Is the Transfusion Service Responsible?

[Christie Loe]

Thanks in advance for your opinions on this topic---

In Neonatal Transfusion when blood is transported to NICU, etc. in an aliquot bag then transferred by nurses into a syringe for pump administration, is the transfusion service responsible for ensuring this process meets regulatory requirements? Please elaborate your opinions.

Christie

[David Saikin]

I do not believe you are responsible for how nursing handles the product, except that once manipulated, you may not receive it back. I am assuming that the component is being transferred into a (labeled?) syringe, but otherwise, no other mandated criteria is attached. As opposed to you distributing product in a syringe, which would require it to be compliantly labeled. It might make an interesting quality monitor, but then your institution might be mandated into some form of regulatory action based on your review of this procedure. Do they have a policy/process that addresses blood administration in the manner in which they proceed?

[Christie Loe]

Thanks David. You asked if they had a policy/process addressing blood administration. Since I work for a manufacturer, let's assume facilities do indeed have a practice in place that is defined by nursing. This question stems more from the disconnect between transfusion services and nursing blood administration practices. In actuality, many times the blood component is transferred into a syringe that IS NOT labeled nor is the aliquot bag (compliantly labeled by transfusion service) still attached to the syringe during transfusion. Additionally, final filtration may also be in question.

[John C. Staley]

Personally I feel it is not "best practice" to provide NICU with a bag of blood products and then allow them to transfer it to a syringe. Too many possibilities for them to get creative. We load all aliquots for NICU into a syringe set that has a filter in the line. This allows the NICU to use a minimum of tubing because the blood product has already been filtered. By using a SCD we are able to maintain the original blood product for its normal life span. We label the syringes with all appropriate information. The syringes are loaded just prior to issue to minimize the concern of storage in the hard plastic. It actually makes life easier for everyone involved.

[Christie Loe]

Yes sir, I agree completely. Providing neonatal aliquots to NICU in the final storage/transfusion container eliminates or at least limits "creativity" in the nursing unit. It also provides a way for transfusion services to provide a customer service that just so happens to help keep the transfusion service in regulatory compliance!

[Eagle Eye]

The label should be attached to the syringe or component...I think nurses are not going to be so vigilant about bloodbank regulations. I bet you if somebody do an audit regularly..you will definately find non compliance.

I don't think I would be comfortable in providing bag and let RN to transfer it into a syringe...No way I would prefer it. I am sure my medical director wan't allow it either.

[Karen Olsen]

I had the opportunity to observe NICU nurses performing the transfer of packed cells from an aliquot bag to a syringe a few years ago ( yes it was NOT labeled!). That was when we switched to providing them with the blood product in the syringe. We stick the label right on the syringe and place the Transfusion Tag on with the Tack-It Gun right under the edge of the sticky label, so that it stays attached. It really works quite well and the nurses are thrilled with the system.

[GSD2SABSAL]

In our institution, the Transfusion Service Director signs off on Nursing policy regarding transfusion. The Transfusion Service is responsible to monitor that all transfusions are infused withiin a maximum time frame, usually four hours.

The component is the respponsibility of the service and although nursing would take the heat for a type 1 from JCAHO for improperly handling, I am certain JCAHO would hold the Transfusion Service somewhat accoutable. This would include auditing potential problems. The fact that you are allowing nurses to modify the product by transferring into a syringe is a definite problem unless you have audit data to say everything is perfect. Don't forget the new FDA re-lalebing issues. Is the new information barcoded ?