Guidelines / Advice

Ordering and Administration of Blood

Preparation of the patient l Correct identification and verification of the patient and the blood unit l Correct aseptic technique l Monitoring of the patient during the transfusion l Special precautions

The safe transfusion of blood products starts with the positive identification of the patient at the time of drawing a blood sample for compatibility testing. Identification is carried out by questioning the conscious patient or suitable responsible person. After taking the appropriate blood samples, these should be clearly labelled at the patient’s bedside, with full names, date of birth, hospital number, date of sample withdrawal and ward identification. In the under age or unconscious patient the medical staff may assume the responsibility for identification.

The clinician must complete a requisition form outlining all the above information plus details of previous medical, obstetric, and transfusion history, the diagnosis, reason for transfusion, number and type of components should be available. This information will assist the blood bank staff in identifying the recipient and in finding compatible units. The blood bank will return all incomplete or illegible forms, and improperly labelled samples. The transfusion service cannot accept any legal responsibility if they are not supplied with sufficient information to identify the patient.

Laboratory tests are carried out on the sample to determine the ABO and Rh status of the patient, to detect blood group antibodies and to test for serological compatibility with the requested component.

a. The Unit

Inspect for leaks, especially in port areas, by inverting and applying light pressure to the unit. Observe for missing port covers and abnormalities. The colour of a red cell concentrate unit should not be significantly darker than the attached segments. Plasma in the units should not be murky, purple, brown or red. Platelet units will be cloudy yellow/straw colour and should not contain grossly visible aggregates. Thawed fresh plasma will be clear with the colour varying from yellow to straw. Cryoprecipitate will usually be a cloudy straw colour.

When you are ready to start the transfusion, perform the following verification process to help ensure the correct unit will be given to the correct patient. Most acute haemolytic transfusion reactions occur as a result of errors in patient or component identification.

• Recheck the physician’s order against the component received to verify you have received the correct component type.
• Ideally two qualified individuals should verify the patient and unit identification at the patient’s bedside. This process involves one individual reading the information out load from one source and the other individual comparing the information to the other source. The blood unit is preferably verified by a medical practitioner and a registered nurse or by two registered nurses.

Staffing and other requirements do not always make this practicable; nevertheless, special care must be exercised in identification procedures. It should always be assumed that one has the wrong patient or the wrong unit, until all identification has been specifically checked.

The following guidelines should be adhered to:

• All identification is carried out at the patient’s side.
• All information is read aloud by both attendants checking the blood.
• The recipient’s name and identification number on the unit must be identical to that on the hospital record (folder).
• The identification number on the unit must correlate with the unit identification number on the requisition form and/or label.
• The donor’s ABO and Rh groups must be recorded on the blood unit (and the transfusion requisition).
• Verification that a compatibility test between the donor and the recipient has been performed.
• If possible the patient’s ABO and Rh groups should be confirmed from previous transfusion records in the patient’s folder.
• The date and time of expiry of the unit must be checked. Expired blood must not be transfused.

If any abnormalities are noted, the components should NOT be transfused. It should be returned to the hospital’s blood bank.

b. The Patient

Asking for his/her full name, birth date and other relevant details identifies the patient. The questions should be phrased so that the patient gives a specific answer and not just ‘yes’ or ‘no’. For example “What are your full names?” and not “Are you Mr J Smith?”. The patient information must correlate with that on the blood unit (and requisition form).

Extra care must be taken in identifying the unconscious, anaesthetised or unidentified patient by checking identity bands, written records and requisition forms. ONLY if all identification is in order may the transfusion be initiated.

If the patient is to receive autologous or directed units, they should be administered first. If a patient has both autologous and directed units available, autologous units should be given before directed units. If a patient has both directed units and non-directed units available, directed units should be given before non-directed units.