All transfusions should be planned during business hours, whenever possible, for patient safety. Only emergency transfusions should be entertained after hours.
The following is only a guide for administration of blood components as individual hospital guidelines should be followed.
Staff should be vigilant in the checking procedure to ensure that the right blood is given to the right patient. The bedside check is a vital step in preventing transfusion error.
- Patients receiving a blood transfusion must be monitored for signs of potential complications of transfusion, and administered in an environment where any suspected problems can be dealt with swiftly and appropriately.
Inspect and ensure the container is not compromised (eg, entered, spiked or vented) prior to use.
- Mix components thoroughly by inversion and transfuse through an intravenous line approved for blood administration, incorporating a standard 170 to 200 μm filter to remove clots and aggregates. It is important that blood filters are used in accordance with the manufacturers’ instructions.
A standard blood giving set incorporating filter (170 to 200 µm) should be used in the transfusion line for all blood components, which filters out large clots and aggregates and ensures an effective transfusion flow rate. Most standard blood filters are designed to filter 2 to 4 units of blood, however, each giving set should be changed at least 12 hourly or earlier if flow rates are compromised.
There is insufficient evidence to recommend the routine use of microaggregate filters (20 to 40 µm), to filter out microaggregates consisting of fibrin, leucocytes and platelets in red cell components. The hard evidence for their use in massive transfusion is marginal(1) but individual clinicians may elect to use microaggregate filters in massive, rapid transfusion (however the flow rate may be slowed) or in patients with compromised circulation.
- Do not prime, add or infuse medications or solutions through the same tubing with blood components, except 0.9% Sodium Chloride Injection. ABO-compatible plasma, 4% Albumin or other suitable plasma expanders may be used only upon approval of the patient’s physician.
Electrolyte solutions containing calcium, such as Haemaccel, must never be added to or administered through the same intravenous line as blood components containing citrated anticoagulant.
Blood of the same component type can be administered sequentially without flushing between packs. Flushing with a small amount of normal saline between component packs may help improve venous access flow rate or keep access open if the next pack is not readily available.
After completion of the transfusion blood administration sets should be flushed with normal saline to ensure that the patient receives all of the blood. The volume of normal saline required to prime the IV line is a suggested volume taking into account the individual circumstances of the patient (for example in the neonate or patients on fluid restrictions).
- All equipment used to administer blood components including plasma thawing devices, intravenous fluid pumps and blood warmers should be operated according to the manufacturer’s instructions and be designated safe and appropriate for blood transfusion.
Equipments should undergo constant monitoring, calibration and maintenance.
Warm blood components during or just prior to transfusion using designated blood warming devices, if clinically indicated, for example for massive transfusions.
Transfuse one unit at a time. Administering two different types of blood components concurrently (such as platelets and plasma) is not recommended in routine practice because in the event of an adverse reaction it is difficult to ascertain which component was responsible. However, this may be unavoidable in an urgent massive transfusion episode.
- Start transfusion within 30 minutes of removing a blood component from its approved storage. You must complete transfusion of a particular unit prior to its expiry or within 4 hours, whichever is sooner.
Blood components have been prepared by techniques that aid in preserving sterility up to the time of expiration. If the container is opened in a fashion that violates the integrity of the system for any reason, the component expires 4 hours after opening when maintained at room temperature (20 to 24 ºC).
- Proceed with the transfusion no faster than 5 mL/min for the first 15 minutes, unless otherwise indicated by the patient’s clinical condition. The rate of the transfusion will depend on the clinical context, age and cardiac status of the patient.
For more details on specific aspects of blood component administration, consult the Guidelines for the Administration of Blood Components.
- Australian New Zealand Society of Blood Transfusion. Microagregate Filters. Topics in Transfusion 2003;10(1):10.