HHC Health & Home Care Clinical Policy And

HHC HEALTH & HOME CARE Section: 9-30
Infusion Therapy: Administration of Packed Red Cells With Use of Microaggregate Blood Filter Set __RN
PURPOSE:
To replace red blood cells (RBCs) lost due to anemia or to
restore blood volume due to chronic occult blood loss. A
microaggregate filter is used to filter out cellular debris in
addition to filtering out white blood cells that may cause febrile,
nonhemolytic reactions. This procedure is rarely done in the
home health care setting.
TYPES OF CELLS:
1. Packed cells, red cell mass, whole blood with the plasma
removed - approximate volume 250cc.
2. Leukocyte-poor RBCs are prepared by centrifugation or
saline washing and contain few WBCs, platelets and
minimal plasma -approximate volume 200cc.
3. Frozen thawed, deglycerolized RBCs contain minimal
WBCs no plasma - approximate volume 180cc.
4. AS-1 red cells is a new product to which ADSOL (AS-1), an
additive that extends the shelf life of a unit to 49 days, is
added to red cells after the plasma has been removed (can
be used in place of whole blood or packed red cells) -
approximate volume 300cc.
CONSIDERATIONS:
1. Packed red cell transfusions consisting of no more than
500cc in 24 hours are to be given to patients with severe
anemia and relatively normal blood volume. For these
patients, transportation to the hospital for a transfusion
would be physically exhausting.
2. Disease states in which home therapy may be applicable
include:
a. Chronic gastro-intestinal bleeding.
b. Anemia in the presence of chronic renal disease.
c. Anemia with bone marrow transplant.
d. Anemia associated with malignancy.
e. Sickle cell anemia.
f. Undiagnosed symptomatic anemia.
g. Angina when anemia is a factor.
h. Congestive heart failure when anemia is a factor.
i. Chemotherapy induced anemia.
3. Patients with a history of adverse transfusion reactions,
cardiovascular impairment or no previous history of
transfusion should be referred to the Medical Director for
evaluation.
4. The physician's written order is to include:
a. Type and amount of blood component.
b. Date of transfusion.
c. Pre- and post-transfusion blood work.
d. Duration of infusion.
e. Pre-medications.
f. Emergency medications/procedure to be used in case
of a transfusion reaction.
5. A patient/caregiver able to assist the nurse administering
the transfusion and capable of observing the patient for
adverse effects of transfusion must be present during and
after the transfusion.
6. The physician must be readily available by phone and may
be notified at the start and conclusion of a transfusion.
7. Patients may be pre-medicated with Lasix, Benadryl and/or
Tylenol prior to transfusion.
a. Oral medications should be given 30 minutes prior to
transfusion.
b. IV medications should be given immediately prior to
transfusion.
8. Emergency medications or an anaphylaxis kit must be
available. Most adverse reactions occur within the first 15
minutes.
9. Use at least two (2) patient identifiers prior to administering
medications.
PRECAUTIONS:
1. If the patient has a temperature above 100.3 degrees
Fahrenheit orally, notify the physician before proceeding
with procedure.
2. Assure accessibility to venous access prior to obtaining
blood from the blood bank, if possible.
3. The blood must be stored in an ice packed cooler with the
temperature ranging between 1-10 degrees Centigrade
during transportation from blood bank to patient home.
4. A new blood filter is used with each unit of blood infused.
5. Normal saline is the only IV solution that should be used
with a blood transfusion and should both initiate and end the
transfusion.
6. Blood should be infused within 4 hours after initiation of
transfusion. After that time, the blood is considered
contaminated.
7. The patient should be observed throughout the transfusion
for a possible blood reaction, chills, elevated temperature,
restlessness, anxiety, dyspnea, flushing, changes in pulse
rate, chest pain, rash, or itching. If these symptoms or other
reactions to the blood transfusion are noted, see
Management of Blood Transfusion Reactions, No. 09.40.
EQUIPMENT:
Gloves
Alcohol applicator (wipe/swab/disk/ampule)
Transfusion Record Form
Packed cells
Microaggregate blood sets, Y-type preferable (2)
Leukocyte removal filter (optional)
Standard IV tubing
250cc bag of normal saline - 1 bag/unit to be infused
IV pole (optional)
Needleless adaptors
Heparin solution (100 units/cc, or as prescribed)
Thermometer
Puncture-proof container
Impervious trash bag
Cooler and ice
Equipment and emergency medications for transfusion reaction
(see Management of Blood Transfusion Reactions)
219