product administration

Safety Transfusion safety Immediate management of suspected transfusion reaction Care of transfused patients • Starts with a properly labeled pre transfusion specimen Recognise React • Monitor your patient for adverse effects of transfusion, • Make sure the right patient gets the right blood (always adhere • F e v e r Stop transfusion (leave IV line in place) then: observe closely during the first 15 minutes to the bedside pretransfusion check on the back of the Blood • Chills • Provide emergency patient care • Record vital signs (T, P, RR, BP and O2 saturations also document Transfusion record) condition of the site being used to transfuse): • Urticaria (hives) • Arrange immediate medical review • Start blood products within 30 minutes of issue and complete – before starting • /hypertension • Keep IV line open with N/ (flush IV cannula within 4 hours – 15 minutes after commencement • Pain (alone IV site, chest or back) or attach side arm) • The record is a legal document and must be filed – hourly in the medical record on completion of the transfusion • Acute respiratory distress/stridor/wheeze • Repeat pre-transfusion check – at completion • Blood products should only be stored in approved refrigerators • Dark urine Report – 4/24 hourly for 24 hours if inpatient NOT ON THE WARD •  oozing (DIC) • Telephone RCH ext 5829 • Calculate the transfusion volume as stipulated in the formulas • Complete transfusion reaction form, in Common Blood Products table document reaction in patient notes Blood filters & giving sets Common blood products

Standard McGaw in-line blood filter Smart site infusion set Baxter neonatal giving set Tuta blood/solution administration pump set Formula for calculating (170–260µm) Alaris SE pump (contains inline 170–260 µm filter) (contains inline 170–260 µm filter) Pack sizes required Rate Maximum infusion/hang time volume to transfuse

Packed cells (mLs) = wt(kg) × Hb rise required (g/L) × 0.4 Start at no more than 5mL/kg/min Filter type/ 250 – 300 mL packs Yes for selected Red products for the first 15 minutes unless 4 hours giving set MIS prescribed 50 – 60 mL pedipacks patient groups* Hb rise required = an emergency wt(KG) × 0.4

Pump blood* Variable No 4 hours cell salvage

It enables the pack to remain in-line during To filter out large clots and aggregates, transfusion – this provides safe identification To administer fresh blood products rapidly, Purpose Must have the McGaw in line filter added all fresh products including cells salvaged of the product and the pack can be returned to in an emergency situation See separate information poster blood bank should a transfusion reaction occur To be used for all transfusions of FFP, To administer blood in small volumes Clinical indication , & leucocyte depleted For use in transfusion of any blood products Emergency/rapid transfusion via a red cells & platelets 300 mLs Start at no more than 5mL/kg/min FFP*** 10 – 20 mL/kg No can be increased to 10 – 20mL/kg/ 4 hours 50 mL pedipack min if tolerated Filters how Change when flow rate compromised Change when flow rate compromised Change when flow rate compromised Change when flow rate compromised many packs? or at least 12 hourly. or at least 12 hourly or at least 12 hourly or at least 12 hourly

Start at no more than 5mL/kg/min Can be flushed Cryo*** 5 – 10 mL/kg 30 – 40 mL No can be increased to 10 – 20mL/kg/ 4 hours Yes Yes Yes Yes with N/saline? min if tolerated

*See section on irradiation below **Post cardiac bypass ***Please note blood bank require 30 minutes to defrost FFP and cryo prior to collection

Compatible fluids and medications Irradiation Compatible ABO groups Neonatal testing ASBT (Australian Society

No medications or solutions should be added to or infused What does it do? • Group identical blood products should be given. However in circum­ of Blood Transfusion) protocol through the same tubing as blood products except for stances where this is not possible, a non-identical but compatible • Impairs donor lymphocyte’s ability to divide 0.9% Sodium Chloride, ABO compatible plasma or 4% Albumin. group may be issued What is it? (does not remove/destroy them) • It has been shown to be safe to co-administer morphine (1mg/mL), • Rh Negative patients should always receive Rh Negative blood products A protocol that allows issue of red cell products to suitable infants Which products? without repeated crossmatching pethidine (10mg/mL) and ketamine (1mg/mL) if diluted in 0.9% Sodium • Rh Positive patients can receive either Rh Negative or Rh Positive Chloride with red cells. In these situations, the blood product should be • cellular products (platelets, red cells, ) blood products Which patients? administered via the closest to the patient (distal lumen). Why do it? • Under 4 months of age • If other medications are required during a blood transfusion the ABO group of compatible ABO group of compatible • Prevents Transfusion-Associated Graft Versus Host Disease (TA-GVHD) transfusion must be stopped and the line flushed with 0.9% Sodium Red cells FFP/cryoprecipitate • Ongoing need for blood

Chloride before and after administration of the medication. The blood When? Group 0 B A AB Group 0 B A AB Sample requirements transfusion can then recommence. • Ring blood bank to request irradiation of unit prior to collection • Crossmatch meets lab criteria (blood bank will inform requesting • Fluids containing are not compatible with red blood cells, (allow at least 5 minutes) AB     AB  clinician if not eligible): they cause clumping of the red blood cells. – Sample size: red top EDTA tube >1.5mls in 2.7 tube Which patients? A   A   • Crystalloid or colloid solutions that contain calcium should never • All PICU & NNU patients How to request ASBT? be administered concurrently with any blood product. B   B   • All immunocompromised patients Calcium reverses the citrate causing red blood • Request “ASBT protocol” with first crossmatch cells to clot. • All Children’s Centre patients Recipient ABO blood group O  O     • Indicate if any previous transfusion What about platelets • Ordering Blood – once on ASBT repeated crossmatch not required, order blood by telephoning hospital blood bank (ext 5829) • See Platelet Product Administration Poster ERC: 100404