Patient safety with use of blood products begins with a decision to transfuse based upon appropriate clinical guidelines. Blood specimen labeling, from the time of collection of initial specimens from the patient for blood typing, to release of blood products and proper identification of the patient to whom the products are issues, is critical to safety.
Blood products issued from the blood bank must be used without delay.
During blood product administration, proper infusion times must be followed, and patient status must be monitored for possible adverse reactions.
Following transfusion, the patient status is assessed for outcomes.
Proper blood product transfusion guidelines help prevent transfusion errors to reduce patient morbidity and mortality.
Specific guidelines (American Red Cross, http://www.redcrossblood.org/sites/arc/files/coi1113.pdf) include the following:
Aseptic technique must be employed during administration of blood products. If the product container is entered in a manner that violates the integrity of the system, the component expires 4 hours after entry if maintained at room temperature (20 to 24°C), or 24 hours after entry if the product remains refrigerated (1 to 6°C).
All blood components must be transfused through a filter designed to remove clots and aggregates (generally a standard 150 to 260 micron filter).
Blood and blood components should be mixed thoroughly before use.
Blood and blood components must be inspected immediately before use. If, upon visual inspection, the container is not intact or the appearance is abnormal (presence of excessive hemolysis, a significant color change in the blood bag as compared with the tubing segments, floccular material, cloudy appearance, or other problems), the blood or blood component must not be used for transfusion and appropriate follow-up with the transfusion service must be performed.
No medications or solutions may be added to or infused through the same tubing
simultaneously with blood or blood components with the exception of 0.9% Sodium Chloride Injection (USP), unless: 1) they have been approved for this use by the FDA, or 2) there is documentation available to show that the addition is safe and does not adversely affect the blood or blood component.
Lactated Ringer's Injection (USP) or other solutions containing calcium should never be added to or infused through the same tubing with blood or blood components containing citrate.
Some life-threatening reactions occur after the infusion of only a small volume of blood or blood components. Therefore, unless otherwise indicated by the patient's clinical condition, the rate of infusion should initially be slow.
Periodic observation and recording of vital signs should occur before, during, and after the transfusion to identify suspected adverse reactions. If a transfusion reaction occurs, the transfusion must be discontinued immediately and appropriate therapy initiated. The infusion should not be restarted unless approved by transfusion service protocol.
Specific instructions concerning possible adverse reactions shall be provided to the patient or a responsible caregiver when direct medical observation or monitoring of the patient will not be available after transfusion.
Transfusion should be started before component expiration and completed within 4 hours.
All adverse events related to transfusion, including possible bacterial contamination of blood or a blood component or suspected disease transmission, must be reported to the
transfusion service according to its local protocol.