Non-urgent blood transfusion should occur between the hours of 8am and 8pm. Administration outside of these hours must be based on clinical need as determined by medical staff.
 

Blood Group Compatibility

Red Cells

Donor red blood cells must be ABO group compatible with the recipient as outlined in the table below.

Donor red blood cells must also be Rh (D) compatible with the recipient’s red blood cells. During periods of blood shortage, Rh (D) positive red blood cells may be administered to Rh (D) negative recipient following approval from a Haematologist. Particular care must be exercised in situations involving women of childbearing age.

Plasma

Plasma must be ABO compatible with the recipient’s red cells as outlined in the table below.

Matching Rh (D) group is not necessary when administering plasma. A sample for blood grouping should always be taken but a crossmatch is not required.

Platelets

Platelet components should preferably be ABO and Rh(D) identical or compatible with the patient's ABO and Rh(D) group. If ABO compatible platelets are not available please discuss options with the Blood Bank on ext 5230

Cryoprecipitate

Cryoprecipitate should be ABO group compatible with the recipient's red blood cells. Rh (D) group is not relevant.

Equipment

Venous Access

The size of the intravenous cannula should reflect the intended rate of administration. Generally, an 18gauge intravenous cannula is recommended for blood administration in adults. Central venous access devises can be used for blood administration.

Blood Administration Sets

Blood components and blood products shall be administered through a blood administration set incorporating a standard 170-200 micron filter, which removes clots and small debris that may form during collection and storage. The length of the membrane filter should be covered when priming the administration set.

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1. Explain the procedure
2. Inform the patient of the indication/s for blood transfusion
3. Educate about adverse reactions
4. Provide a patient information brochure on Transfusion of Blood & Blood Products.  Information brochures are available in multiple languages.  Information brochures can be located in the Prescribing Blood page of this site, or the Asutin Health intranet site via the following link:  http://armcnet/Departments/PatEdProject/default.htm
5. Identify allergies and relevant past history from patient and/or medical record
6. Assess patient for any pre-existing fever, rash, itching or other signs which may later be confused with a transfusion reaction
7. Ensure written consent for blood transfusion is obtained using the Blood Transfusion form M109.0

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Checking the Blood

ABO incompatible blood transfusion can be fatal. These incidents are the result of a failure to adequately verify the identity of the patient and blood prior to administration.

• ALL blood components and blood products must be checked at the patient's bedside immediately prior to administration by two qualified members of staff holding current registration: RN, EN IV endorsed, medical.
• The staff member spiking/hanging the blood must be one of the two staff members who have undertaken the blood product and patient identity check.
• ALL patients having blood transfusions must have an identification wristband in-situ that includes the patient’s FULL name, date of birth and UR number. No Wristband = NO TRANSFUSION

Patient and Blood Component Identification Procedure

1. Establish positive identification of the patient by asking them to state their FULL name and date of birth and ensuring that the details provided (including UR number) are identical to those on:
   • The patient's identification wristband
   • Blood Transfusion Form M109.0
   • Compatibility and Administration record D1.1, and
   • Patient label on the unit of blood

In the unconscious / confused / infant patient, the wristband must be used to verify the patient's identity. Check the patient's surname, given name(s), UR number and date of birth on the identification wristband. It is also important to verify the patient's identity with a carer/spouse/parent if available.

2. Cross check the following blood component details against the blood component label, patient label attached to the unit and the Compatibility and Administration Record D1.1:
   • Blood group - is it compatible?
   • Type of blood component
   • Donation number
   • Expiry date
   • Special requirements e.g. irradiation, CMV negative

3. Check the prescription (Blood Transfusion Form M109.0) for the following:
   • Type of blood component
   • Duration of infusion
   • Special requirements e.g. irradiation, CMV negative,
   • Medication requirements e.g. premedication, frusemide

4. Visually inspect the blood component Bag for:
   • Leaks at ports or seams
   • Evidence of discolouration or turbidity
   • Presence of clots

If there are any discrepancies with the above steps DO NOT PROCEED and rectify the problem immediately. If unsure seek advice from senior staff or blood bank.

Monitoring the Patient

Commence ALL transfusions slowly, unless administering in an emergency.

The following vital signs are the minimum required for every individual unit of blood component administered.

• Vital signs (temperature, pulse rate, respiratory rate and blood pressure) immediately prior to commencing the red cell unit.
• Repeat vital signs after 15 minutes.
• Repeat vital signs half- way through the unit, and
• Repeat vital signs at the end of the unit.

Use clinical judgement to determine if the patient requires more frequent monitoring of vital signs e.g. in the case of an unstable underlying condition or the patient shows signs of a transfusion reaction.

Visually observe the patient at least every 15 minutes throughout the entire transfusion for signs of transfusion reaction or fluid overload. A reaction can occur at any stage during a transfusion. Record ALL vital signs taken during transfusion on the appropriate hospital observation chart with reference to the start and completion times of each unit of blood component.

Further information about patient monitoring and administration rates for different blood component and products can be found in their respective procedures.

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Blood Administration Procedures

Administration of Albumin

Administration of Cryoprecipitate

Administration of Fresh Frozen Plasma

Administration of Flebogamma

Administration of Intragram

Administration of Octagam

Administration of Platelets

Administration of Prothrombinex - VF

Administration of Red Cells

Administration of Sandoglobulin

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Documentation

It is a requirement that all blood / blood products can be traced back to the individual recipient by donation or batch number for a period of 20 years. An effective system of component and product traceability involves maintaining records of product being issued from blood bank and documented evidence of administration to the patient.  At Austin Health evidence of traceability is available through electronic issue of the product from blood bank and a completed (dated and signed) Compatibility and Administration record D1.1 and Blood Transfusion form M109.0 that is filed into the patients medical record.

Ensure that all documentation relating to the transfusion is complete. This includes: vital signs taken throughout the transfusion, administration start/stop times of each unit, signatures of staff checking and administering the blood component/product and patient tolerance of the procedure.