Blood -down (2024)

Background

This chapter focuses on the principles of safe blood transfusion practices.The aim of this chapter is to develop and support knowledge of healthcare professionals involved in prescribing or administering blood components (red blood cells, platelets, plasma) and plasma protein products (PPP).The minimum criteria required to maintain safety and to improve transfusion practice.Desse includes the Canadian Standard AssociationBlood and blood components,1De Canadian Society of Transfusion Medicine(CSTM) Standards for hospital transfusion services,2Health CanadaGuidelines: blood rules,3AABBStandards for blood banks and transfusion services4OG College of American Pathologs (CAP)Transfusion -Medicine Accreditation Checklist.5The policy and procedures of each health institution must include mechanisms to guarantee continuous training and competence assessment of the theoretical and practical knowledge of all the staff involved in the transfusion process.

Considerations for earlier transfusion

The patient's blood control

Patient blood management (PPE) is a evidence -based interdisciplinary approach aimed at improving the results of the patient by avoiding or reducing unnecessary transfusion during the treatment of a patient.6This can be achieved preoperatively by optimizing the hemoglobin levels with the help of iron and erytropoëtin and assessing the potential for correction of coagulation abnormalities.7For non-surgical patients, alternatives to avoid or limit transfusion must also be considered when possible.

Decision to transfer

Prescribing a blood component or PPP is a clinical decision of a care provider (ie a doctor or other professional in health care who is authorized to order transfusion) based on evidence -based practical guidelines and often done in consultation with a doctor with a doctor with withA doctor with a Doctor's colleague transfusion man expertise.Diagnostic test results Before transfusion can suggest that transfusion is justified, a clinical assessment of symptoms and consideration of outcome measurements must be included in the decision to transfer.

Informed permission

Informed permission for transfusion is a standard security requirement.8In the committee of inquiry for the blood system in Canada, the honorary commissioner Justice Horace Kriver emphasized the importance of informed permission for the administration of blood components and OPP.9His recommendations were included:

“The fact that the license of the medical profession in their standards for practice requires that the doctor present the patient's informed consent for the administration of blood and blood products reaches in such a way that patients in Canada, the blocking of incompetence orA surgical emergency procedure will be informed about the risk and benefits of and alternatives to allogeneous blood transfusion. ”(P. 1133, Appendix A)9
"The risks, benefits and alternatives are presented in languages that the patient will understand and in a way that allows questions, repetitions and sufficient time for assimilation."9

The health care system is responsible for developing the policy and the procedures for informing permission before the transfusion of blood components or ppp.des must contain the following:8

a description of the blood component or PPP;
the connected risks and benefits, including life -threatening risks;
Alternatives, if relevant to clinical conditions, including their benefits and risks.

The discussion between the care provider and the patient must take place well before the surgical or therapeutic intervention, if possible, to give the patient the time to consider their options.

The health provider must document the discussion about risks, benefits and alternatives with the patient in accordance with the facility -specific policy. Informed permission for blood transfer,,On the Professional Education website

Informed rejection

Patients have the right to refuse transfusion or treatments with the use of blood components and OPPs.Informed discussion about the risk of refusal.Rejection must be clearly documented on the medical registration of the patient in accordance with the specific policy of the facility.

Patients can choose to refuse the treatment of the use of blood components and OPPs for personal or religious reasons.10Each member of the faith decides individually what is personally acceptable and the rejection documentation must clearly represent the details of the patient's decision.0327 or online on J.org.10

Transfusion statements

The caregiver documents orders to manage a blood component or PPP and to document the clinical indication.2

The full name of the patient
Unique Patient Identifier (defined by the plant)
Product type that must be managed
Volume or amount to be managed
Infusion speed or duration (some settings can refer to a procedure that defines a standard control rate)
Date and time of transfusion
Order, where products must be transferred (when multiple products are ordered together)
With the help of pressure infusion -units when specified
Use blood koërers when specified
If someone, if applicable, to blood components
Special transfusion requirements if present
Medicine related to the transfusion, if necessary, including dosage, route and when the medicine must be managed (i.s., pre-, intra or post-transfusion).
- For example, Kan are considered pre-media, such as diphenhydramine and/or acetaminophen, if the patient has a documented history of previous transfusion reactions.
- For example, Intra or Post-Medicin, such as Furosemide, are considered if the patient has an increased risk of complications for liquid over tax.

For-Transfusionstest

Pre-transfusion tests are completed to guarantee the compatibility between the patient and a blood component for transfusion.

The incorrect identification and incorrect test marking of the patient contributes to the submission of Abo-in-compatible blood and the potential for hemolytic transfusion reactions.11Misinational can occur on various points during the transfusion process, including during the collection and testing of patient samples, the request of blood products, problem and administration.

Pre-transfusion blood tests are labeled at the time of drawing on the patient's bedroom with the help of at least two unique identification data.The accuracy must be accurate that the patient's bracelet is confirmed by asking the patient to spell his name and state date of birth dates.

To prevent ABO-in-compatible transfusion errors, the Health Policy can require ABO blood group confirmation for first transfusion patients or the use of positive patient identification technology to confirm the donor unit and patient identifiers.1

For more information about pre-transfusion tests, including identification of the patient and labeling trial troublesChapter 8of this guide.

Pre-transfusion test and identification of compatible red cells are usually simple, but can be a complicated and time-consuming process when antibodies are present.Immediately.In emergency situations, red cell units could be issued before the end of testing based on health facilities and procedures and/or transfusion drugs and participating in a doctor.

IV access

Blood components and PPP can be managed via a number of central venous access units (CVAD) or peripheral intravenous catheters.

Measurement or lumeng size: This must be large enough to enable the flow of the blood component or PPP within the specified administration time and to prevent damage to the cells.2
- 20–22 Gauge for routine transfusions in adults.12
- 16-18 Gauge for fast transfusions in adults.12
- A smaller meter can be used in adult patients with fragile or difficult veins, but can limit the flow rate.13
- 22-25 Gauge is recommended for pediatrics.^14,,15
A special line for administering blood components or PPP.
Multiple lumen -cvads make it possible to give blood components or PPP products via a lumen, while other medicines or solutions are supplied via other lumen.
Management of no medication that is known to cause side effects at the same time as a blood component or PPP where it is possible because it is a challenge to distinguish between symptoms and signs of a drug -related side effect and transfusion reactions.
In emergency situations it may be necessary to manage different blood components and products at the same time.

Administration set

Requirements for administration sites vary for blood components and opps.

Set to blood components

Admission of blood components requires the use of a standard blood filter that can vary in porage size from 170 to 260 microns.

A leukocytr reduction filter is no longer required during transfusion, because all blood components issued in Canada have undergone leukocyte reduction of filtration in preparation (see Canadian blood servicesCircular of Information16InChapter 2of thisGuideFor mere information).17

Blood components must be transferred within 4 hours after the edition.Blood administration kit.If there is one delay between devices in a multiple unit transfusion, the administration kit must be changed to minimize the chance of bacterial growth.

Set on PPPs

The administration of PPPs requires different supplies that differ according to the product type and brand.PPPs for intravenous administration may require the use of a standard, ventilated or filtered set or can be managed by direct intravenous push.The product monographs and the local policy to determine what, if present, filtration requires during reconstitution or administration.

Infusion -units

All equipment used in the transfusion process must be approved by Health Canada and the manufacturer and maintain in accordance with the manufacturer's specifications for continuous security.

Infusion units are known to cause mechanical hemolysis;18Before the implementation of the use of an infusion unit must confirm that it has been approved for use when transferring blood components, the manufacturer is obtained.Chapter 10of thisGuideFor more information about the causes of mechanical hemolysis.

Infusion units can be used to transfuse blood components (eg infusion pumps, fast infusers, blood heaters and pressure devices).

Printing infusion -units

A pressure infusion unit can be used for rapid administration of blood components.

Blood warmer devices

A blood stove device can be used to prevent hypothermia during rapid administration of cold blood components, such as in the operating room or trauma setting.^12,,19A blood heating device can be used for routine transfusion for a patient with cold agglutine disease;However, there is limited evidence of the effectiveness of this strategy and that the heating of the patient is more possible and is equally favorable.20Blood heating units must have a temperature alarm system if the temperature exceeds 42 ° C.

Baseline -PatientVurdering

Pre-transfusion patient assessment and a measurement of essential signs of baseline must be documented within 30 minutes of transfusion.

If the patient is able to participate, education must be provided, so that the patient understands the importance of immediately reporting new initial symptoms during or after transfusion.

Each required pre-media must be prepared and administered as arranged (eg 30 minutes before the start immediately before the initiation).

Transport and storage

Blood components and PPP must be stored in controlled blood storage and transported in a validated system.8

A blood component or PPP may only be obtained from storage when all preparation for the administration is completed.

Follow the healthcare procedures when you get a blood component or OPP from the transfusion service or satellite blood fridge.

If the collected blood component or PPP is no longer necessary, it must be returned immediately to the transfusion service to maintain safe storage conditions and prevent waste..

Transfusion

Pre-transfusion safety control

Safety check before transfusion includes checking the blood component or PPP and verification of positive patient identification on the product to the patient identification tape.

There are several important points in the security check before transfusion:

Confirm that the blood component or PPP corresponds to the order of the provider for transfusing.
Check the blood component or PPP information on the label corresponds to the corresponding transfusion service and the roof.
- Websites must have a policy for the use of almost expiry date of blood components.21
Make sure that the ABO and RH are compatible for the blood component and the patient (see tables 1 and 2).

Investigate the appearance of the blood component or PPP.Confirmation that there are no blood clots, lumps or discoloration (see Canadian blood services'Visual Inspectorate);If it is present, you must inform the transfusion service and return the blood component or PPP.For PPP depicted as a lyophilized powder, inspect the solution after reconstitution.

Confirm that the unique patient identifiers of the blood component or PPP correspond to the patient's identification band.

Always follow the facility -specific policy for confirmation of patient identification and blood component or PPP.

Table 1:ABO -Compatibility


Blood group of recipient	Antigen (s) present when receiving red blood cells	Antibody present in receiver blood	Compatible red blood cells from groups	Compatible plasma from groups	Can receive platelets from groups
IN	IN	Manufacture	NASTY	A, AB	A, AB, B, O
B	B	woman	B, o	B, AB	B, AB, A, O
Aab	A, B	Nee	AB, O, A, B	Aab	AB, A, B, O
O	Nee	You are good	O	A, B, AB, O	O, AB, A, B

Table 2:RH -Compatibility of Red Persaling


RH van Recipient	Can receive from groups
RH Positive	RH -Positive Eller RH -Negative
Rv -negative	RH Negative*

*See facility-specific policy and procedures for the use of RH-positive red blood cells for emergency situations (ie unequal) situations in RH negative recipients, because RH-positive red blood cells can be transferred to women older than 45 years old and for male patients.

Depending on the blood component or PPP to be managed, there will be additional considerations.14

As mentioned earlier, an incorrect identification can occur on different points during the transfusion process, and it is necessary that positive patient identification is maintained during the entire process.Wrong when the patient.

Initiate the transfusion

The following list summarizes the general steps that are included in preparation and started with a blood transfusion.

1. View the order of the provider to transfer.
2. Confirm permission for transfusion.
3. Give information to the patient about the planned transfusion (eg preparation and monitoring required, symptoms to report immediately).
4. Confirm pre-transfusion test or collect sample before transfusion (if applicable).
5. Collect the required equipment.
6. Complete a patient assessment and receive vital signs of basic line within 30 minutes before transfusion.
7. Manage premedication (s) if necessary.
8. Get the blood component or PPP from storage or transfusion drug laboratory.
9. Full pre-transfusion control.se facility-specific policy and procedures.
10. Documents for transfusion controls, including the date and time and the identity of the persons performing the checks.
11. Prepare to start the blood component or PPP:

Blood component: the prime -administration line and filter with the blood component or a compatible solution (eg sterile 0.9% sodium chloride (NACL) solution for IV use).
PPP: Reconstitut, if applicable.Procedures for facilities or the manufacturer's product monograph to identify the correct administration stocks on intravenous, intramuscular or subcutaneous administration route

Table 3:Overview of requirements initiate

Blood component	Sign	Compatibility	Administration
Red blood cells	Anemia with reduced oxygen delivery	Must be ABO and RH -compatible Crossmatch required	Standard blood administration sets with a filter of 170-260 um. Transfuse slowly in the first 15 minutes:^14,,19 Voksne: 50 ml/t Pediatry: 1 ml/kg/t, tot 50 ml/t Can be increased if they are properly tolerated without side effects in the first 15 minutes. A device usually takes 1.5-2 hours to infunder, but can be added for up to 4 hours of volume-sensitive patients. Maximum infusion time is 4 hours.
Platelets	Treatment/prevention of bleeding in patients with reduced or dysfunctional platelets	The preferred ABO and RH compatible with donor plasma Must have confirmed blood type.RH -compatibility is important for RH (D) -Negative women with child -cheap potential. RH Immun Globulin (RHIG) administration can be considered if RH-positive platelets are given to a RH-negative patient, especially women with a poaching potential	Standard blood administration sets with a filter of 170-260 um.New set recommended. Transfuse slowly in the first 15 minutes if possible.^14,,19 Voksne: 50 ml/h Pediatry: 1 ml/kg/t, tot 50 ml/t Can be increased if they are properly tolerated without side effects in the first 15 minutes. Recommended infusion time is 60 minutes a day. Dose. Maximum infusion time is 4 hours
Plasma	Replacement of multiple coagulation factor Exchange of transfusion Therapeutic aeresis	Should Abo -Compatible* Confirmed blood group required * In an emergency or massive bleeding institution, some transfusion services can have specific policy that makes the use of group A plasma possible for recipients with an unknown blood group.	Standard blood administration sets with a filter of 170-260 um. Transfuse slowly in the first 15 minutes if possible.^14,,19 Voksne: 50 ml/h Pediatry: 1 ml/kg/t, tot 50 ml/t Can be increased if they are properly tolerated without side effects in the first 15 minutes. A device usually takes 30 minutes - 2 hours to add. Maximum infusion time is 4 hours
Kryoprecipitat	Diffuse microvascular bleeding and/or bleeding due to pitfinogenema and dysfibrinogenemia	ABO compatibility is not required Confirmed blood group required	Standard blood administration sets with a filter of 170-260 um. Transfuse slowly in the first 15 minutes if possible.^14,,19 Voksne: 50 ml/h Pediatry: 1 ml/kg/t, tot 50 ml/t Can be increased if they are properly tolerated without side effects in the first 15 minutes. The recommended infusion time is 10-30 minutes a day. Dose. Maximum infusion time is 4 hours.
Plasma -protein products	Varies per product type MetChapter 3, Albumin;Chapter 4,Immune globulin products;Chapter 5, Concentrate on hemostatic disorders and hereditary angio -edema	ABO compatibility is not required	Reconstitution, filter and pipe requirements vary per.Product type/fire. Gradual tariff increases may apply. Maximum speed varies per product type/fire. Interest requirements are usually the same for adults and pediatrics.

Patient monitoring

Severe and life -threatening reactions can be unpredictable and quickly improve;And searches of age the same as the symptoms are observed.12

Patient monitoring and vital signs must be based on the clinical state of the patient and are implemented in accordance with facility -specific policy for the duration of the transfusion.

If a transfer reaction is suspected, immediately stop the transfusion and keep vascular access with normal saline solution.

Homemade

At the end of the transfusion, the management set can be flushed:

Blood components: can rinse with sterile 0.9% sodium chloride (NaCl) solution;
PPP: can flush the intravenous administration with a compatible liquid (see product monograph from the manufacturer);Use at least volume for patients with liquid limited.

The empty blood component or PPP container and any administrative diet must be safely thrown away in accordance with the facility-specific policy.

Documents transfusion event according to facility -specific policy and procedures.In addition, in -terms that receive blood components or PPP must receive a notification of the transfusion according to facility -specific mechanisms.8

For outpatient patients you must undergo care with the patient or caregiver after transfusion.

Keep following the patient after transfusion for drawing and symptoms of a transfusion reaction.In general, changes in the status of the patient or vital signs that take place within six hours of the transfusion must be considered a potentially negative result of the transfusion and must be reported transfusion service.

Continuous infusion of coagulation factors

Coagulative factor replacement due to continuous infusion is used in many centers throughout the country to deal or prevent severe bleeding in patients with coagulation disorders.

As this procedure falls external recommendations in product monography, each institution is obliged to develop its own policy and procedures to steer and guide this practice.

Continuous credits for professional development

Fellows and health care professionals participating in the Canadian Royal College Maintenance of Certification (MOC) program can read to readClinical guide for transfusionAs a continuous activity of professional development (CPD) underSection 2: Self -reading credit.Reading a chapter corresponds toTwee credits.

Medical laboratory technologists who participate in the Canadian Society of Medical Laboratory Science Professional improvement program (PEP) may require reading Clinical guide for transfusion as an unverified activity.

Acknowledgment

The author recognizes Leonor de Biasio, RN, BSCN, CPNC and Tihiro Rymer, BSCN, MLT, as writers of an earlier version of this chapter and Allahna Elahie, BSC (Hons), MLT and Sarah Oxley, RN, BSCN, Review of theOverview of the current version.

Proposed quote

O'Reily C. Blood Administration.I: Clarke G, Chargé S, Editors.Clinic Guide to Transfusion [Internet] .Ottawa: Canadian Blood Services, 2019 [Cited Yyy MM DD] .kpitel 9. Beschikbaar bij:https://professionaleducation.blood.ca

If you have any questionsClinical guide for transfusionor suggestions for improvement, contact us viaReturn message from.

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2020-10-06