This is your final chance to once again check the identity of the patient, and the blood component to be used, to prevent a potentially fatal error.This check must be repeated for every unit transfused, and the time of the transfusion. This must be done at the patient’s bedside. If for any reason the checking process is interrupted, it must be started again from the beginning.
You have a legal duty to do all in your power to ensure that patients’ are given the right blood, so it is very important not just to perform all the patient identity checks but also to carefully record what you have done, should it ever be called into question in the future.
You should also ensure that the patient has given informed consent to the procedure, this is a good time to reaffirm their consent.
You must not administer a blood transfusion unless you are a registered practitioner who has been not only trained, but also passed a competency assessment in line with local policies. Transfusion may only go ahead if the details on the patient’s ID band (and, ideally, verbal ID confirmation from the patient) match the details on the label which was created in the laboratory and placed on the blood pack. This should also exactly match what is on the transfusion prescription. If there is any discrepancy or you are in any doubt you should report this back to the lab. At this point, it is also worth a final check on the expiry date of the component.
Inspect the pack for any signs of leakage, clumping or discolouration.Again if you are in any doubt about the quality of the pack you have received you should contact the transfusion laboratory before proceeding.
Once you are satisfied that you have the right blood and the right patient, you should sign the prescription and all other associated paperwork including the patient’s record. You will need to note the component donation number the date and time of starting the transfusion (and the time it stops). Include the dose or volume of the component to be given and your name.
Any component transfusion should be completed within 4 hours of its removal from storage where the temperature was controlled. This helps to reduce the risk of bacterial infection developing in the blood, and being transfused into the patient.
Transfusion of platelets
The administration should begin as soon as possible once the platelets have been collected received and checked from storage. The main aim for platelet transfusion is to stop bleeding. Ideally, the transfusion should be given over 30 minutes.
If both platelets and red cells are to be transfused, the platelets should be transferred first. This is because the platelets will act to stop bleeding before the new red cells are given.
Platelets should not be stored in a refrigerator, but kept at room temperature to keep them active.
Wherever possible use a platelet giving set. These are shorter than other giving sets and help to maximise the volume of platelets the patient receives. This not only helps to prevent wasted components left in the tube but also ensures the patient receives maximum benefit.
To prevent the platelets clumping together, you should agitate the pack. This is another reason the platelets should be administered quickly.
As soon as you begin, monitor the patient for any signs of rashes, changes in consciousness or rate of respiration. Monitor their temperature, blood pressure and pulse. Reactions are possible with platelet transfusion because the rate of delivery is quite quick. They are also more likely to react than red cells because they are stored at a higher temperature.
Transfusion of Fresh Frozen Plasma (FFP)
Follow the same procedure as platelets. However, ensure that any unused FFP is returned to the blood storage area within 30 minutes if they are not going to be used so that they can be preserved. FFP are more likely to give patients an allergic reaction because of the plasma proteins.
Red Cells transfusion
The administration should begin no later than 30 minutes after delivery to the ward area. Red cells take longer to transfuse than platelets or FFP, but the maximum time that this can take is 4 hours from the time they were removed from the fridge. Red cells may only ever be used for the person whose name is listed on the compatibility tag.
If there is an uncertainty about how long the component has been out of the fridge, the pack should be returned to the laboratory with an explanation so that the staff can investigate.