Blood & Blood Product Administration

Transcription

1 Approved by: Blood & Blood Product Administration Addendum to: Corporate Policy VII-B-397 Transfusion of Blood Components and Products- Pediatric/Neonate Gail Cameron Senior Director Operations, Maternal, Neonatal & Child Health Programs Dr. Ensenat Medical Director, Neonatology Neonatal Nursery Policy & Procedures Manual : Date Effective Next Review Aug 2018 Dr Sharif Shaik Medical Director, Neonatology Purpose Applicability To provide additional guidelines for the safe handling and administration of blood components and blood products in conjunction with Corporate Policy VII-B-397 Transfusion of Blood Components and Products Pediatric/Neonate All Covenant Health facilities, staff, members of the medical staff, volunteers, students and any other persons acting on behalf of Covenant Health. BLOOD PRODUCTS Blood and blood products include reconstituted whole blood, packed red cells, plasma, fresh frozen plasma, albumin, platelets, cryoprecipitate and IV Immune Globulin (IVIG). Information on blood products from the blood transfusion manual is located at: CONSENT FOR BLOOD TRANSFUSIONS Good transfusion practice includes informing families that transfusion of red blood cells, plasma or both is a possible element of the planned medical or surgical intervention and provided with information about the risks, benefits, and available alternatives. Telephone or written consent will be obtained prior to the administration of blood or blood products. The practitioner ordering blood products should be responsible for obtaining informed consent for red blood cell or plasma administration. In emergent situations, where parents cannot be contacted, two practitioners may approve the urgent administration of blood products. Parents should be notified at the next possible opportunity, and written consent obtained for the remaining hospital stay. Refer to Covenant Health consent policy and Minors/Mature Minors CROSS MATCHING A cross match is required before transfusion of packed red blood cells, whole blood, frozen plasma and platelets but a cross match is not routine on all new patients. For the first transfusion, in infants less than four months of age, a properly labeled blood specimen will be collected and sent to the Blood Bank (1 ml in an EDTA tube). The infant s ABO, Rhesus type, direct antiglobulin test and an antibody screen will be done. Equipment Crossmatching Blood collection equipment BBIN band with BBIN number Regional Blood Transfusion Service Requisition

2 Page 2 of 8 Blood/Blood Product Administration Transfusion Filter Blood administration syringe and tubing Syringe Pump Procedure OBTAINING A CROSS MATCH ACTION 1. Select a Blood Bank Identification Number (BBIN) strip and slide it into the red armband. Detach the extra BBINs and place one each on the order sheet by the cross match order, the specimen container, the cross match form, and the patient s kardex. Place a patient identification sticker on the outside of the red armband so that the ID# is visible but does not obscure the BBIN. Fix the BBIN band in a loop through the patient identification band. All patients should wear an identification band at all times. Very low birth-weight infants may wear a Posey identification band. The BBIN tag remains looped through the ID band at all times including transfers to different facilities. 2. With a second nurse or physician, the following patient information is checked to ensure that the patient identification band, the chart admission form, and the cross match requisition are the same: Patient s last name and given name (or girl/boy) Sequence of birth order if one of a multiple birth Blood Bank Identification Number Patient s Health Number Patient s Hospital Identification Number RATIONALE A BBIN is assigned to infants when a crossmatch is performed. Once a crossmatch is completed on a newborn infant, it does not need to be recollected until the infant is four months of age or unless the BBIN is lost or misplaced. Once an infant reaches four months of age, a crossmatch is only valid for three times from the time of collection. Proper patient identification. Identification of patient using two patient identifiers. 3. A registered nurse or physician collects the cross match specimen in an EDTA (lavender) specimen tube. Minimum 1 ml of blood. 4. The specimen is labeled with both a BBIN and patient identification label.

3 Page 3 of 8 5. The person who collected the specimen signs the cross match requisition in the Collected by area and marks the date and time of collection. 6. The individual who checked the patient information signs the requisition in the Identified by area. 7. For crossmatch/type and screen indicate the volume required only of transfuse orders have been given. 8. The labeled specimen and completed requisition are taken to the Blood Bank. If the cross match requisition is incomplete, or there is conflicting information between the label and the cross match requisition, another blood specimen must be drawn and sent to the Blood Bank. 9. Once a blood product transfusion is ordered, telephone the Blood Bank and request the blood product and volume required. Complete a blood request slip to pick up a blood product. 10. Document on the patient care record and the kardex that a crossmatch was collected. Identify time, date and individuals involved, as well as patient response. A. Blood Products Excluding Albumin & IVIG After the initial cross match and if there are no unexpected antibodies, unmatched group O Rh compatible red cells will be issued. Infants older than four months must have a new cross match sent before every transfusion. Infants with unexpected antibodies, or whose mothers have unexpected antibodies, may require a cross match before each transfusion. If the patient s name is changed but the original name and BBIN bands are kept, another cross match is not necessary. The blood must be ordered using the patient s original name and patient number. Products are checked against the original bands. Reconstituted whole blood is ordered for an exchange transfusion. The physician or nurse practitioner specifies a Hct of and a volume of 80 ml/kg x ml for tube priming. The blood is irradiated before an exchange transfusion and for subsequent top-up transfusions until 4 months of age. All infants with cardiac lesions and unknown results for deletion 22q and / or

4 Page 4 of 8 unknown status of thymus gland will receive irradiated blood products. Infants with Deletion 22q will receive irradiated blood products until their immunology status is determined. Infants that received an intrauterine transfusion will receive irradiated blood for all transfusions until 4 months of age. B. 25% and 5% Albumin Check order on patient s record. Fill out a pick-up slip for product. Check the infant s name, hospital number and physician s name on the chart and the infant s identification band. Complete the Blood Transfusion record (CHA-30-BB) Retain cardboard copy and return top copy to the blood bank. C. IVIG Refer to Infusion of blood products under

5 Page 5 of 8 ADMINISTRATION OF BLOOD PRODUCTS ACTION RATIONALE 1. Perform hand hygiene. Infection prevention precautions. 2. Check the blood product with another RN or physician for the following: the order for product type, amount and speed of delivery. 3. Confirm the information on the blood product bag/container, tag and patient admission Sheet is correct and matches Patient s name and hospital ID number, BBIN, Canadian Blood Service number, ABO grouping, Rh factor. Check the donor blood group and type. 4. Adhere to strict sterile technique throughout the transfusion procedure. 5. Run through a filter system (exception IVIG refer to Specific Brand Name Monogram) before administration to the infant. Using a filter, withdraw blood/blood product into a syringe for administration Blood products will be administered via a syringe pump over an ordered amount of time. EXCEPTION Exchange transfusion or emergency situation where blood products may be given manually by physician order. Red cell donors are O negative or O positive, depending on the baby s Rh type, unless the infant has specific antibody problem or is greater than 4 months of age, in which case a cross match compatible with recipient blood group and type will be done. AB plasma is given to all infants. Blood should be CMV negative. Prevent introducing infection to the patient. Blood products are filtered when withdrawn from the supplied bag and into the syringe for administration. Not all IVIG require filter refer to specific Monogram under Brand Name *Blood administration set is used once only 6. Run through a syringe pump EXCEPTION - Exchange transfusion or emergency situation where blood products may be given manually by physician order 7. Begin Infusing product within 30 minutes of receipt from the Blood Bank or the blood product must be returned to the Blood Bank. *Establish intravenous site for blood administration before blood requested from the Blood Bank Blood that has been out of a refrigerator for longer than 30 minutes without initiation of the transfusion must be returned to the Blood Bank to be discarded. Do not store in the unit refrigerator or warm products on the unit. EXCEPTION reconstituted whole blood for exchange transfusion my be run through a blood warmer.

6 Page 6 of 8 8. Complete infusion within 4 hours of dispatch from the blood Bank. Platelets should be given as quickly as possible 9. All Blood and blood products are administered through a venous route unless otherwise ordered by the physician/nurse practitioner. 10 Flush IV site with normal saline and attach blood administration set to patient Obtain vital signs and monitor patient condition throughout the transfusion process. Ensure vital signs are documented. If the infusion is to be longer than 4 hours, notify blood Bank when ordering the blood to divide the blood unit To Reduce platelet clumping IV site is assessed for patency prior to transfusion. lines are flushed with normal saline before and after receipt of blood products. All blood and blood products, including albumin, must NOT be mixed with intravenous solutions containing dextrose Vital signs including temperature, heart rate, blood pressure and respiratory rate are recorded pre-transfusion and every 15 minutes for the first hour of transfusion, Re-check vital signs over the second and third hours every thirty minutes then every hour until the transfusion is complete or discontinued, and post transfusion. The intravenous site is monitored for signs of infiltration. Transfusion reactions including fever, rashes, tachycardia, hypertension, cyanosis, hematuria, etc. should be reported to Blood Bank and documented on the patient record. The infusion should be discontinued as soon as a reaction is noted and the physician/nurse practitioner informed. The blood tag and bag are returned to the blood bank. 12. When the transfusion is complete, disconnect the administration set and flush the intravenous line with normal saline. 13. Complete documentation. Patient flow sheet: Time of transfusion Amount & type of product received Any adverse reactions

7 Page 7 of 8 Blood Transfusion Record: Time & date of start of transfusion Time transfusion completed Signatures of individuals confirming product & patient information 13. Once the blood transfusion record is complete: Place the top copy in the appropriate section of the patient chart. The bottom copy has two sections, one section is returned to the Blood Bank for their records and the small tag is given to the parents for their records. MISCELLANEOUS 1. DO NOT add any medications to blood or blood products 2. Infants under phototherapy receiving blood products containing red cells, must have the intravenous lines exposed to the phototherapy light covered with opaque material to prevent red cell hemolysis. 3. Infants less than 1000 gram whose potassium is elevated, should receive washed cells. Other infants with very elevated potassium levels receiving > 10 ml/kg of packed cells, should also receive washed cells. 4. A pre-transfusion platelet count must accompany requests for platelets. A platelet count should be done one hour post-transfusion. 5. Infants with an intravenous in place to meet fluid and caloric requirements and who are receiving blood products instead must have their glucose monitored every ½ hour. If the value if less than 2.5 mmol/l, notify the charge nurse. The transfusion will likely be delayed and the infusion containing dextrose resumed until the glucose level reaches 2.5 mmol/l or greater DIRECTED DONATIONS Directed donations of blood from parents to their children are possible for planned nonurgent transfusions. A physician must discuss this with the parents and contact Canadian Blood Services. Related Documents Adapted with permission from Stollery Children s Policy and Procedure Manual: Blood & Blood Products, June 2011 RELATED POLICIES & PROCEDURES Transfusion of Blood Components and Products - Pediatric / Neonate Corporate Policy & Procedure manual VII-B-397 Corporate policy, Identification of Patient Resident or Client Using Two Identifiers VII-B-25 Revisions November 2004

8 Page 8 of 8 Signing Original Signed GAIL CAMERON SENIOR DIRECTOR OPERATIONS MATERNAL, NEONATAL & CHILD HEALTH PROGRAMS COVENANT HEALTH GREY NUNS & MISERCORDIA HOSPITALS Original Signed DR. SANTIAGO ENSENAT MEDICAL DIRECTOR NEONATAL PROGRAM COVENANT HEALTH GREY NUNS HOSPITAL August 2015 DATE September 2015 DATE DR. SHARIF SHAIK MEDICAL DIRECTOR NEONATAL PROGRAM COVENANT HEALTH MISERCORDIA HOSPITAL DATE