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


Special Precautions

a. Rate of transfusion

The rate of transfusion depends on the clinical condition of the patient. A patient in acute shock from massive blood loss will require rapid transfusion whereas a patient with chronic anaemia should not exceed 2ml per minute. A relatively slow rate of 5ml per minute is recommended for the first 30 minutes and if there is no sign of untoward reaction the rate can then be increased.

Blood transfusions must be completed within 6 hours of entry of the pack. Blood components that are not used immediately should be stored at the temperature specified by the blood bank. Blood components that are no longer required for a specific patient must be returned to the blood bank for correct storage (if still contained in the original packaging and no seals are broken) or disposal.

b. Filters

Red blood cells, whole blood, cryoprecipitate, FFP and WPBTS VIAHF (Factor VIII concentrate) are administered through a standard blood recipient set, or Y-type giving set. These sets have 120 – 240µm mesh filters to prevent the transfusion of clots or coagulation debris. The filter should be covered with blood to ensure that the full filtering area is used. A platelet giving set should preferably be used with platelets although the standard filter administration set may also be used in an emergency. The latter results in greater loss of the available platelets due to a larger surface area for adhesion.

The use of micro aggregate (40µm) filters is not recommended.

The administration set should be changed:

  • When there is a transfusion reaction, in order to prevent further potentially harmful blood entering the patient’s system.
  • Between red cells and other blood products, and between red cell transfusions of different ABO groups.
  • Before infusing other fluids, e.g. Dextran, Ringers lactate.
  • Every 12-24 hours in patients requiring long term transfusion.

c. Temperature of the blood

If cold blood is administered at a slow rate it does not appear to affect the circulatory system. However, in cases where rapid transfusion is necessary, complications such as cardiac arrhythmias can be avoided by warming the blood to not more than 37oC. Overheating of the blood can cause extensive haemolysis with renal damage and possible death. Blood should be warmed with a blood warmer specifically designed for this purpose. This apparatus should be equipped with a visible temperature-monitoring device and should have an audible alarm. The practice of warming blood in a sink is ineffectual, as only the outer red cell layers are warmed. It may also present an infectious hazard as the ports may be contaminated. Furthermore, overheating may occur with devastating haemolysis.

Under no circumstances should blood be heated in a microwave oven or similar device. This not only results in extensive haemolysis but also causes conformational changes and denaturation of proteins.

Blood warming is not routinely indicated and refrigerated blood may be transfused without harm over several hours.

Indications for warming are:

  • Massive transfusion of more than 50ml/kg/h.
  • Infants transfused at greater than 15ml/kg/h.
  • Neonates receiving exchange transfusion or large volume transfusion.
  • Patients with high titre cold haemagglutinins reactive in vitro at temperatures above 30°C.

d. Additives

No medications or other fluids should be added to the blood or blood products before or during a transfusion because:

  • Bacterial contamination is a real hazard whenever any unit of blood is entered.
  • A reaction could occur between drug and the anticoagulant or nutrient fluid in the blood, e.g. Dextrose solutions might cause lysis or aggregation of the red cells in the transfusion set.
  • Because blood may be administered slowly therapeutic levels of a drug may not be achieved.
  • It is difficult to infuse medication through an alternative access site then a Y piece may be inserted near the junction of the insertion of the intravenous transfusion cannula.

The only fluids that can be given concurrently through the same IV device as a red cell transfusion are:

  • Normal saline
  • 4% Albumin
  • Plasma protein fractions
  • ABO – compatible plasma
  

 
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