Administration of Blood Products POLICY NUMBER 3581 You MUST review this Policy - it is located in this section..
ORDER VERIFICATION
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There must be an order for transfusion prior to obtaining the blood product.
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The order must specify a. type of product b. amount c. rate of administration
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Informed consent for the transfusion of blood products must be obtained from the patient/legal surrogate, signed by the Physician, Licensed AHP or Resident, patient, and witness prior to obtaining the blood product, except in emergencies.
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Upon receipt of the blood component a RN and a second RN, LPN, Physician, Licensed AHP or
Resident will check at the bedside the identification of the unit with the patient information. If there are any discrepancies Transfusion Service is to be notified immediately and the transfusion is NOT to be initiated.
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Once identity verification of recipient and blood product has been confirmed, both individuals who performed the verification will sign the tag prior to initiation of the transfusion. Remember
you only have 20 minutes from the release of blood to initiate the transfusion.
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The RN who initiates the transfusion will document the start date and time on the tag.
The RN who finishes the transfusion will document the stop date and time, check complete/partial, and reaction – yes/no.
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Before separating the forms, Transfusion Services or their designee is to check completeness of the form. Place the top copy in the transfusion record of the patient’s medical record. The hard copy is kept in Transfusion Services.
WHEN - Transfusion of Blood MUST BE COMPLETED within 4 HOURS of release from the
Transfusion Services.
VITAL SIGNS
Vital signs will be taken and documented as follows and will be documented directly on the transfusion tag. The transfusion tag must remain attached to the blood product throughout the entire transfusion process. Use the same route for temperature assessment throughout the transfusion.
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Within 15 minutes prior to initiation of transfusion (baseline)
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15 Minutes After Initiation of Transfusion
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Upon Completion of Transfusion
TRANSFUSION REACTION
The final section of the Blood Products Administration Policy pertains to Transfusion Reactions.
A Transfusion reaction is any unfavorable event occurring in a patient during or immediately following (1-2 hours) transfusion of blood products that can be related to that transfusion.
A TRANSFUSION REACTION IS A MEDICAL EMERGENCY.
Additional Facts
We have several types of transfusion tags
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Crossmatch Transfusion Tag (Regular Blood Transfusions)
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Emergency Transfusion Tag (for Trauma/Emergencies when Crossmatch and/or names are unable to occur)

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Component Transfusion Tag (for Fresh Frozen Plasma/Platelets etc.)
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Autologus Donation - green color tag from American Red Cross - can only be used by the donor. On the reverse side of the tag is the type of Blood.
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Intended Recipient Information for a Directed Donation – orange color tag - this is when an individual with same type blood donates for another person's use. If we do not need to administer to the intended recipient the Transfusion Service has the option of using for another matched individual.
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Ambulatory/Outpatient setting – all patients are to receive the discharge instruction letter found at the end of the Blood Administration policy prior to discharge.
** The State of New Jersey Department of Health mandates that all components transfused have a completed transfusion tag reflecting the episode. Transfusion Services of the Laboratory houses the hard copies. The threshold of compliance for this rule is 100% (this means there can be no errors or omissions).
Remember when sending Type and Cross matches to the Lab the tubes must be:
 Hand Labeled at the patient’s bedside
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Specimen Labels must match the information on the patient’s ID band exactly. That means if the patient’s last name is Snuffelupphagos, Elizabeth – and that is how it is entered into the computer system, but the ID band states Snuffelupph, Eliz, you must make arrangements for a corrected ID band to be generated.
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Use only 1 color ink when writing on the tube of blood.
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Be certain to sign your initials ONLY.
Second Blood Type Required
To ensure the safety of a patient prior to transfusion, a second venipuncture must be obtained to confirm the ABO group in all patients requiring non-emergent transfusions.
Exceptions:
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Patient is Group O;
There is a record of a previous blood type in the Transfusion Service;
Emergent/critical transfusions;
Neonatal transfusions.
Some more Important Facts
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Individuals picking up a blood product must present a blood issue form #25145. At a minimum this form must contain the patient's first and last name, medical record number, and location.
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Individuals picking up blood product from Transfusion Services for the first time will be accompanied by an individual who will orient them to the process.
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Blood products should be picked up immediately prior to transfusion with the transfusion to be initiated within 20 minutes from release from the Transfusion Service, and completed within four hours .
NOTE: If the transfusion is not started within 20 minutes (excluding Blood/Blood products issued in the validated TS cooler), the blood product can still be transfused as long as the four hour time limit is not exceeded. If it is determined that a delay will cause the four hour time limit to be exceeded, the un-spiked blood/blood product must be returned to Transfusion Services once that determination is made.
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Only 1 unit at a time will be released for any one patient. There are only several exceptions, multiple units for OR patients, or trauma patients. Please see procedure for OR refrigerator or issue of blood products for Trauma).

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Only 1 unit of blood can be picked up by an individual at a time - if you have 2 patients requiring transfusions the staff can only pick up one unit at a time.
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Massive transfusion is defined as infusion within 24 hour interval of a volume of blood approaching or exceeding replacement of the recipient's total blood volume. This may occur unexpectedly in surgical and medical emergencies and/or in planned circumstances such as cardiac and vascular surgery. Exchange transfusion of an infant is also massive. See Massive Transfusion Policy specifics in the unit specific policy books.
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Release of Blood in Emergency situations - when there is a desperate requirement for blood, the patient's physician must weigh the risk of transfusing blood products when the recipient has not had complete pre-transfusion testing performed. The blood transfusion tag for EMERGENCY
TRANSFUSIONS must be signed by the Physician (see sample). If we do not have patient ID in an emergency situation you will use the Emergency ID kits and use those Identification numbers - should you obtain information please keep both ID bracelets intact for cross-referencing post
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 identification.
T & S is good for 72 hours.
T & C is good for 72 hours.
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( 0 ) is considered the universal donor
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(AB + ) is considered the universal recipient
1.
You need an order to administer blood products? True False
2.
It is always necessary to obtain Informed Consent prior to administering Blood. True False
3.
Transfusions must be initiated within __________ minutes of withdrawal from the Blood Bank.
4.
Transfusions must be completed within _________ hours of release from the blood bank.
5.
You may administer blood only with 0.9%NS. True False
6.
Anyone can perform the identity verification for the recipient of blood products. True False
7.
List the time frames for taking Vital Signs pre/during/post transfusion.
8.
Define a transfusion reaction and list 5 symptoms.
9.
Explain the procedure that is to be followed for Transfusion Reactions.
10.
In the event of a Trauma/Emergency explain the Process.
BldAdmin06; 12.08.doc.Rev12.21.10; 09.04.12