Procurement of Blood

All requests for blood or blood components must originate from and be signed by a physician (or an Advanced Practice Nurse with prescriptive authority privilege) and must be submitted by direct computer entry or on the RML Blood Center Transfusion Requisition Form 5709. Information regarding the patient and diagnosis is important for selecting the best possible product for the individual patient. The physician's signature indicates that all information is accurate and has been reviewed.

Red cell products ordered, crossmatched, and not immediately transfused will be held until the expiration of the sample used for crossmatch.

Labeling of Patient Samples used for Type and Crossmatching

The content of each sample label must include the patient's full name and medical record number, the phlebotomist's initials, the date and time the sample was collected and, for non-LLT draws, the initials of a second medical professional who has confirmed that the sample came from the patient whose name is on the label (LLT phlebotomists should write ?LLT? for the second set of initials); the computer label must have this same information plus an accession number and the tests ordered.

Patient samples are useable until midnight on the third calendar day following collection.

The Blood Center is strictly regulated and cannot accept improperly labeled samples.

If the sample is missing the date and/or time, the sample can be returned to the floor for correction. Blood Center personnel affix a "mislabeled sample" sticker to the sample and tube it back to the patient care unit so that the missing information can be added. Prior to tubing the sample, Blood Center personnel should notify the patient's nurse that it is being returned. Blood Center personnel should record on the quality assurance log the date, time, the patient's identification information and room number, and a brief description of why the sample was unacceptable. Unlabelled samples and samples lacking two sets of initials are never accepted or returned to the patient care unit for relabelling; instead, Blood Center personnel should discard the samples and send a requisition to the patient care unit with a sticker requesting a redraw. In any of the following circumstances, the sample must be discarded.

• The patient?s name and/or medical record number are missing or discrepant.
• The label does not include two sets of initials.
• There is more than one tube of blood wrapped in a single label.
• The blood type of the patient?s sample does not match the patient?s historical blood type.
• The sample is drawn in the wrong tube.
• There is a blank label on the sample
• The patient ID information is unreadable (e.g., blurred, part of name/medical record number cut off).
• Any case other where there is a discrepancy or doubt of proper labeling.

Transfusion Request

To order blood products, use the computer order entry (POE) function in PCIS or complete an RML Blood Center Transfusion Requisition Form (5709) available on the patient care units.

Mandatory Information on Transfusion Request

• Patient's full name, medical record number, and room number. If the patient's name is not known, the medical record number or disaster patient number is adequate.
• Transfusion indications
• Number and type of components
• Date and time of planned transfusion
• Physician's signature
• Priority of request
• Diagnosis
• Special requirements

Supplemental Information

• Previous transfusion(s), when, where? (if known)
• If release of ABO group/Rh type specific or O Rh negative blood without crossmatch is required, call the Blood Center at ext: 25920. The Emergency Transfusion Release section must be completed and signed by a physician within 24 hours.

For computer order entry, a print-out summarizing the order should be placed in the patient's chart. If form 5709 is used, the top copy of the completed form is placed in the patient's chart while the bottom copy (and a properly labeled patient blood sample if needed) should be delivered to the Blood Center, room 262 Jelke.

Crossmatch and Component Transfusion Tags

A computer-generated tag is made in the Blood Center and attached to each component unit issued and attached to the unit. The following information will appear on the tag:

• patient's name, medical record number, physician, age, room number, sex
• product type, donor number, donor ABO/Rh type, patient ABO/Rh type, and unit expiration
• accession number of the sample used for crossmatching, crossmatch interpretation, technologist's name, date, time, and crossmatch expiration (for red cell containing products only)

Prior to release of a component, a Blood Center technologist verifies all patient and donor unit information and initials the appropriate places.

Other Blood Center Requests (Form M4009)

Use the Blood Bank form M4009 for type and screen and all other Blood Center tests that are not related to transfusion.

Emergency Ordering and Release

In an emergency where a physician believes the urgency of the situation warrants release of blood products without typing and/or crossmatch, he/she should call the Blood Center at extension 25920.  Within 24 hours, the "Emergency Transfusion Authorization" section of a transfusion requisition (Form 5709) must be completed, signed by the physician, and returned to the Blood Center. The type of the emergency must be included in the red shaded area at the bottom of the requisition.

Emergency release can only be made upon the order of a licensed physician and not of a nurse or medical student.

A maximum of two units of Group O Rh negative RBCs will be released without crossmatch for a patient whose blood type is not known. If additional blood is required without crossmatch prior to confirmation of the patient's blood type, group O Rh positive RBCs will be issued. Once the patient's blood type is confirmed, or if it is known at the outset of the emergency, group specific RBCs will be issued without crossmatch. Crossmatches will be performed and reported to the physician as quickly as possible.

Routine Release and Delivery of Blood Products

Blood components will be released to the patient care units when the Blood Center receives a computer generated Product Release Slip or a "Blood Component Release Request" (Form 5720), signed by a physician or nurse.

Only one unit at a time will be released for routine transfusion. Patient care areas with approved Blood Center refrigerators (operating room, SIT, PICU, birth room, or outpatient clinic) may store up to two red cell units per patient until the expiration of the sample used for crossmatching.

Procedure for Tubing Blood via the Translogic Tube System

Blood products can be delivered by a Translogic Tube system to  most patient care areas throughout the medical center.  For other areas, blood is picked up and delivered by a designated individual.

1.         After release authorization is received, Blood Center personnel perform the required information checks before the product is released.

2.         A Blood Center employee immediately tubes the product to the patient care area. The secure transaction code will always be the tube station number of the patient care area requesting the product. The unit clerk or other designee should release the unit from the tube system within 10 minutes of arrival using the secure transaction code.  If the unit is not released within 10 minutes, the tube system will lock the unit in place. The Maintenance Department must then be notified at ext. 26589 (07:30-16:30, Monday-Friday; after hours and on weekends, page 85-7000) to release the unit. The entire tube system zone is inoperable while the unit is locked up; therefore, Maintenance must be notified as soon as possible.

3.         Units may be returned to the Blood Center for several  reasons.

a.         If the unit is unentered (not spiked), it can be used at a later time if it is returned to the Blood Center within 30 minutes from the time of issue.  Notify the Blood Center, ext. 25920. Return the unit via the tube system to station 178.

b.         If the unit has been entered (spiked), it cannot be re-issued.  Notify the Transport Department at ext. 21791 (in-house) to pick up the unit and return it to the Blood Center.

4.         If the tube system is inoperable, the Transport Department must be called to pick up the release slip from the floor after the nurse has confirmed with the Blood Center that the blood product is ready. (Or, if the PCIS Product Release Slip has already been electronically entered, the transporter should go directly to the Blood Center.) The transporter delivers the slip directly to the Blood Center, waits for the blood product accepts the product and then delivers it to the nurse or unit clerk.

If the blood product must be returned for any reason and the tube system is inoperable, notify the Blood Center at ext. 25920 that the blood product is being returned and why it is being returned. The Transport Department is notified at ext. 21791 (in-house) to pick up the blood product and return it to the Blood Center.

Blood Delivery To and Removal From the OR

A satellite dispensing station is maintained by the Blood Center in the operating room area ext 24155 or 50683. The hours of operation are from 06:30-17:00, Monday-Friday. After hours, blood products are obtained from the main Blood Center Laboratory, ext 25920. Phone requests from the O.R. suites for blood products are routed directly to the satellite dispensing station. All requests are processed as STATs within 1 hour or less of receiving the sample in the Blood Center and the operating room is notified when the products are available. Red cell products crossmatched for a patient undergoing surgery will be delivered to the OR dispensing station by 06:30 (or when ready) and, if not transfused, will be held there until 17:00 on the day of surgery.  Blood Center personnel will return unused blood products to the main Blood Center at 17:00 and at 19:00.

Blood Administration

The following information must be recorded by the transfusionist:

?          Signature, as one of the two cosigners who performs the clerical verification of patient and donor unit information.

Complete the Transfusion Reaction Section, if appropriate.

Medication must not be added to the blood product bag or in tubing prior to or during transfusion. Normal saline (0.9% NaCl) is the only solution to be hung with blood products. Never attach more than one unit simultaneously to a "Y" donor set for sequential transfusions.

Any blood product should be completely transfused within 4 hours of release from the Blood Center. If transfusion is delayed, units (unentered) must be returned to the Blood Center immediately to avoid wasting the unit. Unentered units may be reissued only if they have not been out of a Blood Center monitored refrigerator longer than 30 minutes.

After an uncomplicated transfusion, discard all blood product bags into biohazard waste containers located on the nursing unit. Place one copy of the completed Blood Center Transfusion Tag into the patient's chart and return the blue copy to the Blood Center.

Blood Filters

All blood and blood products must be transfused through a blood administration set that includes a (170 - 260 micron) screen filter obtained from the Supply, Processing, and Distribution (SPD) Department. These filters are stocked in the OMNI cells on the nursing floors.

Neonate filters are used to prefilter blood drawn into a syringe prior to infusion. Neonate filters must also be used to filter small volumes of platelet concentrate, cryoprecipitate, or reconstituted lyophilized coagulation factors. These are sent with the blood or blood product from the Blood Center.

Reaction to a Transfusion of a Blood Component

When a reaction to a blood component occurs, stop the transfusion, notify the physician and the Blood Center immediately.

1. Complete the bottom part of the Blood Center Transfusion Tag (5715):
   1. Check the box or boxes that apply (eg, chill, pain, shock, etc)
   2. Complete the transfusion administration portion of the requisition, including vital signs, etc.
   3. In the "Describe" section, include blood pressure, pulse, temperature, and any other pertinent observations (eg, hemoglobinuria, lower back pain, shortness of breath, etc).
2. Send to Blood Center:
   1. Remaining blood component in container and all tubing solutions attached to blood container along with the blue copy of the transfusion tag.
   2. A full 7 ml lavender top (EDTA) tube drawn after the transfusion reaction is required for blood bank testing. The specimen must be properly labeled to be accepted. Some specimens may need to be kept warm; consult the specific test for transport instructions. The content of each sample label must include the patient's full name and medical record number, the phlebotomist's initials, the date and time the sample was collected and, for non-LLT draws, the initials of a second medical professional who has confirmed that the sample came from the patient whose name is on the label (LLT phlebotomists should write ?LLT? for the second set of initials); the computer label must have this same information plus an accession number and the tests ordered.
   3. The first urine specimen voided by the patient after the reaction. The specimen should be labeled with the patient's name, date and time of collection, and should be accompanied by a Urine/Body Fluids Tests Requisition (4011) for each urine specimen. Mark the requisition "Transfusion Reaction" and properly imprint and initial.