Transfusion awareness bloody lesson! Transfusion awareness SPOTs

Transfusion awareness Why do patients get transfused? Red blood cells (RBC) To treat symptomatic anaemia To increase oxygen carrying capacity To treat blood loss Fresh Frozen Plasma (FFP) To replace certain clotting factors during bleeds Platelets (Plts) To correct a low platelet count To boost poorly functioning platelets To combat bleeding/coagulation Cryoprecipitate (Cryo) To treat massive bleeds To treat DIC Transfusion awareness SPOTs

Transfusion awareness When to transfuse Transfusion awareness SPOTs

Transfusion awareness When to transfuse Always take samples from limbs that are not receiving any other type of infusion. Blood samples taken from limbs receiving clear fluids will be diluted, rendering inaccurate . results, this often leads to unnecessary/over transfusions (externally reportable to SHOT). Always suspect and re-check spurious blood test results that don’t appear to match clinical symptoms prior to prescribing a blood transfusion. Normal Hb = 140g/l – 180g/l (Men) 120g/l – 160g/l (Women) Hb between ‘normal’ and 70g/dl should be investigated and treated but not necessarily with a blood transfusion. Transfusion awareness SPOTs

Transfusion awareness Samples Never pre-label sample bottles Always have the request form available pre-bleed Always identify your patient Always label the sample before leaving the patient Second samples About 1 sample a month is sent through to Blood Bank which shows a different blood group to a sample previously tested for that patient! (We know that wrong patients are being bled regularly – a potentially fatal mistake!) 2 samples must be taken on 2 different occasions ideally by 2 different people (to guarantee the right patient has been bled = safety measure) Do not take 2 samples at same time and use 2 different pens (we can tell!) Do not take 2 samples at same time but put different times on bottles (defeats the object!) Transfusion awareness SPOTs

Transfusion awareness How to prescribe blood Considerations: Could I use an alternative? Can I justify this transfusion? What should it be written up on? What time is it? Consent Patient information Transfusion awareness SPOTs

Transfusion awareness How to prescribe blood Dosage: Red blood cells = 1 bag Platelets = 1 bag Cryoprecipitate = 2 bags FFP = 3 bags Over how long: Red blood cells = <3 hours Platelets = <30 mins Cryoprecipitate = <30 mins FFP = <30 mins Transfusion awareness SPOTs

Transfusion awareness Safe storage Red blood cells (RBC): Must only ever be kept in a blood fridge An adult dose of RBC is one bag Max out of fridge time = 4 hours Must be returned within 30 minutes Every bag of RBC thrown away costs you £150 Fresh Frozen Plasms (FFP): Can be kept in a blood fridge or at room temperature An adult dose of FFP is usually 3 bags Max out of fridge time = 4 hours Must be returned within 30 minutes Every bag of FFP thrown away costs you £40 Platelets (Plts): Must be stored agitated at room temperature An adult dose of Plts is one bag Max out off the agitator = 2 hours Must be returned within 30 minutes Every bag of Plts thrown away costs you £250 Cryoprecipitate (Cryo): Must only be kept at room temperature once defrosted An adult dose of Cryo is usually 2 bags Max time from thawing = 4 hours Must be returned within 30 minutes Every bag of Cryo thrown away costs you £250 Transfusion awareness SPOTs

Transfusion awareness Pre-transfusion checks Is the blood ready – how do I know? Is the patient ready – is it prescribed? are the obs ok? route of administration? is the patient going to be able to have it now? what time is it? Who is allowed to collect the blood? Transfusion awareness SPOTs

DOUBLE CHECK! Transfusion awareness SPOTs Blood Bank label: A MISTAKE COULD KILL!!!! Blood Bank label: NHSBT label: (Must check against info brought with you) Full name Date of birth Hospital number (All this info found by comparing these 2 labels) Check donor numbers Blood groups Expiry date Donor number Must be exactly the same Donor number Transfusion awareness SPOTs

Blood group compatibility Red Blood Cells Blood Group: A B AB O Can have: A or O B or O A, B, AB or O Must not have: B or AB A or AB - A, B or AB Blood Group: D-positive D-negative Can have: D-positive or D-negative Must not have: - Platelets Blood Group: A B AB O First choice: Second choice: Third choice: O (HT neg) Fourth choice: - O (HT neg) = High Titre Anti-A and Anti-B negative FFP Blood Group: A B AB O Can have: A, B, AB O, A, B, AB Must not have: - Cryoprecipitate - does not need to be ABO or Rh D matched. Transfusion awareness SPOTs

Blood group compatibility The most compatible blood group to give to your patient is exactly the same group that they are (this includes O-ve too!) If Blood Bank issues blood that is not the same group as your patient it must display this sticker ATTENTION THERE IS A DIFFERENCE BETWEEN THE DONOR AND THE RECIPIENTS BLOOD GROUP. HOWEVER THIS UNIT IS SUITABLE TO TRANSFUSE If you do not see this sticker and you have been given a different blood group do not transfuse it – ring Blood Bank for clarification. Transfusion awareness SPOTs

Transfusion awareness Tracing where the blood has gone Legally we must be able to track all units of blood and prove which blood has been given to which patient and which units were wasted It is no longer acceptable to just write ‘blood’ in the patients notes – the donation number must be recorded (use the stickers off the bags) In emergency situations this information can be entered retrospectively Even the emergency O-ve has to be traced! ? Transfusion awareness SPOTs

Transfusion awareness The blood prescription chart Blood must be written up on an STH blood prescription chart Time of collection should be filled in by the person who collected it Should lead you step by step through the bedside checking and administration process Each chart has enough room for 6 bags of blood Transfusion awareness SPOTs

Transfusion awareness The bedside check Two people must check ALL blood components at the side of the patient prior to putting it up for transfusion (not at the nurses desk!!!) These two people must be assessed as competent: Mistaeks Happen Person 1: A qualified nurse A qualified midwife A qualified ODP A qualified doctor Person 2: A qualified nurse A qualified midwife A qualified ODP A qualified doctor Transfusion awareness SPOTs

Transfusion awareness Giving set lines Type of giving set: Blood must only ever be given through a blood giving set (integral filter) and for every different type of blood – use a different blood giving set Changing lines: Manufacturer’s instructions state a blood giving set should be changed after every 2nd unit of blood transfused Priming lines: It is not necessary to prime a giving set with anything other . than the blood (only 0.9% sodium Chloride is compatible with blood) Volumetric pumps: Where possible/when appropriate it is preferable . for blood to be given via a volumetric pump Flushing lines: On completion of the transfusion, do not flush the . . . blood giving set (don’t transfuse the contents of the filter). Type of giving set: Changing lines: Priming lines: Volumetric pumps: Flushing lines: Transfusion awareness SPOTs

Transfusion awareness Minimum observations Blood observations must be clearly identifiable, and must be retained with the transfusion episode as part of the notes which must be kept for 30 years. Observations must be recorded electronically or on the observation chart & prescription chart (Minimum obs) Pre-transfusion: at least 15-30 minutes before the transfusion a . full set of SHEWS and temperature must be recorded 15 minutes after starting each unit of blood (not just red cells): . another full set of SHEWS and temperature must be recorded Hourly: (If the patient is ok) a temperature and pulse must be . . . . recorded. On completion: a full set of SHEWS and temperature must be . . . recorded Transfusion awareness SPOTs

Transfusion awareness Reaction management If a transfusion reaction is suspected you must immediately stop the transfusion Contact doctor and nurses in charge Re-check that the right bag of blood was put up for the right patient Record observations every 15 minutes until episode subsides If the blood is to come down – send it back to Blood Bank for investigation along with . . a suspected transfusion reaction form (download from the intranet) fresh samples will . also be required Document what has happened and what has been done about it – it will need . . . . . reporting as an incident as it will go to the Serious Hazards of Transfusion! Transfusion awareness SPOTs

Transfusion awareness SPOTs

Transfusion awareness For more information SPOT - Jill Rowlands (0114 27)15246 (There will be a Transfusion Practitioner where you work – Jill can put you in touch) Lead Transfusion Consultant Hospital Transfusion Team Hospital Transfusion Committee Hospital Intranet Site Local Blood Transfusion Policy Transfusion awareness SPOTs