Inspira Blood Bank

Question 1

for blood administration; you need two forms, what are they?
who signs them?
how do you print them?

Answer 1

consent form and requisition form
Print requisition form, needs to be signed by 2 RN’s or physician
Check order for “ready”, right click, print requisition
Print consent form
Task -> reports -> consent for blood transfusion

Question 2

A massive transfusion is defined as

Answer 2

an administration of 5 units of RBCs in one hour or 8-10 units of RBC units in 24 hours.

Question 3

What are the Massive transfusion ordering computer order sets

Answer 3

MTP1= 4 RBC, 4FFP
If need continues, MTP2= 4 RBC, 4 FFP, 1 single donor platelet
If need continues, MTP3= 4 RBC, 4 FFP, 10 cryoprecipitate (2-5 packs) (pooled dose (?))
This pattern is repeated in order until the MTP is discontinued

Question 4

The massive transfusion protocol has __ steps in the cycle that are repeated until the need is discontinued.
The amount of blood given in each cycle is equivalent to what?

Answer 4

3

1 blood volume for the average adult

Question 5

Considerations during massive transfusion, name 4

Answer 5

hypothermia, citrate toxicity, air embolism, hyper/hypokalemia

Question 6

what is the phrase that initiates the massive transfusion protocol?
What information must the caller provide?

Answer 6

Must use the phrase “Dr. _____ is initiating the Massive Transfusion Protocol and needs blood STAT”. Phrase must be used every time and is non-negotiable.
caller must provide pt name, DOB, Attending physicians name, Location, and designated contact person and phone number

Question 7

once the massive transfusion protocol is initiated, what is the expectation timeframe from bank to patient?

Answer 7

expectation is to issue the RBC’s within 10 minutes of the BB notification.

Question 8

What labs are associated with a MTP, and how often must they be evaluated?

Answer 8

Labs - CBC, PT, PTT, Fibrinogen, D-dimer, CMP, Mg and Phosphate
Labs must be re-evaluated every 60 minutes and reorder lab tests as needed.

Question 9

Under what conditions is the massive transfusion protocol initiated and when is it discontinued?

Answer 9

• MTP is activated when blood loss >150ml/minute or blood loss >50% in 1-3 hours.
• MTP is discontinued when bleeding <500mL / hour.

Question 10

Patients are required to have 2 ABORH types on file from 2 separate collections prior to transfusing under what circumstances?

Answer 10

non-group O red cells

Question 11

What is a good source for patient education as far as transfusion reactions?

Answer 11

Transfusion reaction- Go on policy tech for: Circular of Information (contains the internet link for blood components)

Question 12

What are some examples of special requirements regarding blood products?

Answer 12

Special requirements may include Irradiated, Sickle Neg., CMV Neg., HLA matched.

Question 13

What are 2 orders you need to be familiar with when transfusing blood?

Answer 13

Transfuse Now: Ready for transfusion, contains “blood product ready” companion order to print the pickup form
-Make Available: Needs to have a “transfuse now” order added when ready for transfusion

Question 14

How long is blood consent good for?

Answer 14

• Blood consent form is valid for the duration of the hospital stay
  
  • for outpatients, consent form is good for a year

Question 15

what are 4 things to remember regarding equipment when transfusing blood?

Answer 15

18 or 20g IV, if 22 must be used then use caution to infuse slowly

- 250 ml NSS @ 20ml/hr 
- ensure that the filter is primed with saline so that the saline is above the top of the filter 
- if using a central line use the distal lumen (preferred)

Question 16

what fluids are compatible with blood products and why?

Answer 16

The only fluid compatible with Blood products is NSS 0.9%.

- No medications
- solutions with dextrose can lyse the red cells
- solutions containing calcium can cause clotting of the red cell component.

Question 17

When ending the transfusion, what are 4 steps you have to take?

Answer 17

Continue to observe patient for at least one hour
Change tubing after 2 units or 4 hours
Submit a copy of Transfusion Record to the BB
Follow up instructions must be included in discharge instructions.

Question 18

Name 4 key points when transfusing blood
documentation
VS
pt education

Answer 18

Document pt education about S+S of transfusion reaction
Infuse only 15-30ml over the first 15 mins for ALL blood components (non-emergent)
VS 15 minutes after starting transfusion
15 minutes remain with patient

Question 19

Transfusion reactions

what are the immediate, the delayed types

Answer 19

Immediate; most serious, ABO compatibility, severe allergy

Delayed; Transfusion transmissible infections, Hemolytic

Question 20

What are the characteristics of fever associated with a transfusion reaction?

Answer 20

Fever may appear during or within 4 hours of trans, rise of 2 degrees F or chills, rigors

Question 21

Transfusion reaction Management

What are the 10 steps?

Answer 21

Stop transfusion
20ml/hr minimum NSS
Change tubing
Notify transfusion service
Place orders in computer per Transfusion Services Medical Director
Complete Transfusion Reaction form
Send blood bag/tubing to lab along with transfusion reaction form
Enter STAT order for Blood Transfusion Reaction into information system
Collect urine and send to Lab
Document in chart.

Question 22

After a transfusion reaction, when is it ok to restart the blood?

Answer 22

Blood may be restarted if; only hives (urticaria) appear and patient has been treated with an antihistamine and the hives disappeared, and physician gives order to restart.