Review of Standards of Practice: Blood Transfusions Prepared for Case-Based Learning May 30, 2002 Lou Ann Montgomery, PhD, RN, CCNS, CCRN Director, Nursing Education Department of Nursing Services and Patient Care

Standards of Practice: Blood specimen collection for Type and Screen/Type and Crossmatch

1. Prepare Requisition Patient’s name Hospital number Doctor’s name and CLP number Blood products ordered Other information, testing, preparation as appropriate Blood availability (routine/emergency)

2. Prepare Typenex Band Patient’s name (first and last) Hospital number Date sample drawn Detach one numbered label from the band and attach it to the requisition in the location indicated

3. Obtain a Witness All blood draws and labeling must be witnessed! - Doctor - Physician's assistant - Medical student - Registered nurse - Licensed Practical Nurse - Nursing Assistant - Nursing Unit Clerk - Pathology Personnel - Similar healthcare providers but not including patient/family

4. Identify the Patient Ask the patient to state their name Verbally verify that ID bands (inpatients), Typenex band and requisition are correct If anything is incorrect, DO NOT PROCEED Correct as necessary! If no discrepancy, proceed

5. Draw Sample Phlebotomist and witness sign requisition and initial Typenex band Label tube in the presence of the patient* Attach Typenex band to patient; it not possible to physically attach, consult UIHC policy for acceptable alternatives * Whenever possible, confirm identification with a patient, a family member or other persons familiar with the patient.

6. Deliver Sample and Requisition to the Blood Bank Any specimen mislabeled or completely/illegibly labeled (including missing signatures) must be discarded and will need to be redrawn

Standard of Practice Blood Transfusion

1. Doctor’s Order Doctor will have written an order to transfuse the patient Verify the doctor’s order to transfuse the patient

2. Obtain Blood from Blood Center Imprint a 3x5 card with the patient’s addressograph (or write the patient’s name & hospital number legibly) AND the blood product desired Go to the Blood Center Verbally check the blood unit labeling with Blood Center Personnel Sign for blood product in Blood Center dispensary log Take blood to patient care area

3. Verification Checks in the Presence of the Patient * The transfusionist and another staff member must recheck ALL blood and recipient information verbally: - primary label on front side of unit - pink label on back of unit - pink chart label - patient ID bracelet - Typenex band Sign the chart copy, pink label – verifies that labeling was checked and found to be correct Whenever possible, confirm patient identification with the patient, a family member or other person familiar with the patient If patient is in Isolation/witness can’t enter room, transfusing RN should be in room and other staff member in doorway, using “chart copy” label for verification. Transfusing RN verbally does the identification steps

4. Prepare to Transfuse Assure IV is patent Prime blood administration set/filter (0.9% saline is the only solution approved for direct mixing of blood) Instruct patient regarding reaction sign/symptoms* - dyspnea/wheezing - cyanosis - anxiety - chills/fever (> 1º C baseline) - flushing/hives/errythema/uticaria - sudden severe headache - flash pain/hematuria - sudden abdominal pain/diarrhea

4. Prepare to Transfuse (cont’d) If there is difficulty in determining if sign/symptoms are due to transfusion or acute illness: –Per UIHC Transfusion committee, house staff, if notified of potentially critical transfusion reaction symptoms, must consult with attending/faculty physician before ordering continuation if any of the following are present - Marked, sustained change from baseline (two, 60 seconds apart) - Hematuria - Marked back or abdominal pain - Altered sensorium decrease systolic BP , 30 mm Hg increase in HR  30 BPM or age determined increase in temperature  1.5º C, with/without chilling marked SOB, dyspnea, 0 2 sat. decrease 10%

5. Transfuse Initiate transfusion at slow rate – no more than 50 ml in first 15 minutes Monitor patient and document Vital signs  Baseline  After first 15 minutes  At completion  PRN if s/s occur Signs and symptoms of reaction  Constant first 15 minutes  Every 30 minutes during transition  At completion

6. If a Transfusion Reaction Occurs Stop the transfusion Notify the doctor Monitor vital signs Follow procedure from Blood Center