Posted September 14, 200915 yr comment_17336 When we have a patient whose temperature increase is greater than or equal to 2F during a transfusion, this is cause to stop the unit and perform a reaction workup. Does anyone stop the transfusion until a hemolytic reaction cna be ruled out and then restart the transfusion? I would appreciate it if you could share with me what the policy is at yourefacility. We are a 125 bed facility.Thanks for your help!!
September 14, 200915 yr comment_17339 The only time they are allowed to restart the transfusion is for an allergic reaction, ex. hives, rash, etc. With a temperature increase, I would be concerned about a contamination risk as well as a hemolytic reaction.
September 14, 200915 yr Author comment_17341 Thanks, this is what I am trying to get across to my manager.
September 14, 200915 yr comment_17343 KKidd - Just a question: Does the nurse initiate/call the Transfusion Rxn Workup, or does a physician have to evaluate the situation and order it?We usually have an unusually low number of Transfusion Reaction Investigations ordered (ie: <10/year), and the majority of them are due to an increase in the patient's temperature. Because of that (and along with the fact that our staff rotates departments, rather than being dedicated to BB), we have stayed with policy that the donor units gets sent back to Blood Bank for the investigation (and we do not restart the transfusion of that unit.)
September 17, 200915 yr comment_17430 We also have the unit sent back to BB for the workup. No suspected transfusion reaction is allowed to start up again once it is reported to us - who knows what they do with the ones they do not report!Nursing is expected to report suspected transfusion reactions without waiting for the doctor to return their call. We tell them that they are the ones with the patient, so if they don't like what they are seeing, then they should trust their instincts. I'd rather waste a unit and find out there was no reaction than find out that the patient had a bad outcome because no one would stop the transfusion. Nursing calls us and they call the physician when they stop the transfusion.We had a real surprise one time when we found out about a lawsuit that a family filed against the hospital. When we read the chart, the physician had written a note that he suspected the platelet unit the patient was given was contaminated. There was never a report of this suspicion to the blood bank at all! I still shake my head over that one.:disbelief
September 17, 200915 yr comment_17435 We also have the unit sent back to BB for the workup. No suspected transfusion reaction is allowed to start up again once it is reported to us - who knows what they do with the ones they do not report!Nursing is expected to report suspected transfusion reactions without waiting for the doctor to return their call. We tell them that they are the ones with the patient, so if they don't like what they are seeing, then they should trust their instincts. I'd rather waste a unit and find out there was no reaction than find out that the patient had a bad outcome because no one would stop the transfusion. Nursing calls us and they call the physician when they stop the transfusion.We had a real surprise one time when we found out about a lawsuit that a family filed against the hospital. When we read the chart, the physician had written a note that he suspected the platelet unit the patient was given was contaminated. There was never a report of this suspicion to the blood bank at all! I still shake my head over that one.:disbeliefMy goodness, that really is scary. You are not supposed to double post, I know, but that story should, in my opinion, also be in the "Just for Fun" Thread, simply because, if you look at the number of hits it has got, it will be seen by the widest audience.I take it the medic still has a job (they always do).:mad:
September 17, 200915 yr comment_17436 We also have the unit sent back to the blood bank. We will also not issue another unit until the initial workup is completed. If the only symptoms are hives/itching they can give benadryl and continue.
September 19, 200915 yr comment_17467 The only time they are allowed to restart the transfusion is for an allergic reaction, ex. hives, rash, etc. With a temperature increase, I would be concerned about a contamination risk as well as a hemolytic reaction.We do the same...
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