dr norris- good trasfusion practice.pdf
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Tx PracticeTRANSCRIPT
Transfusion Safety
Workshop:
Good Transfusion Practices
Dr Norris Naim
Pusat Darah Negara
What is blood for?
• Purpose of blood transfusion
– Safe patient life, improve patient
recovery
• Improve O2 carrying capacity
– Red cells (PC, BCPPC, WB)
• Stops bleeding, improve hemostasis
– Platelets, FFP, Cryoprecipitate, factor
concentrates
• Transfusion process
– From vein-to-vein (donor to patient)
Good Transfusion Practice
• Transfusion that is just, indicated and clinically sound with patient best interest at heart
• Transfusion of appropriate type and volume of blood and components
• Transfusion of blood and components that are of good quality
• Transfusion that is performed according to procedures that minimise errors and mistakes that would harm the patient
Good Transfusion Practice
• Patient safety is a priority in blood
transfusion
• It involves correct patient identification:
– when taking pre-transfusion sample
– When transfusing blood to patient
• Also involves patient monitoring during
and after transfusion for any adverse
reactions
Do it right from the beginning
• Taking pre-transfusion sample
– Must follow procedure (no exception)
• Identify patient: by name, IC – ask patient, relatives, check wristband
• Don’t use bed numbers
• Label sample at bedside: do not label away from the patient, do not leave the sample unlabeled and unattended even for a while
• Use hand written labels: don’t use pre-printed labels
• Sampling and labeling must be
performed on one patient at a time
• Label the sample immediately – do not
delay
• Don’t allow yourself to be distracted •
• Those who take the sample, must label
it and must initial the label
• Do it yourself – don’t ask others for
help
Filling in the form
• If you take the sample and label it, write
your name as the person who did it
• Make sure
– Proper diagnosis is written
– Indication for transfusion is filled (eg type of
surgery).
– Avoid using vague reasons (eg for op,
surgery, for intervention)
– Date and time blood is required is written
(for GXM request)
• Avoid calling the Blood Bank
unnecessarily just to ‘confirm’ blood
• What is “confirm blood”?
– ?Sample received by BB
– ?Blood ready for collection
• Use of dispatch book helps you keep
track of the sample sent
– Record the samples sent, who received it
and what time its received at Blood Bank
• When to collect the blood for
transfusion
– Collect when and only when blood is
needed for transfusion
– Non-urgent transfusion: XM blood can be
collected after 2 hours after BB receive the
sample or as written on request form
Pre-transfusion Testing
• Except for a few, all non-emergency requests should be treated as GSH
• Tests performed:
– ABO and RhD grouping, antibody screening
• Antibody positive cases
– Ward will be informed.
– Need to send extra sample (10cc EDTA) for antibody identification
– To d/w BB MO on duty
– All antibody cases will be crossmatched
• Rh negative cases:
– Ward will be informed.
– To d/w BB MO on duty
– Ability of BB to supply Rh neg blood depends on stock
– May need to call in donors; thus delay in supply
• Platelet and plasma request
– New patient: fresh sample for ABO and RhD grouping
– Known patient: attach copy of previous request form (had at least 2 previous transfusions)
• Emergency XM
– For cases that require immediate transfusion
but no sample was sent to BB earlier
– Request for XM just to get blood to OT with
patient, is NOT Emergency XM
– Emergency XM is not as safe as a full
complete crossmatch
– Blood is supplied after ABO and RhD
grouping, and quick crossmatching at RT
• Emergency XM (cont’)
– Antibody screening only performed after
blood is issued out
• chance of supplied blood causing reaction to
patients is higher than normal
– Should only be requested when transfusion
is necessary and require immediately
– If probability of transfusion is minimal or
transfusion is to be performed later, full
crossmatch should be requested instead.
• Collecting Blood
– Bring along written document of the patient’s details, blood component needed and number of unit needed
– When urgent transfusion is needed, save time by calling blood bank to prepare the blood while PPK/porter is sent to collect the blood
– Before taking blood back to ward, check details on request form against that on PPDK1 card and blood bag
• Blood should be taken back immediately
to the ward
– Red cells and Plasma products: ice-
containing box
– Platelets: ice-free box
• Blood must only be collected when its
going to be transfused
– The shorter the period the blood is outside
the BB, the better
Checking the blood at the ward
• Checking of blood – ensure the blood collected is
for the patient intended (tallying info bw blood, form and PPDK card)
– can be performed by SN
• DO NOT sign the PPDK card yet – may initial the card and
request form as indication that checks have been made
• Transfuse blood as soon as it arrived
• Red cell units that are not to be transfused yet, must be stored in blood fridge
• Keep record of movement of the red cell units in and out of the fridge
• Plasma and platelet – transfuse as soon as possible
– MUST NOT be stored in fridge
Transfusion of Blood
• Plasma and platelet: immediately after it arrive to the ward
• Red cell transfusion – DO NOT warm the blood (ie. blood warmer, run
under tap water)
– Take out of blood fridge for 15 minutes before transfusion
– Use administration set: 1 set per 2 units
– Each unit should not be more than 4 hours to complete
– Do not add in any other fluid or medicine through the same iv line (except normal saline)
Before transfusion:
• Check blood JUST BEFORE the transfusion –
at bedside, by two staffs (doctor and SN)
• Document the checking in the checklist form
• Ensure patient is the right pt – check blood
bag against request form, PPDK card,
patient’s wrist band/patient ID, asking patient
• Check each unit the same way before each of
the unit being transfused
THEY MAY LOOK THE
SAME, BUT NOT
NECESSARILY THE SAME
Not Vigilant Enough
Patient Monitoring
• Vital signs (BP, HR, Temp) must be taken
before transfusion of each unit
• Monitoring must be close for first 15 minutes,
then every half to one hour (if no complication)
• Avoid transfusion in the evening especially for
pts in rooms, unless in emergency
• Document the details of the transfusion (vital
signs, blood units transfused, any reactions)
Completion of transfusion
• Complete the PPDK card
only after transfusion is
finished
• Fill in the necessary details
and sign the card (by doctor
or staff nurse)
• Return the card with the
used blood bag to BB
Transfusion Reactions
• Stop transfusion if patient show any reaction
• Investigate all reactions
• Return all used blood bag to BB – empty or not, and any unused blood units
• Should patient needs the transfusion, make a fresh request