ADMINISTRATION AND MANAGEMENT OF BLOOD AND BLOOD PRODUCTS

Transcription

1 Plicy Applies t: All Clinical staff at Mercy Hspital invlved with the management, prescribing r administratin f bld r bld prducts. Related Standards: Refrigeratin Guidelines, Requirements fr the Strage f Bld and Bld Prducts (2017) EQuIP Standard 1.5: The rganisatin prvides safe care and services. Criterin The system t manage sample cllectin, bld, bld prducts and patient bld management ensures safe and apprpriate practice ANZSBT Guidelines NZBS Guidelines Ratinale: Ensure that bld and bld prducts are prescribed, btained, stred and administered in a safe and effective manner in line with the NZBS requirements. Definitins: Bld Transfusin- refers t the intravenus administratin f bld cmpnents r bld prducts Fractinated Bld Prducts -This is the term used fr plasma derived fractinated bld prducts and equivalent recmbinant prducts. They are manufactured in a highly regulated envirnment. Prducts are frequently upgraded with the incrpratin f new safety r purificatin steps e.g. Albumex Abbreviatins; NZBS - New Zealand Bld Service Objectives: T ensure that the patient has understd the risks, benefits, and any alternatives, and has prvided written cnsent prir t the prcedure f transfusin f bld cmpnents and/r fractinated prducts. T ensure that bld is transprted and stred in a manner that meets all safety requirements T ensure the right patient is identified using the crrect prcedure T ensure the right bld cmpnent / fractinated prduct is issued t the right patient T ensure dcumentatin requirements are met. Implementatin: IV certificatin Clinical rientatin Page 1 f 17

2 The Registered Nurse, the Credentialed Specialist, and Registered anaesthetic supprt staff are respnsible fr administering, bserving, and dcumenting the transfusin f bld cmpnents/fractinated prduct. All clinical staff invlved with the transfusin f bld cmpnents/fractinated prduct must have validated skills and expertise t prvide clinical care in a safe and apprpriate manner. Fr Registered Nurses and Anaesthetic Technicians validatin ccurs thrugh IV certificatin. T ensure safety and best utcme, all Mercy Hspital staff authrised t administer bld cmpnents and bld prducts must fllw the plicy, prcess and guidelines related t bld cmpnents r prducts. Mercy Hspital staff and Credentialed Specialists will use this plicy and prcess in additin t the infrmatin available n SharePint thrugh the NZBS Clinical Data Resurce website and the NZBS Clinical Cmpendium website t ensure currency f bth practice and infrmatin. Evaluatin: Incident frms Daily Bld Fridge Temperature & Visual Check frm (Nv 2015) Weekly review f temperature graph disk Mnthly Bld Fridge Alarm Checks 6 mnthly Internal audit f the cmpletin f the Mercy Bld Cmpnent /Prduct Issue and Administratin Recrd frm (Previusly referred t as the Green Frm) Preventive Maintenance reprts 2 yearly NZBS external audit 6 mnthly Bld Refrigeratin Audit Assciated Legislatin The Medicines Act 1981, Medicines Regulatins 1984 References Refrigeratin Guidelines, Requirements fr the Strage f Bld and Bld Prducts 7th Editin, Oct ANZSBT Guidelines NZBS Guidelines External Dcuments (all available n the NZBS Clinical Data Resurce accessed via SharePint) NZBS Clinical Data Resurce Mercy Bld Cmpnent/Prduct Issue and Administratin frm NZBS Request fr Bld Bank Tests & Bld Cmpnent r Prduct Page 2 f 17

3 NZBS Patient leaflets NZBS Transfusin related Adverse Reactin Ntificatin frm NZBS Ntificatin f suspected adverse reactin t a Fractinated Bld Prduct NZBS Despatch Ntificatin Frm - Return f bld t Bld bank NZBS Bld Packaging Training and Infrmatin Pack lcated in Red Flder by Bld Fridge. Internal Dcuments Cnsent Plicy Medicatin Management Plicy Incident Plicy Emergency Plan (see appendices Emergency transprt & Alarm Bells, Plant and Equipment Alarm Statin (PEAS) Adverse Reactin t Medicatin Plicy (see Anaphylaxis flw diagram ) Mercy Hspital IV Manual January 2016 NZBS Bld bank Hurs Bld Fridge Maintenance guidelines Taxis Bld Cmpnent Prduct Issue and Administratin Recrd Audit Tl F:\Mercy Shared\Audits\Clinical Audits\Clinical Audit Tls and Checklists\Tls\Bld Cmpnent - Prduct Issue and Administratin Recrd Audit Tl.dcx Assciated frms Mercy Infrmed Cnsent frm Medicatin chart Fluid Balance chart Patient Observatin chart Anaesthetic recrd IV certificate practical checklist Mercy Hspital Bld Cmpnent/Prduct Issue and Administratin (Green Frm 2018) Daily Bld Fridge Temperature and Visual Check Frm (Nv 2016) Audits Bld Refrigeratr Audit (Clinical Audit tls /checklist/tls PACU) Mercy Hspital Bld Cmpnent/Prduct Issue and Administratin Recrd Audit (Clinical Audit tls /checklist/tls PACU) Bld Refrigeratin RBC Dispsing Audit (Clinical audit tls and checklists PACU audit tls Bld fridge) Page 3 f 17

4 References n line NZBS Clinical Data Resurce- Sharepint - NZBS Clinical Data Resurce NZBS Clinical Cmpendium- Sharepint - NZBS Clinical Cmpendium Appendices 1. Mercy Bld Cmpnent/Prduct Issue and Administratin frm (Green Frm) 2. NZBS Request fr Bld Bank Tests & Bld Cmpnent r Prduct Frm 3. NZBS Transfusin related Adverse Reactin Ntificatin frm 4. NZBS Ntificatin f Suspected Adverse Reactin t a Fractinated Bld Prduct 5. Bld Cmpnent/Prduct Type and Administratin frm (Green frm April 2018) 6. Daily Bld Fridge Temperature and Visual Check frm( Nv 2016) 7. Bld Cnservatin 8. Return f Bld t Bld Bank Checklist (May 2017) 9. Despatch Ntificatin Frm 10. Bld Cmpnent List (Nvember 2016) Page 4 f 17

5 Prcess Intrductin Outlined in this prcess dcument is the management f Red Bld Cells, the mst cmmn prduct that is administered at Mercy Hspital. Althugh there are many similarities in the management f ther bld prducts particularly with cnsent, bedside checking and mnitring, fr specific instructins n ther bld prducts please use the NZBS Clinical Data Resurce lcated n Sharepint. The NZBS Clinical Cmpendium als lcated n SharePint prvides additinal infrmatin n NZBS prtcls and guidelines In rder t minimise patient risk assciated with the receipt f bld and bld cmpnents careful attentin must be paid t; 1. Crrect patient identificatin/pre transfusin testing - strict adherence t patient identificatin during bld sampling and clerical checks pre transfusin 2. Pre administratin strage 3. Issuing frm strage 4. Bedside checking 5. Administratin and dcumentatin 6. Mnitring 1. Crrect patient identificatin/ Pre transfusin testing As Mercy hspital is a private elective surgical hspital, a grup & screen r crss match fr bld is generally dne prir t admissin t Mercy by the admitting Credentialed Specialist. Similarly cnsent fr receiving bld is als generally undertaken prir t admissin. This des nt lessen ur respnsibilities fr ensuring safe rdering, strage and administratin f bld and bld prducts. Transfusin f ABO incmpatible red cell cmpnents may result in acute and severe haemlysis and shck. In a cnscius patient a few mls may cause symptms within 1-2mins. Befre a bld cmpnent (and sme bld prducts ref: Bld Cmpnents List App:11) can be issued the patient s ABO & RhD bld grup needs t be determined and the presence f any red cell antibdies needs t be knwn (grup and screen). Where Mercy staff are undertaking t prvide a specimen fr grup and screen (G&S) r crss match (XM) a fully and accurately cmpleted NZBS Request fr Bld Bank Tests & Bld Cmpnent r Prduct (App:2) must accmpany the pre-transfusin specimen when frwarding t Bld Bank fr prcessing. Page 5 f 17

6 As the majrity f transfusin errrs are clerical in nature, specimens fr grup and screen (G&S) r crss match (XM) must be clearly hand labelled at the bedside (preprinted labels are nt accepted) with the patient s: - Christian and surname (d nt include middle names); - Date f birth; - Natinal Health Index (NHI); - Date/time f cllectin; - Signature r initials f cllectr Fr the EDTA 6 ml tube the details must be written directly nt the tube. The NZBS Request fr Bld Bank Tests & Bld Cmpnent r Prduct frm (App:2) must be cmpleted with; (patient sticky label) r fully cmpleted patient identifying details first name surname gender NHI/hspital number and/r date f birth (bth are preferable) Name and signature f requesting practitiner (dctr r nurse) Date and time f cllectin Signed and dated declaratin that bld was labelled at the bedside and labelled by the persn drawing the bld. This is part f the NZBS Request fr Bld Bank Tests & Bld Cmpnent r Prduct frm Bld cmpnents/prducts and/r tests required Shuld als include: Relevant patient histry, details r cde (cdes n back f frm), plus tick bx cmpleted Nte that an inadequate patient histry may result in the sample expiring sner than necessary and a lwer pririty when testing Patient's lcatin Date f surgical prcedure (if applicable) Page 6 f 17

7 A grup and screen sample is nly valid fr 72 hurs unless the fllwing infrmatin is prvided: Cnfirmatin that the patient has nt been transfused in the last three mnths Cnfirmatin that the patient has nt been pregnant in the last three mnths If the patient has nt been pregnant r transfused in the last three mnths, the sample is valid fr 7 days. Extended validity (up t 21 days) is available fr elective surgery if a date f surgery is prvided. All details n the NZBS Request fr Bld Bank Tests & Bld Cmpnent r Prduct frm and specimen must match exactly, befre Bld Bank can prcess the specimen. The details supplied n the request frm and specimen, are the details that will subsequently appear n the unit swing label. The EDTA Tube (6ml pink tp) accmpanied by the NZBS Request fr Bld Bank Tests & Bld Cmpnent r Prduct frm is then frwarded t NZBS Bld Bank, Dunedin Hspital. The venepuncturists take the sample with them (if they d the sample) therwise the sample is sent by taxi. 2. Mercy Hspital Bld Fridge T ensure cmpliance with Bld refrigeratin requirements PACU staff undertake; A daily visual check f the bld fridge temperature recrding and view any bld prduct crss match & expiry date and time Maintenance: NZBS Refrigeratin Guidelines, 7 th Editin Octber 2017 (nline) page 15. Bld Fridge Maintenance Guidelines (clinical services wrk manual/bld fridge maintenance guidelines). 3. Cnsent and Prescriptin Cnsent Prir t administering a bld cmpnent (red cells, platelet cncentrates, fresh frzen plasma, and cryprecipitate) r bld prducts (albumin, immunglbulin, cagulatin factrs) the Registered Nurse, AT, r Credentialed Specialist needs t ensure that cnsent has been recrded n the Mercy Cnsent frm. Page 7 f 17

8 If cnsent is nt recrded n the cnsent frm, cnsent t the administratin f bld must be sught frm the patient. In additin the patient shuld be ffered written (NZBS patient leaflet) and /r verbal infrmatin as part f the cnsenting prcess. Cnsent (with the exceptin f an emergency) must be btained prir t rdering any bld cmpnents/fractinated prducts frm Bld Bank. Where administratin f bld cmpnents and prducts are refused by an adult fr any reasn, this decisin must be respected, recrded in the clinical recrd, ensuring that thse making the decisin fully understand the implicatins this may have n the clinical utcme (fr additinal infrmatin please access the Cnsent Plicy n SharePint) Fr further infrmatin abut care fr patients wh decline bld transfusin refer: Bld Cnservatin (App: 8) Prescriptin Bld cmpnent and fractinated prducts are classified as prescriptin medicines. A prescriptin fr a bld cmpnent / fractinated prduct must be written by the credentialed specialist n a Mercy Medicatin and IV Prescriptin Chart r the Mercy Anaesthetic Recrd. The prescriptin must specify; The bld cmpnent / fractinated prduct t be administered including any special requirements e.g. irradiatin. Rute t be administered. Quantity t be given ( e.g. units, ml, grams) Duratin f the transfusin (hurs r parts f a hur) e.g. ver 2 hurs, nt 2QH Special instructins e.g. premedicatin r diuretic Each item signed and dated (nt ne signature and brackets) 4. Obtaining Red Cells frm the New Zealand Bld Service (NZBS): Crss matched red cells are requested using the Mercy Bld Cmpnent/Prduct Issue and Administratin frm (App: 1) When yu require the crss matched red cells: Fax the Mercy Bld Cmpnent/Prduct Issue and Administratin frm t the NZBS Bld Bank, Dunedin Hspital. Nting the type f bld prduct required and the number f units. (Fax number is pre-set n McAuley ward and Theatre fax machines) In additin, phne Bld Bank t verbally cnfirm yur request Ntify Receptin that yu are waiting fr bld t be delivered Page 8 f 17

9 Please Nte: after being faxed t Bld Bank, the Mercy Bld Cmpnent/Prduct Issue and Administratin frm is n lnger required and is t be dispsed f in the secure bin. NZBS will deliver the bld prduct t Mercy hspital with a faxed cpy f the Mercy Bld Cmpnent/Prduct Issue and Administratin frm. Receptin staff either call McAuley t let them knw the prduct has arrived r ensure that PACU staff are aware bld prduct has arrived. 5. Strage f Bld Prducts Where a bld prduct is stred in the Mercy Hspital Bld Fridge nursing staff must ensure that individual units are signed int the Mercy Hspital Bld Prduct Frm (App:5) Details must include: Date, Time, Nurse Signature, Patients full name and NHI, Type f bld prduct and each unit number. The units must have been transprted crrectly accrding t the NZBS Red Bld Cell packing prfile that will accmpnay the bld prduct. Cnfirmatin f apprpriateness f packing is faxed back t the NZBS n the NZBS Despatch Ntificatin Frm (App:10) The Mercy Bld Cmpnent/Prduct Issue and Administratin frm is kept in the bld fridge attached t a unit f bld prduct r in patients ntes if previus unit already transfused. If a discrepancy exists n any f the dcumentatin r n the infrmatin attached t the bld prduct, ntify Theatre r PACU Crdinatr, NZBS Persnnel, Surgen and Anaesthetist and apprpriate actin will be taken. NB: Ballasts are t be placed in the bld fridge immediately n arrival, in a plastic bag with the date and time attached When retrieving bld frm the bld fridge a date, time, signature / destinatin is required t be written n the Mercy Hspital Bld Prduct Frm (App:5) held n the clipbard attached t the Bld fridge. This is t ensure that there is a rbust audit trail fr all bld prducts. Page 9 f 17

10 Red cells can be stred in the Mercy bld fridge fr up t 72 hurs. After 72 hurs a new crss match must be cmpleted. (Platelets, FFP and Cryprecipitate cannt be stred in any Fridge including the Mercy Bld Fridge). Never stre bld cmpnents in the standard ward refrigeratr. All Bld cmpnents (except Platelets) shuld be infused within fur hurs f receipt frm Bld Bank. If returning bld t Bld Bank, Dunedin Hspital (see appendix 9) Return f Bld t Bld Bank Checklist (App: 9) Cmplete the Mercy Hspital Bld Prduct Frm n the clipbard n the side f the bld fridge t recrd which individual units are being returned Cmplete NZBS Despatch Ntificatin Frm (App:10) Return f Bld t Bld Bank Checklist (App:9) fr prducts being returned t Bld Bank. Fax this frm t the NZBS All bld must be returned fllwing the NZBS Bld Packaging Training and Infrmatin Pack lcated in Red Flder by Bld Fridge. Cmplete taxi chit and phne fr taxi. Take items fr NZ Bld Service t Main Receptin fr pick up. 6. Pre Transfusin Checks and Dcumentatin Once bld btained, prir t cmmencing the transfusin yu must cmplete the Pre Transfusin Checks as utlined belw and tick ff n the Mercy Bld Cmpnent/Prduct Issue and Administratin frm (App:1). Cnsent: sighted Patients cnsent frm Prescriptin: signed and relevant written infrmatin prvided Patent venus access and standard bld infusin set with filter in situ Baseline bservatins: dcumented Mercy Hspital Medicines management plicy requires tw registered health prfessinals, t cmplete the checks fr bld prducts at the patient s bedside. The secnd persn needs t perfrm the checks independently. There must be n discrepancies Check that all pre transfusin checks cmpleted and recrded Page 10 f 17

11 Bedside check: Ask, verify, bag t tag and visual check Take t the bedside: The medicatin chart (prescriptin), Mercy Bld Cmpnent/Prduct Issue and Administratin frm (App:1) The issued cells with a swing label attached. Cmplete the Bld Issue and Administratin Recrd dcumentatin as utlined in the bedside check prcess belw n the NZBS cpy f the Mercy Bld Cmpnent/Prduct Issue and Administratin frm (App:1). Ask the patient their identity (their full name and date f birth). D nt tell him r her. Verify that the patient details n the patient s wristband, the Mercy Bld Cmpnent/Prduct Issue and Administratin frm, the prescriptin, the swing label and the patient s respnse all match exactly. Visual check - assess the bag and cntents fr abnrmalities. Check Unit/Batch numbers n Bag & Swing label are identical Check Bld Grup n Bag & Swing label are identical Check expiry n Bag/Bttle Check DO NOT USE AFTER date n Swing Label Check Cnsent Check Prescribed When the checks are cmpleted, bth checkers sign the Mercy Bld Cmpnent/Prduct Issue and Administratin frm and recrd the date and time the infusin cmmenced. In additin when the unit is cmpleted als recrd the time n the Mercy Bld Cmpnent/Prduct Issue and Administratin frm. Page 11 f 17

12 7. Administratin ADMINISTRATION AND MANAGEMENT OF BLOOD Transfusins at night (after 2200 hurs) are undesirable and nt recmmended unless urgent. 30 Minute Rule: Transfusin r red cells shuld begin as sn as pssible fllwing the remval frm the bld fridge. Return the red cells t the Mercy bld fridge if the transfusin cannt be started within 30 minutes f remval f the bld frm the bld fridge. D nt stre red calls anywhere else. When administering platelets and red cells, administer the platelets first. If this is nt pssible, change the infusin set after administering the red cells and befre cmmencing the platelet transfusin. All bld cmpnents r prducts require a dedicated line. The recmmended cannula size is 18-20G fr adults (smaller gauges can be used but they restrict the flw rate) and 22-24G fr children. N medicatins are t be given int the unit f bld r the IV system as they may cause red cell haemlysis r adversely affect platelets r plasma prteins. Bld / Slutin set includes a 200 micrn filter and must be used fr administratin f all bld cmpnents - Red bld cells, Plasma, Platelets, Cryprecipitate and Granulcytes. The filter will remve any aggregated material and fibrin clts. All bld cmpnents in New Zealand are leucdepleted at surce by NZBS. The use f bedside leucdepletin filters is nt necessary. Infusin sets / bld filters shuld be changed 12hrly. 2-4 units can be administered via ne infusin set. Where the rate is rapid, e.g. theatre, 8-10 units may be administered via the set; The Bld/Slutin Set must be replaced at the end f the transfusin, befre any further IV therapy is undertaken. Fr manufactured bld prducts (presented in bttles), syringes r a standard IV infusin set may be used. Nte that glass bttles als need t be vented with a filter needle(see NZBS Clinical Data Resurce) Prime the infusin set with Nrmal Saline r the bld cmpnent. Priming with bld must nly ccur after 2 health prfessinals (ne f whm must be registered) cmplete the tw persn check at the bedside Never prime r flush using Dextrse Saline (causes haemlysis) r Lactated Ringers (causes cltting) r gel slutins (causes cltting). Remember t dcument any nrmal saline used t prime r flush n the fluid balance chart. Warming Use nly if clinically indicated. A bld warmer may be indicated fr: Page 12 f 17

13 Large vlume rapid transfusins f >50 ml/kg/hur in adults r >15 ml/kg/hur in children Exchange transfusins (unlikely at Mercy) Patients with clinically significant cld agglutinins Bld and cmpnents must nt be warmed abve 41ºC. The temperature f the warmer must be mnitred and recrded n the bservatin chart. We have ne warmer a Ranger Bld/Fluid warming device that is kept in the Theatre 6 Anaesthetic rm Never imprvise by placing a bld pack int ht water r a micrwave. Pumps Pumps shuld be used t deliver bld prducts when: Cntrlled flw rates are required fr specific patients, e.g. paediatric patients, r thse at risk f fluid verlad. Infusin f bld prducts via gravity is unreliable e.g. via PICC r small gauge cannula. Clleague pumps are bld cmpatible. Never use pumps with granulcyte/buffy cat infusins Pressure Bags An external pressure bag may be used during emergency situatins nly and when a large gauge venus access cannula is in situ. Pressure must be exerted evenly ver the unit and never exceed 200mm Hg. The pressure device must have a gauge t measure the pressure and be mnitred at all times during its use. Cmmencing the infusin Ensure the baseline bservatins BP/TPR (temperature, pulse, respiratin & bld pressure) are recrded up t 60 minutes prir t the infusin n the bservatin chart. If the patient is febrile befre transfusin yu must discuss with the medical staff befre cmmencing the transfusin. Maintain Strict Asepsis (wear glves) Gently agitate the bld bag; Attach the red cell bag t the Bld /Slutin Set Recrd start time n the Medicatin chart and the Mercy Bld Cmpnent / Prduct Issue and Administratin Frm Set the transfusin rate as prescribed; in the rutine setting, transfuse each unit slwly (up t 50mL) fr the first 15 minutes and bserve the patient fr any adverse reactin. Page 13 f 17

14 Stay with the patient fr the first 15 minutes f the transfusin then repeat the TPR/BP. The first 15 minutes carry the greatest risk f an acute adverse reactin; Ensure the call bell is within reach. Cmpleting the infusin Nte the cmpletin time n the bservatin chart, the Mercy Bld Cmpnent/Prduct Issue and Administratin frm and the fluid balance chart. Affix the red cell cmpatibility sticker (swing label) t the Mercy Bld Cmpnent/Prduct Issue and Administratin frm. Discnnect the empty bld bag and discard int the apprpriate waste stream. In the event there has been a Transfusin related Adverse Reactin the bld bag and IV tubing must be placed within a sealed bihazard bag and left in the bx prvided ppsite the bld fridge in the Theatre suite. McAuley staff will leave in dirty utility rm in a sealed bihazard bag. The rderly will take the unit dwn t the theatre suite and place in the bx ppsite the bld fridge. The unit must be returned t Bld Bank alng with a cmpleted NZBS Transfusin related Adverse Reactin Ntificatin Frm and patient s bld sample in pink tp tube (refer t adverse reactins in this plicy). Dcument the transfusin in the patient s clinical recrd. 8. Mnitring Baseline bservatins recrded. If the patient is febrile befre transfusin yu must discuss with the medical staff befre cmmencing the transfusin. TPR & BP at 15mins then, ½ hurly TPR and hurly BP until the transfusin is cmpleted. Increase the frequency f the BP recrding ½ hurly if there are any cncerns ver the patient s status r any ther parameters are abnrmal. Remain in the rm r in immediate prximity fr the first 15 minutes f the cmmencement f each unit. Let the patient knw t call a nurse if they start t feel itchy, develp a rash, shivery, and have any breathing difficulty r if they feel their heart is racing. Fr each unit: Repeat TPR and BP at 15 minutes. Thereafter mnitr TPR every 30 minutes and BP hurly. Increase BP mnitring if cnditin changes. Visually assess thrugh-ut the infusin Page 14 f 17

15 After each unit: recrd pulse, bld pressure, respiratin rate and temperature and visual bservatin f the patient's appearance and cnditin up t 60 minutes pst infusin. If the transfusin rate is slw, repsitin the limb where the IV is sited, investigate ther variables including gravity, nn-patent cannula, clgged filter and clsed clamps. Check the IV site befre, during and after the transfusin. Dcument the VIP Scre n the Observatin Chart. Adverse Reactins (please utilise the infrmatin n the reverse side f the NZBS Transfusin related Adverse Reactin Ntificatin frm (App:3) Fr bld and NZBS ntificatin f suspected adverse reactin t a fractinated bld prduct ref: NZBS Ntificatin f a Suspected Adverse Reactin t a Fractinated Bld Prduct (App: 4) Adverse reactins can be immediate r delayed. Symptms can include urticaria, fever, chills, rigr, chest tightness, hyptensin, dyspnea, and chest r lin pain. Types f reactins can include: Febrile r allergic reactins; ABO incmpatible reactins; Red cell antigen immunisatin and antibdy develpment; TRALI (transfusin related acute lung injury); TA-GVHD (transfusin-assciated graft-versus-hst-disease) if nnirradiated units are transfused t smene wh requires irradiatin prtectin; TACO (transfusin assciated circulatry verlad); Metablic events: e.g. rapid transfusin f large vlumes may lead t hypthermia. Hyperkalaemia is a ptential risk in patients with prir elevatin f ptassium; Infective: risk frm viral infectin is rare. Bacterial cntaminatin is uncmmn. Symptms will usually present in minutes, may include chills, rigrs, fever, nausea, vmiting, and abdminal and muscular pains. Clinical Symptms A mild febrile reactin has an increase in temp <1.5 C frm baseline Stable haemdynamics N respiratry distress and n ther symptms Page 15 f 17

16 A mild allergic reactin will have ccasinal urticarial spts and n ther symptms Actin fr first mild reactin: Stay with the patient and call fr help; Take vital signs, TPR& BP (temperature, pulse, respiratins & bld pressure); Check labels & recipient ID Slw transfusin Cnsider giving medicatin: Antipyretic fr pyrexia, e.g. paracetaml Antihistamine fr urticaria Cntinue transfusin at a slwer rate with increased mnitring, e.g. BP/P/T mins Send NZBS Transfusin related Adverse Reactin Ntificatin frm (App:3) t Bld Bank. Send ne EDTA (pink tp) tube and the bld prduct with IV set attached (in plastic bag) with the cmpleted NZBS Transfusin related Adverse Reactin Ntificatin Frm t Bld Bank. Clinical Symptms f Significance: Temperature rise f greater than 1.5ºC abve baseline, bld pressure rise r fall f 30mmhg, and /r heart rate greater 120 beats a minute r a rate that has increased by 40 beats r mre that are incnsistent with the patient s cnditin. Other significant symptms may be rigrs, chills, respiratry distress, a change in urinary utput, rashes. Mst reactins will ccur within 4 hurs f the bld transfusin. Acute dyspnea with hypxia and bilateral lung infiltrates ccurring within 6 hurs f the transfusin, with n apparent cause shuld be investigated as sn as pssible. TRALI investigatin is required. Actin if a mderate r severe reactin is suspected: Stay with the patient and call fr help;( press emergency bell) Stp the transfusin; Imprtant stp the transfusin but d nt flush the infusin set; Maintain airway, breathing and circulatin, apply xygen Take vital signs, TPR& BP and Sp02 Page 16 f 17

17 Lie flat if hyptensive, cnsider upright psitin if dyspnea Check label and recipient ID infrmatin is crrect Replace IV set; give saline t keep vein pen and, r maintain BP Call fr medical assessment Obtain specimens: Bld grup serlgy: 1 x 6 ml EDTA (pink tp) tube (cllect away frm site f transfusin) FBC and Serum bichemistry And cnsider need fr: Bld cultures if sepsis suspected Bld gases if respiratry distress present Urine t check fr haemglbinuria Cagulatin screen if bleeding Send a NZBS Transfusin-related Adverse Reactin Ntificatin Frm (App:3) bld prduct with IV set attached (in plastic bag) t Bld Bank and specimens t relevant labs Ntify Bld Bank by phne: discuss urgency f fllw up tests and further transfusin needs Discuss with NZBS Transfusin Medicine Specialist if severe reactin present Further treatment - depends n cause *Nte further infrmatin abut types and management f transfusin reactins can be lcated in the NZBS Clinical Data Resurce n SharePint. The NZBS staff will relay immediately any abnrmalities that are fund. Obtaining Bld Prducts in Adverse Weather Delivery f bld frm Dunedin Hspital will be required if theatre is running. Liaise with the Theatre Crdinatr as t what is required and use the 4WD fr pick up. ICU r ut f hurs requirements Generally managed via Taxi pick up Page 17 f 17