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Blood administration

  • 1.  Blood administration

    Posted 09-09-2019 08:55
    ONS community,

    We are writing to you all today in hopes of obtaining policies, teachings, or current practice regarding blood administration, specifically vital sign frequency, in your institution. We are a group of three nurses currently involved in Huntsman Cancer Institute's Oncology Nurse Residency program. We are conducting an evidence-based practice project regarding our current blood administration practices and how we can improve.  We would greatly appreciate any material or information you can give us in order to further our project.

     

    Thank you for your time and consideration,

     

    Shay Alba RN, BSN Huntsman Cancer Institute

    Corey Harlos RN, BSN Huntsman Cancer Institute

    Mykala Rast RN, BSN Huntsman Cancer Institute



  • 2.  RE: Blood administration

    Posted 09-10-2019 04:59
    Hi Shay,
    We do baseline, then 5 minutely for 15 minutes when transfusion is commenced, then every hour until completed including obs on completion. It is the same for every bag so even if they have 3 bags it is the same requirement for each bag.
    We follow national guidelines see below website. Hope this is helpful    Regards Jackie
    Patient Blood Management Guidelines Progress Update : June 2019
    Blood remove preview
    Patient Blood Management Guidelines Progress Update : June 2019
    The Patient Blood Management (PBM) Guidelines are a series of six modules that focus on evidence-based PBM. Each module has been written for clinicians treating specific patient groups including Critical Bleeding/Massive Transfusion (2011), Perioperative (2012), Medical (2012), Critical Care (2012), Obstetrics and Maternity (2015) and Neonatal and Paediatrics (2016).
    View this on Blood >


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    Jackie Morgan RN, BN, GCert Onc, GCert Mgt
    Registered Nurse
    Southport
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  • 3.  RE: Blood administration

    Posted 09-10-2019 07:36
    Hello!
    I have worked several hospitals and I stayed using one protocol that I felt safe for myself and the patient.
    Vitals and temp obtained 30 minutes prior to administration ( along with pre medications if ordered).

    Retake vitals

    I would hang the blood and would not start the initial 15 minutes until the blood reached the patient and it was at 50 ml/hr. If okay increased rate and document.
     30 minute x2
    1hr x until done
    Recheck vitals one hour post

    That was our standard at Christus and so far the one I've felt the most comfortable with.

    Hope it helped.

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    Christina Lopez RN
    Registered Nurse II
    Texas Oncology
    Lewisville TX
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  • 4.  RE: Blood administration

    Posted 09-10-2019 08:46
    ​Hi all,
    Currently at our hospital, Blood administration protocol has us take a set of pre vitals before we send request for blood product, then start blood and once it has reached the patient we time to 15 minutes of infusing and take another set of vitals, then 1 hour into the infusion we take another set and finally 30 to 60 minutes after blood has completed we take our last set. Nurses still take them hourly during the transfusion if they want to but this is no longer required in our protocol.

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    Karen Seal RN BSN, RN
    Clinical Educator
    Franklinton LA
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  • 5.  RE: Blood administration

    Posted 10-10-2019 22:42
    ​Hey Shay/ ladies:
    Our policy for blood administration requires vital signs pre administration (must be within the last 60mins), another set of vitals 15mins into the infusion, and a last set of vitals after infusion is completed (assuming no reactions at anytime).
    Personally, I opt to obtain additional set of vitals hourly as long as the blood product is infusion as an additional safety measure. that's my personal practice which is more than what our policy calls for, but it makes me feel more comfortable and at ease.

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    Florence Okafor MPH, MSN, RN-BC, CPHON
    Professional Development Specialist:
    Adult Oncology; Ambulatory Infusion Center;
    Adolescent & Young Adult Oncology; &
    GYN-Oncology.
    Baylor All Saints Medical Center
    Fort Worth TX
    ------------------------------



  • 6.  RE: Blood administration

    Posted 10-14-2019 16:54
    Hi
    Our policy, which follows the AABB guidelines, is 15 minutes prior to starting, 15 minutes after starting, and after completion (and PRN). You can always exceed the minimum requirements (as noted by the first response) but I strongly believe it depends on how many blood products you give, and how adept your staff is at managing them and potential reactions.

    Our outpatient center administers between 800 and 900 transfusions per month, so our staff are quite experienced. We're also well staffed so patients are easily monitored. But if we did not transfuse often, and staff were not as comfortable identifying reactions, more frequent VS might make sense.

    Seth

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    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
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  • 7.  RE: Blood administration

    Posted 10-15-2019 12:25
    question re: blood transfusions and change in blood pressure.
    most transfusion reaction work ups include any change in blood pressure > 20mm​ Hg...in the cancer patient, this could be as a result of volume increase, rate of volume too fast, excitability, etc. my question is, most of the time it is not a true symptom of a reaction.
    does anyone have a 'carve-out' policy for oncology patients specific, and/or any changes to the standard s/s of a transfusion reaction? If a change in the BP is the only change?
    thanks, Dana

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    Dana Cunningham RN MS ARNP
    Sedro Woolley WA
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  • 8.  RE: Blood administration

    Posted 10-16-2019 07:19
    We take vital signs within 30 minutes of start of infusion, 10-20 minutes into infusion, and at the end of infusion for each product.  For stem cell infusions and CAR-T infusions we take vital signs at the start and at the end.  If the product is large volume (such as bone marrow) we perform vital signs as we do for vital signs.  If your policy states vital signs are taken 15 minutes after initiation, you set yourself up for not following procedure/policy if your Department of Public Health monitors you.  That is why we decided to give the staff a bit of "wiggle room."  The product must be started within 30 minutes of leaving the blood bank.  One of our competencies this year was for nurses to audit their practice of completion of vital signs and filling out the transfusion record with 100% compliance.  One change we made this year was that RNs and not PCAs take the vital signs 10-20 minutes into the infusion.  The rationale was that the vital signs needed to be interpreted by the RN and the patient had to be assessed at that time.  That way the nurse is aware of when to check the vital signs and the patient.  It has worked out pretty well​. We leave it to the RN if they want to utilize pumps or free flow.

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    Kirsten Pedersen RN MSN OCN BMTCN
    Service Line Educator, Hematology, Stem Cell Transplant
    Smilow Cancer Hospital at Yale New Haven
    New Haven, CT. 06504
    203-200-6744
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