Chapter 9 Flashcards
**Safe Blood Transfusion Practices **standards
1-Aim
2-Include?
- Aimed at supporting the knowledge of healthcare professionals in prescribing/administering blood components (RBCs, platelets, plasma) and plasma protein products (PPP).
Standards include:
* Canadian Standard Association’s Blood and Blood Components
* Canadian Society for Transfusion Medicine (CSTM) Standards
* Health Canada’s Guidance Document: Blood Regulations
* AABB Standards for Blood Banks
* CAP Transfusion Medicine Accreditation Checklist
Patient Blood Management (PBM)
Definitions and Examples:
- Evidence-based approach to improving outcomes by avoiding/reducing unnecessary transfusion.
- Pre-operative optimization: iron and erythropoietin to correct hemoglobin levels and coagulation abnormalities.
- Alternatives to transfusion should be considered for non-surgical patients.
Topic: Decision to Transfuse:
A clinical decision based on?
Evidence-based practice guidelines
Pre-transfusion test results
Clinical assessment of symptoms and outcomes.
Involves consultation with a physician with transfusion medicine experti
Topic: Informed Consent
licensing bodies of the medical profession require in their standard:
Informed consent is required before transfusion, following the recommendations of the Krever Report:
* Explanation of risks, benefits, and alternatives in patient-friendly language.
* Documentation of consent and discussion according to facility policies.
* Patients must have time for questions and assimilation of information.
Topic: Informed Refusal
Patients have the right to refuse transfusion?
- For personal or religious reasons.
Example: Jehovah’s Witnesses may refuse transfusion but accept some PPPs or erythropoietin.
Refusal must be documented after a discussion of the risks of refusal.
Additional information is available from the Jehovah’s Witness Hospital Information Services (Canada) 24-hour emergency line at 1-800-265-0327 or online at JW.org.
Topic: Transfusion Orders
Orders must include:
- Patient’s name and identifier
- Product type, volume, and rate of infusion
- Date and time of transfusion
- Sequence of products if multiple are ordered
- Use of pressure infusion devices or blood warmers
- Modifications or special requirements
- Pre-, intra-, or post-transfusion medications if needed (e.g., diphenhydramine, furosemide).
Topic: Pre-Transfusion Testing
Purpose?
Ensure compatibility between patient and blood component before transfusion.
Prevents administration of ABO-incompatible blood and reduces the risk of hemolytic transfusion reactions.
Topic: Patient Identification and Sample Labeling
* Where can misidentification risks occur?
- during specimen collection, blood request, issue, and administration.
- At bedside: Label blood samples using at least two unique identifiers.
- Positive patient identification: Confirm using the patient’s armband and by asking the patient to spell their name and state their date of birth.
Topic: Handling Emergency Situations
If antibodies complicate the testing?
If antibodies complicate the testing, it may take more time to identify compatible red cells.
**In urgent cases, **red blood cells can be issued before testing is complete based on facility policy and physician consultation.
Topic: IV Access for Blood Components and Plasma Protein Products (PPP)
* Gauge/Lumen Size?
* Dedicated Line
* Multiple Lumens
Gauge/Lumen Size:
20–22 gauge: Routine transfusions in adults.
16–18 gauge: Rapid transfusions in adults.
Smaller gauges (22-25 gauge) for fragile veins, may restrict flow rate.
22–25 gauge: Recommended for pediatrics.
Dedicated Line: Blood components or PPP should be administered through a dedicated IV line (no co-infusion of medications).
Multiple Lumens: CVADs with multiple lumens allow separate administration of blood components and medications.
Administration Sets for Blood Components
Blood Filter
* Leukocyte Reduction:
* 4-Hour Rule:
* Changing Sets:
Blood Filter: Use a standard blood filter (pore size 170-260 microns) to remove clots, cellular debris, and coagulated protein.
Leukocyte Reduction: Not needed as blood in Canada is leukoreduced during preparation.
4-Hour Rule: Blood must be transfused within 4 hours of issue. Discontinue if not complete within 4 hours.
**Changing Sets: **If there’s a delay between transfusing multiple units, change the set to minimize bacterial growth.
Topic: Administration Sets for Plasma Protein Products (PPP)
1- Varied Supplies:
2- Routes:
Varied Supplies: Requirements depend on product type and brand (e.g., vented, standard, or filtered sets).
Routes: PPPs may be administered intravenously, intramuscularly, or subcutaneously.
Refer to product monograph or local policy for required filtration during reconstitution or administration.
Topic: Infusion Devices for Transfusion?
* Whose approval do they need to have?
* 3 Examples of infusion devices?
- Must be Health Canada-approved and maintained as per manufacturer’s specifications.
**Infusion devices **(e.g., infusion pumps, rapid infusers, blood warmers, pressure devices) must follow health-care facility policy. - Be cautious of mechanical hemolysis caused by infusion devices.
Topic: Pressure Infusion Devices:
* Use:
* Maximum Pressure:
**Use: **For rapid administration of blood components.
Maximum Pressure: Should not exceed **300 mm **Hg to prevent hemolysis or bag breakage
Topic: Blood Warmer Devices:
* Purpose:
* Temperature Alarm:
* Documentation:
Purpose: Prevent hypothermia during rapid administration of cold blood components (e.g., operating room, trauma setting).
Cold Agglutinin Disease: May be used, but warming the patient may be just as effective.
Temperature Alarm: Device should have an alarm if the temperature exceeds 42°C.
Documentation: Record temperature at initiation and device’s unique identifier (e.g., serial number).
ABO compatibility
