Refer to EMR tip sheet for further information

Patient preparation

The patient should be ready for transfusion prior to picking up blood from the blood bank. eg appropriate IV access, consent completed, pre-medication administered if required. 
For any non-emergency transfusion the patient/parents should have had the benefits/risks of transfusion discussed and an opportunity to have any questions answered.  Consent for transfusion should then be documented on a blood transfusion consent form. 

For further information and for parent and patient information see:  Consent and Consumer Information Guideline

Issue of blood products from the blood bank

The safe transfusion of blood and blood products requires strict adherence to patient identification processes during all steps in the transfusion chain, including collecting the product from blood bank. Blood bank scientists must know they are issuing to the correct patient and require complete patient identification. This includes:

• full name
• date of birth
• MRN

The blood bank release form contains all required patient identification. During EMR downtime use the green blood bank release card and attach a patient identification label.

Blood products are issued from blood bank in 2 ways:

1. Pneumatic Transport System (PTS)
   • suitable for fresh blood products only (i.e. red blood cells, platelets, FFP, cryoprecipitate)
   • Note: batched blood products (i.e. IVIg, albumin, clotting factors) cannot be sent via PTS.
2. Pick-up from blood bank
   • the only option available for batched blood products but also suitable for fresh blood products
   • the staff member must present with the blood bank release form at the time of collection - do not send the blood bank release form in the PTS separately.
     

Blood products should only be released in EMR and retrieved from blood bank when the transfusion is ready to commence. This ensures appropriate storage of blood products. Blood products must not be stored in ward areas or domestic fridges.

Fresh blood products must be commenced within 30 minutes of leaving the blood bank. If circumstances change the fresh blood product must be returned to blood bank for storage.

This does not apply to albumin products. Albumin can be kept at room temperature for a maximum of 24 hours. If the requirement for albumin changes, it should be returned to blood bank at the earliest convenience.

Blood Box

The blood box provides a validated, short term (up to 4 hours) storage for red cells at the point of care. It has a timer attached.

The blood box can be requested for patients who are at risk of critical bleeding and red cells are required to be at the bedside “just in case”. Select the blood box in the prepare section of the red cell order.

Examples of patients who may need a blood box are as follows:

• Emergency Department
  • Trauma or bleeding where red blood cell transfusion may be needed. The blood box can be issued prior to patient arrival
• Rosella
  • Chest opening/closing on the ward
  • ECLS cannulation/decannulation
  • Surgical procedure on the ward
• Theatre
  • Re-do sternotomy
  • Cardiac surgery
  • Craniofacial surgery
• Butterfly
  • Surgical procedure on the ward

Discuss patients who fall outside of these pre-approved circumstances with the on-call haematologist.

Keep the lid closed at all times to maintain an environment cool enough to keep the RBC’s at a temperature to minimize bacterial growth. The lid may be opened to quickly inspect the contents but should otherwise remain closed. 

Do not 'pre-check' the RBCs in the blood box and scan into the EMR. Once scanned into the EMR the unit cannot be removed if it is not transfused. 

Do not place any other blood products or equipment into the blood box. The blood box is only validated to house RBCs. 

A maximum of 2 units of RBCs will be placed inside the box. Do not place the blood box near a heater or in a refrigerator.

If the timer alerts, return the blood box to blood bank. If RBCs are still required these may be ordered again.

Release form

When ready to transfuse the blood product:

• In ‘flowsheets’ select the ‘blood’ tab
• Select ‘release transfusion report’
• Select the ‘release’ hyperlink for the blood product you wish to transfuse

This will print a release form to the nearest printer. Complete all fields including your name, clinical area, PTS number (if applicable) and phone number. This will allow prompt communication from blood bank when the blood product is ready.

For general wards, release will be limited to the following quantities at a time:

• (1) unit of red blood cells
• (4) units of platelets (or one pooled or apheresis bag)
• (2) units of FFP
• (5) units of cryoprecipitate

Special arrangements are available to the Emergency Department, ICU, NICU and Operating Suites for release of greater quantities. 

Pre-transfusion check

Two clinicians must independently complete the patient and blood product identification check at the bedside. By electronically signing the blood administration flowsheet checks in EMR they indicate they have correctly completed this process. 

Positive patient identification

At the bedside, if possible ask the patient or parent/guardian to state the patient's legal name and date of birth 

• Two staff members independently check:  
  • Legal name (family and given name) 
  • Date of birth 
  • MRN 
    
• Match exactly on:
  • ID band 
  • Luggage tag attached to blood product 
  • Patient's EMR story board 
• Within BPAM:
  • Link the IV line to be used for transfusion 
  • Scan the ID band after the above checks are completed  

Once patient identification confirmed check the blood product

Blood product checks 

Two staff members independently check: 

• Blood product type (e.g., red cells) is identical on EMR order, the blood product label and the luggage tag
• Volume ordered appropriate for weight of the patient 
• Duration of transfusion 
• Blood product label checked for any modifications (e.g., irradiation) 
• DIN and check character on blood product label and luggage tag are identical 
• ABO/RhD on blood product label and luggage tag are identical 
• ABO/RhD of blood product is compatible with the patient (displayed in the BPAM window) 
• Expiry date 
• Integrity of blood product 
• Scan the blood product after the above checks are completed 
• Check the correct blood product has scanned into BPAM (DIN, ABO/RhD and product/component code) 

If the blood product is removed from the bedside after the patient identification check is complete, the whole checking process must be repeated. This includes blood products removed from the bedside for priming of circuits. 

Spike the unit only after all checks listed above are completed. The person spiking the unit must be one of the clinicians undertaking the patient and blood product identification check. ¹

Prime blood administration set at the bedside. 

IMPORTANT

If there is any discrepancy between the blood product, patient details & pack tag/label or if you
are concerned about the appearance of the product DO NOT TRANSFUSE.  Report to Blood Bank immediately: extension 55829

Care and monitoring of transfused patients

Vital signs for fresh blood products (temperature, pulse, respirations, blood pressure, oxygen saturations and site observations) should be measured and recorded

• before the start of each transfusion
• 15 minutes after commencement of each pack
• hourly until conclusion
• at the completion of transfusion
• 4 hourly in the 24 hours following transfusion

This is a minimum requirement. Some clinical areas may require more frequent observations particularly in unstable or unconscious patients.

Patients should be directly observed during the first 15 minutes of transfusion as some life-threatening reactions may occur after the infusion of only a small amount of blood. Where possible, patients and families should be informed of possible symptoms of a transfusion reaction and should inform staff immediately if they feel unwell during transfusion.

For information about observation requirements for fractionated blood products, refer to the product page.