blood transfusion medical staff 2011. regulations medicines and healthcare products regulatory...
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Blood TransfusionMedical Staff
2011
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Regulations• Medicines and Healthcare
Products Regulatory Agency (MHRA)
• EU Directive 2005/61/EC
(100% compliance)
• NHSLA
• Induction
• Annual Update
• NPSA competencies (3 yearly)
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Where to find information
• Intranet http://webapps/intranet/departments/blood_transfusion/default.asp
• Link person
• Bi monthly newsletter
• Blood Transfusion Manual
• www.transfusionguidelines.org.uk
• Remember if you are making a service change which involves blood transfusion it may need to go through change control. (MHRA requirement). Therefore inform us ASAP.
• Blood Warmers: Ward 34 and Theatres (UHCW/RSX)
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Requesting Blood• MSBOS – Maximum Surgical Blood Ordering Schedule
http://webapps/elibrary/index.aspx
• Pre optimise your patients
• Electronic issue
• Avoid wastage
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Patient Identification
• Ensure the correct blood sample is taken from the correct patient by identifying and completing patient’s full birth name, hospital/NHS number, date of birth, gender
• Where appropriate ask the patient to state the above details and check electronically issued armband
• If not appropriate check electronically issued armband and if possible check ID with relative
• Do not multi task when obtaining blood samples
• There will be a procedure in every Trust for identifying unknown male and females
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Order of Draw and Inversions
• Every Trust has a collection system
• To ensure a quality sample the correct order of draw must be observed
• All BD vacutainer tubes require immediate mixing following collection
• Avoid the use of needle and syringe for taking blood samples
• Hand label the blood samples clearly, accurately, legibly at patient’s side
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Cross Match Form
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Prescribing blood and blood products• Reason for transfusion
• Identity of prescriber GMC number or name
• Ensure accurate documentation.
• Remember you may be called to recount why you prescribed or administered blood
• Consent (Verbal)
• One unit versus two
• Maximum transfusion time 3 ½ hours
• Each unit volume differs
• Generally increases Hb by 0.8 g
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Indications for RBC transfusion: Medicine
• Acute bleeding: urgent X-match
• Chronic anaemia, if no treatable cause AND symptomatic AND Hb < 8g/dL (or 9g/dL, if age >75)
• Transfusion-dependant Pts, keep Hb >10
• Radiotherapy: keep Hb > 10
• Chemotherapy Pts; keep Hb > 9
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Indications for RBC transfusion: Surgical• Anaemia: if not easily
remediable in other ways
• Bleeding
• Pre-op ordering: Maximum Surgical Blood Ordering Schedule (MSBOS). Tariff. Less can be ordered. More if justified
• Intra-op and Post-Op: know Hb before transfusing.
SPECIALITY: GENERAL SURGERY MAXIMUM BLOOD ORDER (units)Adrenalectomy 2Appendicectomy G&SBreast biopsy No specimen requiredCholecystecomy +/- explore CBD G&SColectomy : Subtotal 2Colectomy: Total or abdominal-perineal(AP)
3
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Indications for FFP transfusion
• Generalised coagulation factor deficiency (DIC, severe liver disease)
• Trauma pt bleeding heavily: may use RBC:FFP 1:1 and later RBC:FFP:Plt 1:1:1
• Warfarin OD: Vitamin K & ‘Prothrombinase complex’
Remember if defrosted can utilise up to 24 hours later if
returned to Blood Bank
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Indications for platelet transfusion
• Not ‘Glue’
• Check FBC before giving
• Plt < 70 and bleeding / surgery
• Plt < 10 - maybe prophylaxis
• Assess function where possible (TEG, PFA)
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Indications for cryoprecipitate
• Not ‘Glue’
• Factor VIII, von Willebrand Factor (but safer concentrates available)
• Fibrinogen depletion (DIC, hyperfibrinolysis, liver disease)
• Fibrinogen < 1g/L
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Blood costsYear Red Cells Platelets FFP
1996/97 35.02 150.00 23.32
1999/2000 78.88 141.93 18.47
2000/01 82.50 151.27 19.47
2001/02 84.56 155.05 19.96
2002/03 99.77 165.22 20.72
2003/04 110.92 178.36 29.17
2004/05 120.22 198.76 30.89
2005/06 132.07 216.87 34.67
2006/07 130.52 213.79 31.64
2007/08 134.27 208.46 32.69
2008/09 139.72 232.29 36.33
2009/10 133.19 229.85 36.18
2010/11 124.21 230.39 28.42
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Administration• 2 trained staff must check patient against prescription and blood label
which is affixed to the bag of blood (luggage tag)
• Positively identify your patient. (Electronically issued wristband/verbal)
• Check vital signs before the transfusion is administered
• Identify adverse reactions. (Patients must be visible throughout the transfusion).
• If there is an anomaly, correct if possible before blood transfusion commences. i.e. Pyrexia
• Complete the blood transfusion administration record. Start and stop times must be recorded
• If patients are being transferred between departments and blood is in progress, they must be accompanied by a qualified nurse/Doctor if appropriate.
• Dispose empty blood bags into the clinical waste stream once the blood has been AutoFated. (Partially full or full must be disposed of into a rigid container)
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Transfusion Reactions: Acute Haemolytic Reaction
• ABO incompatible red cells, e.g. Group A into Group O patient (anti-A, anti-B)
• Errors: 65% ward, 35% Lab
• Patient & Sample ID• Pain (infusion site, back, chest), ‘sense of impending doom’, red
urine
• Shock, DIC, Renal failure
• Death (10%)
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Long term side effects
• Red cell antibodies:e.g. anti-c, Anti-Kell
• HLA-sensitization (now rare)
• Infection: Hepatitis B, C. CMV,HIV, Parvo, HTLV-1/2, malaria, syphilis, vCJD …...
• Iron overload
• Cant donate blood! Recent audit indicates only 19% of unconscious patients at UHCW were notified they had received blood during their hospitalisation
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Emergency Blood• O-• White form• Cool box• Retain skins and fate blood after the
event• Record donation numbers in medical
notes• Red Label
• Fridges (O-)• Pathology Dept, (Main Fridge Blood
Bank), 4th Floor, west Wing• Emergency Department• Main Theatres (Central)• Labour Ward Theatres (West Wing)• St. Cross (Rugby) Opposite Cedar ward
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Patients who refuse blood
•Increasing
•Policy: Really important however minor the procedure!
•Intranet: Resources
•All patients who refuse blood must complete paperwork
•Jehovah Witness Liaison
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Wastage• If you don’t follow process i.e. utilise blood track blood will be wasted
• Must be avoided
• Can lead to limited UHCW blood stocks especially
• O – ve, B –ve and platelets
• Blood / products are expensive and a limited resource
• Complete a blood wastage form (Found on the e-library or blood Transfusion Intranet site)
• Fate must be recorded as wasted
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Contacts:
• Janine Beddow: Modern Matron (Transfusion) X25470 Bleep 1287
• Angela Sherwood: Transfusion Liaison Nurse X25469 Bleep 2280
• John Hyslop: Blood Bank Manager (Network) X25322
• Dr Nick Jackson: Consultant Haematologist (Network), Bleep 1750. [email protected]
• Dr Keith Clayton : Consultant Anaesthetist (HTC Chair). Bleep 1488
• Hayley Brace: Administration X25436
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Questions?