Blood administration

[Susan Arata]

Hello,

again, I need input from the collective: I cannot find it in writing anywhere in our policies and procedures that once blood products are picked up, the transfusion must be started within 30 minutes. That is still a thing right?

thanks 

[SbbPerson ☆]

Yes, it is. It is actually because the transport temperature for whole blood, RBCs, and plasma is 1 to 10 degrees celsius.  After 30 minutes, the internal temperature of the units go above 10 degrees which may promote bacterial growth.  Basic 30 minute rule is that if the unit is outside of a controlled temperature for 30 minutes or more, it must be discarded. 

[applejw]

In my experience, the 30 minute rule is a holdover from the past.  There is some literature (forgive me for not quoting exactly) describing process for measuring temperature of units returned to Blood Bank and it only takes approximately 10 minutes for a unit to exceed storage temperature maximum of 6C.  We measure the temperature of any unit returned, consider the 'away' time to be transport, and may discard the unit if temperature exceeds 10C.

Issued units must have transfusion started without delay - the transfusionist is expected to have already obtained consent, have IV access and be ready to transfuse when the blood arrives at the patient's bedside.  If there is an unexpected problem (can't find the consent, IV infiltration, etc...), blood must be returned immediately and the unit temperature is measured ; it may be reissued for transfusion within 4 hours of the original issue time to that patient only.  If that condition cannot be corrected, the unit is discarded if out of temperature, unspiked, and meets other return criteria established by AABB.

[MAGNUM]

yes, here in the DFW area, it only takes approximately 10 minutes or so for the internal core temp of the unit to exceed 10C. new nurses as well as old ones are still under the fallacy of the "30 minute" rule. 

[Neil Blumberg]

Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement.  There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement.  Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood.  Rant off :).

[John C. Staley]

20 minutes ago, Neil Blumberg said:

Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement.  There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement.  Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood.  Rant off :).

As I've said many times, "Inertia is the most powerful force in the universe and blood bankers prove it everyday!"  Sadly, "that's how we have always done it!" is often our mantra and no amount of data or lack of it can change many minds.  

[AMcCord]

Our nursing policies state that infusion should begin within 15 minutes of checkout. This ensures that the transfusionist and patient are 'ready' for infusion before the nurse comes to Blood Bank to check out the unit: pre-transfusion vitals have been taken and evaluated; IV looks good; infusion set is at bedside; consent has been signed; etc. etc. We implemented this policy in cooperation with nursing service to reduce blood product waste due to inadequate preparation and unexpected patient issues. Fifteen minutes gives them just enough time to come down and check out the product, take it to the bedside, have a buddy ready for the 2 nurse ID process, and to start the infusion. If something unexpected pops up and they have to return the unit, we check the temp. If its over 6.0 C we ask them to take it back to the floor if they think they will be able to start infusion soon and remind them they have 4 hours from the time of original checkout to complete the transfusion. If transfusion is a 'no go' or will be delayed too long, the unit is discarded. This is working well for us - very few wasted units since implementing this policy. Quality includes the 15 minute start time in their transfusion reviews.

[AuntiS]

I think the intent of this "rule" was to not have the blood sitting around.  The pre-transfusion checks should all be completed and the transfusion ready to be initiated as soon as the blood arrives.

Now... in Canada we have a wonderful standard that states we can take the unit back if returned within 60 minutes.  CBS did a lot of validation work to prove that there was no increased risk.  Of course, we also require the unit to be transfused within 4 hours of issue.  sandra

CSTM 5.8.7.2
Blood components may be returned to the TS inventory if the following conditions have been met and documented:
a. visual inspection of the blood component is acceptable
b. the container is intact, including ports on bags
c. at least one sealed segment of integral donor tubing is attached to red cell components. Alternately, an identified segment must be available to the transfusing site.
d. the temperature of the blood component is acceptable as determined by one of the following:
i. a suitable monitoring system indicates the unit(s) has stayed within the acceptable temperature
ii. the unit(s) has been maintained in a container validated to maintain the appropriate temperature for the period that the unit was outside the TS
iii. red cells, plasma and/or cryoprecipitate have not been out of the controlled environment for more than 60 minutes from the time of issue (per occurrence, not cumulative). 
e. The TS Medical Director may approve the acceptance into inventory of blood components that do not meet the requirements of this clause.

[jayinsat]

CAP does not recognize a "30 minute" rule. Each facility has to have a validated policy and procedure that defines when a unit may be returned to inventory post-issue. That usually involves have some sort of thermometer to measure temperature upon return, especially if issued outside a validated cooler.

The time of start of transfusion is really a separate issue that was tied to the old "30 minute rule" that we all went by. The main point for nursing was that they did not pick up a unit before transfusion could be started. Pre-issue vitals, consent, orders, or any other requirement should be complete before the call for the blood. The blood should then be started immediately so that they have the maximum 4 hours to infuse it. Every minute that passes is a minute faster they have to infuse the unit. That may be a problem for someone who cannot tolerate a rapid infusion. We do not want nurses letting the unit sit on a counter somewhere for an hour while they do other things.

[Baby Banker]

On 3/29/2023 at 8:28 AM, MAGNUM said:

yes, here in the DFW area, it only takes approximately 10 minutes or so for the internal core temp of the unit to exceed 10C. new nurses as well as old ones are still under the fallacy of the "30 minute" rule. 

Aliquots will warm even quicker than that due to their smaller mass.

[Baby Banker]

On 3/29/2023 at 9:41 AM, Neil Blumberg said:

Just to be clear, these regulations are almost totally arbitrary and can be overridden by a physician's judgement.  There are no data to support this 30 minutes nonsense nor the 1-10 degree storage requirement.  Just so we all understand there is almost no scientific or clinical basis for our regulatory rigidity and we are usually discarding perfectly safe units of blood.  Rant off :).

Are there still two ranges: one for storage and another for transport?  I've always thought that was ludicrous.

[AMcCord]

On 3/31/2023 at 12:13 PM, Baby Banker said:

Are there still two ranges: one for storage and another for transport?  I've always thought that was ludicrous.

Yes there are.