HHC Health & Home Care Clinical Policy And

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<strong>HHC</strong> 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. 220
<strong>HHC</strong> HEALTH & HOME CARE Section: 9-30 Infusion Therapy: Administration of Packed Red Cells With Use of Microaggregate Blood Filter Set __RN AFTER CARE: 1. Document in patient's record: a. Procedure and observations, including all vital signs. b. Medication administered, dosage, time, route and rate. c. Blood component infused, volume, expiration date, ID numbers. d. Time infusion started and discontinued. e. Amount of normal saline used during transfusion. f. Heparin solution for flush, amount and strength. g. Type and appearance of venous access site. h. Patient's response to procedure, side effects and management. i. Instructions given to patient/caregiver. 221
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