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blood transfusion clinical skill, Cheat Sheet of Nursing

blood transfusion clinical skill in Australia for nursing student to comply with.

Typology: Cheat Sheet

2021/2022

Uploaded on 04/20/2022

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Clinical skills
Patient Blood Management Guidelines
Why are you transfusing?
Documentation of consent
Obtain consent for blood products
3.1 Requirements for blood product prescription
patient identification details: family name and given name, gender, date of birth
(DOB) and unique patient identification number if available
date, timing and urgency of the transfusion
appropriate and consistent terminology for the blood product to be administered
the route of administration
the number of units or dose of blood product to be given, using appropriate units of
measure (e.g. number of packs, volume in millilitres, units or weight in grams); blood
component volumes should be stated in millilitres for maternity patients (i.e. those
<20kg).
the duration over which the blood product is to be administered 33 Section 3
Prescription of blood products 16
special instructions; for example, use of a blood warmer, or any medication required
before or after the transfusion
legibly written name and signature of the prescriber, and a contact telephone number
or pager number, and a Medicare provider number, in accordance with health service
policies.
6.2.2 Priming and connecting blood administration sets
When priming and connecting blood administration sets: o the blood product should be
mixed thoroughly by gentle inversion before use
it is not necessary to prime the blood administration set with anything other than the
blood component, although the blood administration set may be primed with 0.9%
sodium chloride
the manufacturer’s recommendations must be followed when priming the blood
administration.
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Patient Blood Management Guidelines

Why are you transfusing? Documentation of consent Obtain consent for blood products 3.1 Requirements for blood product prescription  patient identification details: family name and given name, gender, date of birth (DOB) and unique patient identification number if available  date, timing and urgency of the transfusion  appropriate and consistent terminology for the blood product to be administered  the route of administration  the number of units or dose of blood product to be given, using appropriate units of measure (e.g. number of packs, volume in millilitres, units or weight in grams); blood component volumes should be stated in millilitres for maternity patients (i.e. those <20kg).  the duration over which the blood product is to be administered 33 Section 3 Prescription of blood products 16  special instructions; for example, use of a blood warmer, or any medication required before or after the transfusion  legibly written name and signature of the prescriber, and a contact telephone number or pager number, and a Medicare provider number, in accordance with health service policies.

6.2.2 Priming and connecting blood administration sets

When priming and connecting blood administration sets: o the blood product should be mixed thoroughly by gentle inversion before use  it is not necessary to prime the blood administration set with anything other than the blood component, although the blood administration set may be primed with 0.9% sodium chloride  the manufacturer’s recommendations must be followed when priming the blood administration.

 the blood administration sets should not be ‘piggy-backed’ into other lines (see Section 6.6)  it is acceptable to attach the set to extension tubing on an IV cannula. When administering blood products through a multi-lumen venous access device, other lumens can be used concurrently for medications and infusion of fluids. Section 6.6 provides further information on coadministration of medications and fluids. 6.2.3 Flushing blood administration sets

  • Priming or flushing blood administration sets with a small amount of 0.9% sodium chloride between red cell packs is not evidence-based and may be unnecessary; however, 0.9% sodium chloride may be required to maintain IV access if the next red cell unit is not readily available.
  • Compatible blood products can be administered sequentially, and sequential administration is the usual practice in critical bleeding. However, platelets must not be transfused through a blood administration set that has been used for red cells (see Section 6.2.1).
  • Once the transfusion episode is complete, blood administration sets may be flushed with 0.9% sodium chloride to ensure that the patient receives the entire blood product. The minimum volume of 0.9% sodium chloride required to completely clear the IV line should be used, taking into account the individual circumstances of the patient where relevant (e.g. neonates, some paediatric patients or those at risk of fluid overload or on fluid restrictions). 6.10 – Infusion rates and precautions Infusion rates for blood products. Product Infusion rate Red cells Red cells 60– 180 minutes per unit Platelets 15– minutes (Australia) or 30– minutes (New Zealand) per standard adult equivalent dose Fresh frozen plasma 30 minutes per unit (i.e. 10– mL/kg/hr)

6.12 – completing the transfusion  The time of each product must be recorded  The form must be in the patients – health record  Patient education on adverse effects are to be explained post blood transfusion The following information must be documented:

  • indication for blood product transfusion
  • consent for blood product transfusion
  • blood product prescription
  • blood transfusion compatibility label or, where used, the report form (including the donation code)
  • start and completion time of each unit
  • patient observations
  • outcome of the transfusion in terms of desired effect
  • occurrence and management of any adverse reactions if applicable. x 8.1 management of possible adverse effects A temperature rise of 1 °C or more above baseline should prompt the interruption of the transfusion and a clinical assessment of the patient The following could be considered signs of a mild adverse transfusion event:
  • an isolated temperature rise of 1 °C to less than 1.5 °C above baseline without any signs of a serious event (including any of those listed below in Section 8.1.2)
  • localised rash or pruritus. If a mild adverse transfusion event is suspected:
  • STOP the transfusion • maintain IV access
  • monitor and record the patient’s temperature, pulse, respirations and blood pressure
    • repeat all documentation and identity checks of the patient and blood pack • contact medical staff immediately for further management and investigation. 8.1.2 moderate to severe adverse transfusions Any of the following could be considered signs of a moderate to severe adverse transfusion event:
  • temperature of 1.5 °C or more above baseline
  • hypotension, shock or hypertension
  • tachycardia
  • tachypnoea, wheeze or stridor
  • rigors or chills
  • nausea or vomiting
  • pain (localised, chest, flank or discomfort at infusion site).