SARASOTA MEMORIAL HOSPITAL TITLE: ISSUED FOR: NURSING PROCEDURE Nursing DATE: REVIEWED: PAGES: RESPONSIBILITY: RN, LPN I, LPN II Per Job Description 03/93 2/18 1 of 6 PURPOSE: KNOWLEDGE BASE: To provide procedures for the safe administration of leukocyte reduced and irradiated red blood cells to the neonatal patient. 1. Corporate Policy 00.PAT.00, Administration of Blood and Blood Products, applies. 2. A physician s order is required for the administration of blood components. 3. Normal Saline, 0.9% USP, will be the flush solution when a flush solution is required for administration,unless ordered otherwise by physician 4. Policies and procedures addressing intravenous therapy and administration of blood components as appropriate. 5. Licensed Practical Nurses (LPN) may monitor rates and sites of infusing blood components. An RN or LPN II must hang the blood. 6. Infant needs to be cross matched (send blood clot) if : a. Designated donor that is not type O b. If infant has an antibody c. Infant is 4 months or older d. See appendix A 7. Red Blood Cells provide a source for carrying oxygen to tissues. Indications for RBCs include: a. Acute blood loss b. Correct anemia that is compromising cardiovascular status or oxygen-carrying capacity. 10. A type and cross match is required prior to administering RBCs unless withholding the RBCs might result in loss of life. 11. Red Blood Cells, Leukocytes Reduced by Filtration, provides a unit of red blood cells with reduced white blood cells. Leukocyte reduced products may be indicated for patients with a history of non-hemolytic febrile transfusion reactions and for immuno suppressed patients. 12. Positive patient identification is required prior to performing the procedure. Refer to SMH Policy (01.PAT.09) Patient Identification: Inpatient/Outpatient and to procedure (blo03) Ordering, Obtaining, Identification and Administration of Blood Products. NOTE: When Red Blood Cells are ordered, the unit will be designated for the neonate and is used exclusively for the patient until discharge or until the unit outdates, whichever
comes first. PAGES: 2 of 6 DEFINITIONS: 1. Informed Consent: Consent voluntarily given without coercion or undue influence by an authorized person after a sufficient explanation and disclosure of the subject matter involved has been provided. The information should enable that person to have a general understanding of the treatment or procedure, the medically acceptable alternatives, and the substantial risks and hazards inherent in the proposed treatment or procedure. EDUCATION: 1. Explain the procedure to the parent/guardian. Verify that informed consent for the administration of blood products has been obtained. Informed consent is the responsibility of the ordering physician. EQUIPMENT: Assemble the following: 1. Assess or initiate IV access prior to obtaining PRBC s from the blood bank. 2. IV setup a. Syringe pump b. Microbore tubing c. T-connector with clamp (if not already in place). 3. Assess baseline vital signs including temperature, pulse, respirations, and BP and record them in the EMR. 4. A metabolic screen must be obtained prior to the administration of any blood products. The only exception is an acute blood loss situation where the delay of treatment could potentially mean loss of life. 5. Infants less than 2 Kg. must be NPO for three (3) hours prior to the blood transfusion and remain NPO for three (3) hours post-transfusion. 6. Note temperature. If the temperature is greater than 37.5 degrees, clarify with MD whether or not to proceed with transfusion. 7. Obtain the blood from the Sarasota Communities Blood bank. A transporter (volunteer) may be designated to obtain the blood with requisition form. 8. The patient s name and hospital ID number on the identification tag must correspond with the same information that appears on the Blood bag Tag, which is attached to the syringe containing the blood component cross-match results, or requisition slip. This will be verified by the RN initiating the transfusion. 9. Blood component type, blood unit number, blood group, an Rh type on the syringe label must correspond with the Blood Bank syringe tag attached to the syringe. This tag must also indicate that the syringe is pre-filtered, irradiated and Leukocyte reduced Verify patient blood type and Rh
PAGES: 3 of 6 compatibility with PRBC product type and Rh. This information will be verified by two nurses, one must be a Registered Nurse. NOTE: If there is a problem with identification of the blood component, return the component to the blood bank immediately. DO NOT INFUSE. 10. When checking expiration dates: a. The date on the Blood Bank syringe tag indicate the expiration date of the crossmatch unless the Blood Bank extends the outdate circumstances. b. The expiration date on the blood component indicates the expiration date of the blood component. 11. If there is a problem with the identification of the blood component, return the component to the Sarasota Community Blood Bank immediately. 12. If there is any question concerning the above confirmations or if any information is missing, contact the Blood Bank and request presence of technician to verify information in writing on label. Verification cannot be taken by phone. 13. Document on the bag tag, the date, the time the unit was started, the patient s vital signs before transfusion and the signatures of the transfusionist and verifying nurse. 14. All blood transfusions received from Blood Bank in a syringe are prefiltered in the Blood Bank and do not require a filter. This small amount may be infused using a syringe pump and regular medication tubing 15. Begin infusing blood as ordered. The maximum time for one aliquot of blood to be infused is 4 hours. 16. If the volume and rate ordered requires that the transfusion will exceed the time limit, only order the first four-hour aliquot. As the transfusion of the first aliquot nears completion, order the second four-hour amount to complete the transfusion (Expiration time begins when blood is transferred to syringe). Remain with the patient during the first ten (10) minutes and observe closely for signs of complications. (Refer to Reactions to Blood and Blood Components, blo12). 17. During the transfusion: a. Document vital signs prior to transfusion, every 15 minutes times two, then every one hour. b. Observe baby closely for first 15 minutes watching for signs of complications. If patient is tolerating the transfusion and no signs of reaction noted, observe the patient every 30 minutes. 18. Transfuse PRBC s completely as ordered. Flush T- connector with saline to clear..
PAGES: 4 of 6 19. Change the blood tubing as follows: a. After the saline flush which follows the blood transfusion. b. Between units of multiple transfusions if the total tubing use time will exceed four hours. c. Between units of multiple transfusions from different donors even if tubing is less than four hours old. CAUTION NOTE: The risk of hemolysis and bacterial contamination rises dramatically after four hours from the presence of residual blood in the tubing. 20. Continue with patient s previous intravenous orders, insert a PRN Adapter or discontinue the access as appropriate to the patient s orders. 21. Following the transfusion, complete the Blood Bank syringe tag, including the time the transfusion was completed, the infant s temperature, blood pressure and pulse, and volume transfused, and remove from the syringe. Attach to the laboratory mounting form in the chart. 22. Place the empty blood bag and used tubing in a biohazardous waste bag and take to the Soiled Utility Room and dispose of in a waste container designated for biohazardous waste. These containers will be lined with red plastic bags. DOCUMENTATION: 1. EMR: a. Document the blood product and volume infused (include normal saline). b. Document the patient responses to treatment and any signs of reaction noted and action taken REFERENCES: American Association of Blood Banks, American Red Cross, Council of Community Blood Centers. Circular of Information For The Use of Human Blood And Blood Components. Author. Sarasota Memorial Hospital Personnel. Biomedical Waste and Sharps (Handling and Disposal) (00.IFC.12). Sarasota, FL: Author. Sarasota Memorial Hospital Staff. Administration of blood and blood products. (00.PAT.00). Informed Consent/Refusal To Consent: For Surgery, Special Procedures, the Administration of Blood and/or Blood Components. (00.RSK.14). Sarasota, FL: Author. SMH Nursing Procedures (blo03). Blood and Blood
PAGES: 5 of 6 Components: Ordering, Obtaining, ID, Administration, Blood Reactions. SMH: Author. SMH Policy. Patient Identification: Inpatient/Outpatient. (01.PAT.09). SMH: Author. Merenstein GB& Gardner SL. 2011. Handbook of Neonatal Intensive Care. 7 th edition. St. Louis: Mo.: Mosby. REVIEWING AUTHOR (S): Heike Bucken RNC-NCC, CLC Clinical Coordinator, NICU Rebbeca Schilling DO, West Coast Neonatologist Appendix A
PAGES: 6 of 6 Procedure for obtaining a blood clot 1. Infant needs to be cross matched (send blood clot) if : a. Designated donor that is not type O b. If infant has an antibody c. Infant is 4 months or older 2. Obtain pink band and unique blood identification number 3. Fill out bracelet insert on the top of the blood bank numbers a. Place small patient ID sticker Date /Time and collector s initials b. Detach and slide into arm band c. Ensure ID number is visible 4. Draw specimen according to protocol and place in pink top microtainer a. Label with patient s ID, date/time and collector s initials 5. Perform Final Check verification for each specimen collected by reading out loud the last three digits of the patients visit number on the specimen label and then reading out loud the last three digits of the patient visit number on the patient identification band. 6. Place specimen and remaining ID numbers in a biohazard bag 7. Send to Blood Bank.