2013 CAP Annual Review Blood and Blood Product (Lab requirement per College of American Pathology (CAP) standards)

Module Objectives After learning and completing the test the nurse will be able to: Identify an adult/pediatric patient transfusion (blood and blood products) recipient. Discuss how a patient is monitored during and after a transfusion. Discuss steps taken when a transfusion reaction occurs. Demonstrate ability to find 2 resources when dealing with for a transfusion on Lake Link

CAP Standard TRM.41025 “Personnel involved in transfusion are trained in the identification of transfusion recipients and blood components, and in observation of recipients during and after transfusion, with in-service education at least annually.” Note: “All personnel who administer blood components must be trained to identify transfusion recipients and components, and to closely observe patients during and for a period of time after blood administrations.”

Emergent Situations A Physician’s order is required specifying the release and administration of blood which has not been cross-matched to the patient.   In an emergent situation Nursing must document the physician’s verbal orders to transfuse blood that has not been cross-matched . Reference: Access by clicking on “Policies” found listed on the lower left side of LakeLink under Featured LakeLink Destinations. Search for policy # noted below. Policy Manual: Patient Care Services/Nursing Section: Nursing Administration Title: Verbal/Telephone Orders Reference #: NNA-051 Revision Date: June 12, 2009 IMPORTANT!

Important Reminders Always use Standard precautions when handling blood/blood products Non-emergent situation – Transfusion consent must be obtained PRIOR to the administration of product. A new consent MUST be obtained for each hospital admit. Emergent situation – Physician’s order is required specifying the release of and administration of blood which has not been cross-matched to the patient. DO NOT remove the blood Bank bracelet. Only certain personnel are authorized to remove the bracelet. If clinical situation requires removal, notify Blood Bank as soon as possible.

Important Reminders (cont) Pumping undiluted blood through an access smaller than 20G is not recommended (avoids mechanical lysis of cells) Only IV solution to be used with blood/blood products is 0.9% NaCl (Normal Saline) No medications are to be administered with blood/blood products. Autologous blood product would be used first. Administration of blood/blood product should begin immediately upon arrival to the clinical area. If there is a delay in the clinical area, Blood has to be returned to the Blood Bank within a 30 minute window of removal from the bank.

Important Reminders (cont) Blood tubing must be changed after the administration of two (2) units of blood/blood product Using a blood warmer: Temp of warming device should not exceed 42˚ C. Blood should be administered in 4 hours or less Reissue of warmed blood is prohibited. Administration times: Blood, washed RBCs – no longer than 4 hours. Platelets, Cryoprecipitated Antihemophilic Factor and fresh frozen plasma – as fast as the patient can tolerate.

Adult and Pediatric considerations Central Venous access – acceptable Peripheral IV – Administration via an 18- 20G catheter is preferred. Leukopoor cells may be administrated via 22G. A smaller gauge is acceptable when no other IV access is available. Pediatric Central venous access – acceptable Peripheral IV Administration via 20-22G is preferred, though a 24G may be used.

Verification of product… Assess temperature, blood pressure, pulse and respirations. Document in the medical record. Flush blood tubing with NaCl and attach to venous access Verify patient and product with physician order Verification must be performed by either two RNs, one RN and one LPN or one RN and one Medical Technologist The RN conducting the verification must initiate the administration of the product to the patient. The other staff member (RN, LPN, Medical Technologist) conducting the verification must be qualified to participate in the process.

Patient Identification Inpatient Two staff members (2RNs, RN and LPN, RN and Medical Technologist) compare the patient’s name and account number on the patient’s armband with the patient’s name and account number on the Blood Bank unit tag. Outpatient (red cell products) Two staff members (2RNs, RN and LPN, RN and Medical Technologist) compare the patient’s name, date of birth, and identification number on the patient’s red blood bank armband with the patient’s name, date of birth and identification number on the Blood bank unit tag.

Product verification … At the bedside – nurse(s)/technologist compare the donor number and blood type on the Blood Bank unit tag with the blood product label. Also verify the expiration date has not passed. Team members verifying patient and blood product must sign the blood bank unit tag. TAG IS NOT TO BE DETACHED FROM THE UNIT.

Aftercare…. Flush tubing with NaCl. Resume previous IV orders Assess/document patient’s vital signs including temperature Affix the completed chart copy of the Blood Bank unit tag to the patient’s medical record. If no reaction occurred, the empty blood bag and tubing is placed in a plastic bag and disposed in the biohazard waste container. Discard the pink Blood slip.

CAP Standard TRM.41650 Transfusion Reaction Recognition/Education “Criteria for the recognition of transfusion reactions are documented and there is documentation of at least annual in-service education on the recognition of such reactions.” Note: “These must be readily available to clinical personnel in areas where patients are transfused.”

Blood Reaction Resources Mosby’s Procedure Guide Access by clicking on Mosby Procedure Guide found on the lower left corner of Lake Link under Featured LakeLink Destinations . Search for “Blood Reaction” First two items on the list are: Transfusion Reaction: Management (Pediatric)Transfusion Reaction Transfusion Reaction (for the adult patient) Note Extended Text…Table 1 for additional information

Blood Reaction Resources (cont) Access by clicking on “Policies” found listed on the lower left side of LakeLink under Featured LakeLink Destinations . Click on OLOL Search for Policy Reference #: NBL-002 Title: Blood Bank Specimen Collection, Administration of Blood & Blood Products and Management of Possible Adverse Reactions Supersedes #: 88, 94, 96, 97 Date Last Revised: June 22, 2011 Note section F: MANAGEMENT OF A TRANSFUSION REACTION

Transfusion reaction: Signs and Symptoms triggered by a blood transfusion that may affect the blood, blood vessels, kidneys, heart, skin, central nervous system and lungs. A two degree Farenheit (2˚) rise above baseline temp. (baseline is temp taken prior to the initiation of the product) Rash Pain/pressure in chest Hypotension Back or flank pain Pain at infusion site Flushing Dyspnea Hematuria Anaphylactic shock Generalized bleeding Oliguria or anuria Any other unusual symptoms

References Mosby Procedure Guide Policy Reference #: NBL-002 Copyright © 2006 - 2011 Elsevier Inc. All Rights Reserved Policy Reference #: NBL-002 Blood Bank Specimen Collection, Administration of Blood & Blood Products and Management of Possible Adverse Reactions Supersedes #: 88, 94, 96, 97 Date Last Revised: June 22, 2011 Laboratory Accreditation Program of the College of American Pathologists. Copyright belongs to the College. All tools are ©2011. College of American Pathologists. All rights reserved.

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