time alloted for blood to hang and resume blood transfusion

[larevalo]

Hi, is there anyone knows what AABB standards that specify how many hours the blood should be hanged , while waiting for allergic reaction to subside ?Because there was a discussion why for returned units of unused blood to blood bank must be < 30 minutes if kept outside the fridge,while pricked units wherein IV set is still attached to patient can still continue even more than 30 minutes?

[QRISTOFIR]

Transfusions should be completed within 4 hours from start time. That said, I believe you can let a unit hang while you resolve an allergic reaction as long as the total transfusion episode does not exceed 4 hours.

For units returned unspiked, the reason why they can't be acceptable after 30 minutes is because if you do, the risk of bacterial proliferation will be transferred to the next recipient of that unit after it has stayed in storage again for God knows how long.

Hope I made sense?

[Deny Morlino]

The protocol QRISTOFIR describes is the protocol we follow if a transfusion is interrupted by a suspected reaction.

Yes, you made perfect sense addressing the reason for the stipulations for returning unused units to the blood bank. The discussion here has been that the time has no direct bearing upon returns as the unit must be assured to have remained cooler than 10C to be acceptable for reissue. This is per AABB.

[QRISTOFIR]

Great point Deny. For those like us that are yet to implement the use of temp indicators, I guess the next best thing (like we currently do) is to take the temperature when the units return rather than going by the 30-minute rule solely. Granted, this doesn't cover the likely Operating Room scenarios were blood could be left on the table for an hour then placed back in the cooler under ice and comes back to you in temp; but that's why we are in the process of validating the Safe-T-Vue temp indicators now.

I digress...... anybody got any luck with the Safe-T-Vue 6 Temp Indicators? My understanding is that the color changes AT 6, which is one degree to strict to be practical.

[clmergen]

We are using the saf-T-Vue 10s to cover the situation of a unit being pulled out of a cooler and left on the countertop for an hour.

We validated our coolers to show they maintain a 1-6C range to cover the FDA requirement. We QC this twice a year to show that coolers are maintaining temperatures. We are using Saf-T-Vue 6's for this.

And we are validating for use the infrared thermometers to get rid of the 30 minute rule (for those units that may not have a Saf-T-Vue 10 on them).

[Lcsmrz]

You can spike a unit, let it sit for 3hrs & 59mins, then infuse it within 60 seconds -- and still be in compliance with my SOP. I don't know why you'd want to do that, though ...

We ask the nurses to return any unit not totally infused to the patient (for our records).

[QRISTOFIR]

You can spike a unit, let it sit for 3hrs & 59mins, then infuse it within 60 seconds -- and still be in compliance with my SOP. I don't know why you'd want to do that, though ...

We ask the nurses to return any unit not totally infused to the patient (for our records).

What's the benefit of returning a partially transfused unit if there was no adverse reaction and if even a single drop in the patient qualifies the unit as "Transfused" in your records?

Please school me if I missed the whole point.

[Lcsmrz]

Partial units are returned in the hopes of detecting something we would want to know about: clotted units, nonreported reactions, and the like. We find the strangest things happen with these units ...

[larevalo]

Hi, is there anyone knows what AABB standards that specify how many hours the blood should be hanged , while waiting for allergic reaction to subside ?Because there was a discussion why for returned units of unused blood to blood bank must be < 30 minutes if kept outside the fridge,while pricked units wherein IV set is still attached to patient can still continue even more than 30 minutes?

QRISTOFIR,I agree with you & its in the Standard that the maximum time for blood to transfuse is within 4 hours.It didn't say if there is interruption...The discussion was about the interruption & the possiblity for bacterial contamination for the same patient since the unit is exposed to ambient temperature,for more than 30 minutes only the line has been closed during the time of transfusion and has to resume once the allergic reaction has gone.

[AMcCord]

Bacteria may be present in the unit from the collection process or because of bacteremia of the donor. Once the unit comes out of the cold and starts to warm up, the bacteria in the unit (if any) can start to multiply. The 4 hour time limit for transfusion was chosen to play it safe - if bacteria are present in the unit from the beginning, they won't multiply enough to cause problems for your patient. If bacteria were introduced into the unit when it was spiked, they won't multiply enough to cause problems for your patient. Whether the infusion was interuppted or not, the time is still 4 hours from the time out of the fridge.

Edited August 29, 2010 by AMcCord
cannot spell

[Vic]

What if the transfusion is stopped because of something happening to the IV? For example, the patient pulls the IV out. Can a new IV be inserted and the transfusion continue? Is there a risk of bacterial contamination at that point? I am not very familiar with how an IV is hooked up to a unit so feel free to inform me!:tongue:

[L106]

You are correct, Vic. The transfusion can be restarted via a new IV site. The four hour time limit for the donor unit to be out of the Blood Bank limits the risks of bacterial proliferation.

Donna

[Malcolm Needs ☆]

I did once hear of a patient who thought that the blood was going in too slowly, and so he cut a notch in the top of the bag "to help it along"!!!!!!!!!!!!!!

[pluto]

I did once hear of a patient who thought that the blood was going in too slowly, and so he cut a notch in the top of the bag "to help it along"!!!!!!!!!!!!!!

I have heard that one as well I believe they called it venting the bag

[hmust1]

I just want to chime in here on an issue that is near and dear to my heart. It can be confusing to associate the 4-hour infusion 'start' time with the 'spiking' of the unit. The 4-hour infusion time starts when the unit leaves the refrigeration unit in the blood bank (i.e. at 'issue').

We had a big problem with transfusions exceeding the 4-hour time limit in our facility. Therefore, I performed an intense incident monitoring review which revealed that everyone (Lab, RN's, Physicians) was aware of the 4-hour time limit...but everyone had a different idea about when 'start' time began. Nursing staff thought it started when they spiked the unit (even if that meant the transporter took 20 minutes to get the blood to the floor (running other errands with the blood in hand), and the RN took 20 minutes to hang the unit (busy with other patients, etc). So, we simply had to clarify the language in the nursing blood administration policy/procedure, provide some education, and transfusions exceeding the 4-hour time limit have all but ceased in our facility.

[EDibble]

But no matter how clearly we explain, write procedures for the nursing manual etc, we get all sorts of opinions as to what the 4 hours means. I had a situation the other day where the nurse was told by a co-worker, that the spiked unit could be returned, 2 hours into the transfusion, and restarted at a later time. The IV had infiltrated. I told them in no uncertain terms that the four hours was up from the time the unit left the BB, and if they wanted to restart it, it had to stay at the bedside.Return a spiked unit???? ::headdesk::

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