The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [286]
Procedure guideline 8.15 Blood components: collection and delivery to the clinical area
Removal of blood components from their storage location continues to be identified as a major source of error in the transfusion process (BCSH 2009). Only those staff who are authorized, trained and competent may remove blood components from storage. A guide to the necessary elements of blood pack labelling is shown in Figure 8.8.
Essential equipment
Documentation containing the patient’s three core identifiers – full name, date of birth and hospital number/unique identifying number – must be held by the person removing the component from storage
Preprocedure
Action Rationale
1 Check that the reason for the transfusion has been documented in the patient notes.
To ensure the transfusion is appropriate and necessary (BCSH 2009, C).
2 Check that there is a valid written order for the administration of the component including special requirements – CMV negative or irradiated components.
To ensure the selected component meets the patient’s individual requirements (BCSH 2009, C).
3 Check the patient is aware of and has ‘consented’ to the procedure.
To ensure the patient is fully informed (BCSH 2009, C).
4 Check the patient is available.
To avoid delays once the component has been removed from storage. E
5 Take baseline observations to include blood pressure, temperature, pulse and respiratory rate.
To ensure that any transfusion reaction can be immediately identified, due to changes in baseline (BCSH 2009, C), and managed appropriately (SNBTS 2004, C).
6 Check the patient has patent venous access.
To avoid any delay in commencement of the transfusion and adhere to ‘cold chain’ requirements (BCSH 2009, C).
7 Check the patient is wearing an identification wristband.
To avoid delays in confirming patient identity (BCSH 2009, C).
Procedure
8 Where possible, the same person who will administer the component should collect from storage.
To minimize the number of people involved in the process (BCSH 2009, C).
9 Remove the component (using electronic or manual method) from storage in accordance with trust policy.
To ensure that only authorized, trained and competent staff may collect blood components (BCSH 2009, C).
10 Remove one component at a time, unless rapid transportation of large quantities is needed or if blood is being transported to remote areas in specifically designed validated blood transport containers.
To ensure components are stored in the appropriate conditions. E
11 Check the component at the point of removal for correct patient-identifying details. A visual inspection of the component should also be performed to check the expiry date and any signs of leakage, clumping or discoloration.
In order to minimize the risk of incorrectly administering the component to the wrong patient (BCSH 2009, C). Expired or damaged products must not be used (McClelland 2007, E).
12 Deliver the component to the clinical area where an appropriately trained and competent member of staff should check that the correct blood has been delivered.
To ensure the correct component has been received for the patient, to comply with traceability and cold chain requirements (BCSH 2009, C).
Figure 8.8 Blood pack labelling.
Procedure guideline 8.16 Blood component administration
Essential equipment
Written order for blood component transfusion
Blood administration administration set with 170–200 μm macroaggregate filter
Preprocedure
Action Rationale
1 Check that the component has been correctly prescribed, including any special requirements such as irradiated or CMV-negative blood, and if the patient requires any other medications, for example diuretic, premedication.
To prevent Incorrect Blood Component Transfused (IBCT) error: ABO incompatibility or non-irradiated CMV-positive products may cause a fatal reaction if transfused (McClelland 2007, C). Negative and positive status should always be written in full and not as