Blood and Blood Product Administration

Duration

1. Fresh Frozen Plasma (FFP): May transfuse for up to one (1) hour. (~ 250 ml)
2. Cryoprecipitate: May transfuse for up to one (1) hour. Single and pooled. (~90-120 ml)
3. Platelets (PLTS): May transfuse for up to one (1) hour. (~250 ml)
4. Red Blood Cells (RBCs): May not transfuse for more than four (4) hours. If using an infusion pump, the rate should NOT exceed 200 cc /hour. Pressure infusions using a rapid infuser or pressure cuff are ONLY done in the critical care areas or Operating Room.

Vital Signs

Vitals signs need to be check: Please include a full set of vitals that includes pain and temperature

1. Prior to start of infusion
2. 15 minutes after start of infusion
3. Then, Every hour until infusion stops
4. End of the infusion

Adverse Reactions

Signs and Symptoms

1. Sense of doom
2. Flushing
3. Chills
4. Pain at site
5. Myalgia
6. Nausea
7. Abdominal, Flank or Chest Pain
8. Shortness of Breath

Types

Type	Mechanism of Action
Allergic Reaction	Allergic reactions occur when patients have antibodies that react with proteins in transfused blood components.
Acute Hemolytic Reaction	Incompatible transfused red cells reaction with patient's own Anti-A or Anti-B
Septic Shock	Transfusion of bacteria contaminated blood component
Transfusion-Related Acute Lung Injury (TRALI)	Acute respiratory distress due to donor plasma containing antibodies against the patient's leukocytes.
Fluid Overload	Toomuch fluid is transfused or too quickly leading to pulmonary edema and acute respiratory failure (ARF)
Non-Hemolytic Febrile Reaction	Patients antibodies reacts to transfused white cells causing a fever

Intervention

1. Stop the transfusion immediately.
2. Hang new tubing and keep the intravenous line open with normal saline.
3. Notify the physician immediately of suspected transfusion reaction to obtain transfusion reaction follow up orders (i.e. first urine).
4. Notify Blood Bank
5. Perform a blood/blood product “records” check with blood bank CLS to re-verify:
   1. Patient’s name
   2. Date of birth
   3. Medical record number
   4. Blood Bank tag
   5. Blood type
   6. Expiration date and time
   7. Unit number on the blood tag compared to the blood/blood product
6. Complete the suspected transfusion reaction Record on the patient’s EHR as well as the paper copy of the “Transfusion Reaction Record” located on the back of the “Crossmatch Transfusion Record”.
7. Send Transfusion Reaction Record along with remaining blood/or blood product bag and all the tubing in a biohazard bag to the blood bank.
8. Submit a notification of adverse event through the electronic occurrence reporting system to the Risk Management and Quality Department.
9. Provide further clinical testing and supportive care as ordered by the physician and/or blood bank medical director.

Downtime Forms

Pending Permission to post downtime forms