mable-Lee Marburld, aged 64, was experiencing difficulty

2. What are the clinical uses of red cells?

3. What are the minimum observations required when

4. What signs and symptoms are being looked for during

5. What are the compatible intravenous solutions for

6. Why has Mable-Lee been ordered Frusemide

REMEMBER: RIGHT patient, RIGHT pack, RIGHT paperwork!

South 5 0 RhD Positive 0 RhD Positive

20-10-2010 29-11-2010 23:59 COMPATIBLE

Cullen Grahame-McGover is a 20-year-old male who

2. What are the clinical uses of platelets?

3. What are the minimum observations when transfusing

4. What signs and symptoms are being looked for during

5. If a transfusion reaction does occur with platelet

6. What is the compatible intravenous solution for

7. Why does Cullen require irradiated platelets?

REMEMBER: RIGHT patient, RIGHT pack, RIGHT paperwork!

East 3 A RhD Positive A RhD Positive

23-10-2010 27-10-2010 23:59 COMPATIBLE

Vladislav Yordanyotou is a 33-year-old male admitted

3. What are the clinical uses of cryoprecipitate?

4. What are the minimum observations when transfusing

5. What signs and symptoms are being looked for during

6. What is the compatible intravenous solution for

REMEMBER: RIGHT patient, RIGHT pack, RIGHT paperwork!

Trauma 1 AB RhD Negative AB RhD Negative

10-08-2010 10-08-2010 23:59 COMPATIBLE