Blood Component Administration

Final bedside checking procedure

All patients who require the administration of any blood component must have a legible wrist band in situ which includes a minimum of the three key identifiers:

full name
date of birth
unique patient identifier number

If two patients are to be transfused on the same ward, the transfusions must be staggered. Once the first unit is started, the blood for the second patient can be sent for. This ensures that two units will not be required at the same time.

Before the transfusion is commenced, the staff member setting up the transfusion must make a final identity check, in conjunction with another registered nurse or doctor.

At the patient’s bedside both individuals must first check the name, unit number and date of birth against the patient's care pathway document. Then the details on the donor unit compatibility or traceability tag are checked. Check for any special instructions on the compatibility/traceability tag i.e. ‘complete by’

Check and confirm the Bag number (G095 310…) are the same on both the compatibility/traceability tag and the pack label. Then check the expiry date on the unit.

Where possible, ask the patient to verbally confirm their name and date of birth. Finally, check and confirm the patient’s identification (name, unit number and date of birth) against the patient’s wristband and the blood bag tag.

Please note - traceability labels are attached to every blood component or product issued by the Blood Bank. Department staff are responsible for their completion and return, at the first convenient opportunity.

Red blood cells (RBC’s)

Depending on the administration rate, transfusions can be documented on either the routine or urgent care pathway.
The transfusion should be started within 30 minutes of removal from the Blood Bank fridge (controlled temperature 2-6°C), or returned.
Transfusion should occur via a standard gravity feed blood transfusion giving set.
The giving set line should be primed with normal saline prior to the first unit.
Each unit should be administered over a maximum of four hours from the time the unit was removed from the Blood Bank fridge. Patients requiring blood to be transfused urgently due to their clinical condition can be transfused STAT.
RBC’s can be stored in an unopened cool box for a maximum of three hours, but once opened the 30-minute rule re-applies. However, if blood arrives in the clinical area in a cool box and is not going to be used imminently it must be returned to the Blood Bank. It should not be stored in a cool box.

Platelets

Platelet transfusions should be documented on a routine or urgent blood transfusion care pathway.
Transfusions should be commenced as soon as possible once removed from the agitator (if delayed, platelets must be used or discarded after 2 hours from issue.
Platelets should never be stored in a cool box.
Transfusion should occur via a platelet giving set (170-200μm ‘screen’ filter). However, if not available a standard blood giving set can be used but not if it has already been used for RBC.
Each unit should be administered over around 30 minutes.

Fresh Frozen Plasma (FFP)

FFP transfusions should be documented on a routine or urgent blood transfusion care pathway.
The average adult therapeutic dose is calculated by body weight (the usual dose is 3-4 units – to be prescribed individually).
Once thawed FFP must be transfused as quickly as possible as prolonged post-thaw storage will result in a decline of labile coagulation factors (maximum storage time 24 hours in the controlled blood bank fridge).
Administer FFP via a standard blood transfusion giving set. There is no need to prime the line prior to transfusion.
Each unit should be administered over 20 to 30 minutes.

Cryoprecipitate (CRYO)

CRYO should be documented on a routine or urgent blood transfusion care pathway.
The average adult therapeutic dose is 10 units (each pack contains 5 units).
Once thawed, CRYO must not be re-frozen or stored in a fridge. It should be transfused as soon as possible. If delay is unavoidable the unit must be transfused or discarded within 4 hours.
Administer CRYO via a standard blood transfusion giving set. There is no need to prime the line prior to transfusion.
Each unit can be transfused in around 15 to 20 minutes.

Albumin

Albumin transfusions should be recorded as administered on the patient’s prescription chart only.
Albumin should be administered via a standard intravenous fluid giving set.
Each bottle should be infused over one to two hours.
Albumin must be administered with caution as a too rapid infusion can lead to circulatory overload or interstitial dehydration.
Once the bottle has been ‘spiked’ the contents must be used or discarded after 4 hours.

Paediatric administration

The principles are the same as for adult administration. Blood administration sets containing 170-200 micron filters should be used. Paediatric blood administration sets appropriate for small volume transfusions are available from NNU (ward 38)

It is vital for the medical team to specify both the volumes in mls and the time over which the transfusion should take place, when prescribing for young children and infants.

Nursing alert

No drugs or other intravenous fluids should be added to, or administered, via the same cannula during the transfusion of any blood component.

Flushing through the remainder of the blood in the line with 0.9% sodium chloride is unnecessary. It is not recommended because it may result in particles being flushed through the filter.

If another IV infusion is to take place after the blood transfusion, a new IV fluid administration set must be used. This is to reduce the risk of incompatible fluids or drugs causing haemolysis of any residual red cells, which may be left in the administration set.

If multiple units of RBC’s are being transfused, the administration set should be changed at least every 12 hours to prevent bacterial growth. Additionally, in cases of massive haemorrhage, where different components are to be given in rapid succession, it is best practice to use a new set for each component.

For further guidance, all clinical staff should refer to the Trust individual blood component guidelines located on the TAD website or Blood Products sharepoint website.

This webpage was reviewed and updated by Mark Taplin, Blood Transfusion Manager, 22nd February 2024