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
PROCEDURE:
1. Contact physician by telephone and verify transfusion
orders, availability of physician in case of emergency and
document on home transfusion record form.
2. Adhere to Universal Precautions.
3. Explain the procedure and purpose to patient/caregiver
including possible adverse reactions. Ascertain whether
patient has had a previous blood transfusion reaction.
4. Verify patient's signature on consent for home care
treatment. Obtain patient's signature on informed consent
for packed red cell transfusion.
5. Verify blood product:
a. Check name and identification number of patient,
identification method should be implemented at time of
Type and Cross-match for positive identification.
b. ABO and RH of the recipient and compatibility with
donor.
c. Donor identification number.
d. Expiration date on unit of packed red cells.
e. Color and appearance of unit of packed red cells.
f. Name of person issuing the unit.
g. Name of person to whom the unit was issued.
h. Date and time of issue.
6. Verify there is a competent caregiver in the home at the time
of transfusion.
7. Sign check off form.
8. Obtain baseline urine specimen (optional).
9. Assemble equipment on a clean surface, close to the
patient.
10. Place patient in a comfortable position, making sure that site
is accessible.
11. Record baseline temperature, pulse, respirations and blood
pressure.
12. Auscultate and record assessment of lung fields for baseline
data.
13. Pre-medicate patient, if ordered.
14. Close blood filter clamp and "patient" clamp and then open
solution clamp.
15. Prepare normal saline bag and remove protective cap from
solution spike.
16. Insert solution spike into normal saline container and hang.
Attach needleless adaptor to end of administration set
(optional).
17. Invert drip chamber and open "patient" clamp. When drip
chamber is 2/3 full, close "patient" clamp and return drip
chamber to normal position.
18. Open "patient" clamp to fill patient tubing and expel air. DO
NOT ALLOW AIR TO REMAIN IN PATIENT TUBING.
Close patient clamp.
19. Clean injection port of central venous catheter, peripheral IV
line or subcutaneous catheter line with alcohol applicator.
Allow to air dry. DO NOT BLOT. Insert needleless adaptor
on administration set into injection port.
20. If not using needleless access system, clean injection port
junction with alcohol applicator and remove injection port.
Attach administration set tubing to IV line.
21. Initiate flow with normal saline, regulating flow by adjusting
patient clamp.
22. To prime blood filter and transfuse blood, gently rotate cell
mass. DO NOT SHAKE.
23. Close "patient" and solution clamps (blood filter clamp is
closed).
24. Remove protective cap from blood filter spike. Grasp blood
filter, insert spike into outlet port of blood bag using half twist
pushing motion.
Note: Prime leukocyte removal filters per manufacturer’s
recommendations only. Prime regular blood filters as follows
(#25 and 26).
25. Hold blood bag and filter upright, approximately 12 inches
below level of normal saline container.
26. Fully open normal saline clamp and adjust blood filter clamp
to allow solution to flow slowly in reverse direction through
blood tubing and into filter until filter is filled with normal
saline. Close normal saline clamp.
27. Hang blood bag. Fully open blood filter clamp.
28. Regulate flow to patient with patient clamp. Flow should be
regulated to deliver 30cc in 15 minutes.
29. Document exact time blood infusion is started. Readjust
flow 15 minutes after start. Average infusion time is 1 1/2 -
2 hours per unit, but must be within 4 hours.
30. Monitor and record patient's vital signs after 15 minutes, 30
minutes, then every 30 minutes.
31. Assess patient throughout infusion for signs and symptoms
of blood transfusion reaction.
32. If multiple units are to be given, flush the line with a
minimum of 50 ml 0.9% NaCl between each unit. Do not
exceed saline flush of 150 ml 0.9% NaCl for one unit.
33. After transfusion is completed, flush tubing and filter with 0.9
% sodium chloride, injection. Note exact time blood
transfusion is completed.
34. Discontinue normal saline infusion - flush venous access
with heparin solution (appropriate for type of venous access
or remove peripheral IV according to Administration of
Intravenous Therapy, No. 9.01).
35. Discard soiled supplies in appropriate containers.
36. Remain with patient for 30 minutes after transfusion is
completed to monitor and record patient's response.
37. Notify physician of completion of procedure and the patient's
response.
38. Schedule follow-up visit per physician’s orders.
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