Saturday, 21 November 2015

Blood Transfusion

THE RIGHT WAY OF ADMINISTERING BLOOD PRODUCTS

[ from "THE CLINICAL USE OF BLOOD: HAND BOOK , World Health Organization & Blood Transfusion Safety , GENEVA ]

✔️Prefer a larger cannula: A doubling of the diameter of the cannula increases the flow rate of most fluids by a factor of 16.

✔️In case of Whole blood, red cells, plasma and cryoprecipitate
>Use a new, sterile blood administration set containing an integral 170–200 micron filter

>Change the set at least 12-hourly during blood component infusion
>In a very warm climate, change the set more frequently and usually after every four units of blood, if given within a 12-hour period

✔In case of Platelet concentrates

>Use a fresh blood administration set or platelet transfusion set, primed with saline.

✔️WARMING BLOOD:

>There is no evidence that warming blood is beneficial to the patient when infusion is slow.

>At infusion rates greater than 100 ml/minute, cold blood may be a contributing factor in cardiac arrest. However, keeping the patient warm is probably more important than warming the infused blood.

>Warmed blood is most commonly required in: [1]Large volume rapid transfusions:
    -Adults: greater than 50 ml/kg/hour      -Children: greater than 15 ml/kg/hour
[2]Exchange transfusion in infants  [3]Patients with clinically significant cold agglutinins.

>Blood SHOULD ONLY BE WARMED in a blood warmer. Blood warmers should have a visible thermometer and an audible warning alarm and should be properly maintained.

>Blood should never be warmed in a bowl of hot water as this could lead to haemolysis of the red cells which could be life-threatening.

✔️Severe reactions most commonly present during the first 15 minutes of a transfusion. All patients and, in particular, unconscious patients should be monitored during this period and for the first 15 minutes of each subsequent unit.

✔️The transfusion of each unit of the blood or blood component should be completed within four hours of the pack being punctured. If a unit is not completed within four hours, discontinue its use and dispose of the remainder through the clinical waste system.

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