Time limit for starting transfusion after issue

[LaraT23]

What time limit is everyone using that a unit must be started after it is issued? Nursing service is balking at our 20 minute limit, which we have had as a policy for 10 years. Our new manager for a couple of the floors says everywhere she has worked for her entire career used 30 minutes. What is the consensus here?

[Steven Jeff]

My understanding for the UK, is that a unit of red cells must be returned within 30 minutes once out of tenmperature controlled storage. There is no time limit for when a transfusion is started, provided the transfusion is completed within 4 hours. Naturally this assumes that the unit is looked after carefully prior to infusion, i.e. not put on a radiator, in a freezer or a ward fridge.

Steve

:o:o

[David Saikin]

No time limit to start transfusion . . . must be transfused within 4 hrs of signing out of blood bank (not starting).

[Deny Morlino]

Same here. Products must be infused within 4 hours of issue. The 30 minute time frame was related to the product's ability to be returned to the blood bank at our facility. If the floor attempted a return after that time frame, we would not accept it, but would explain that the product was still within the 4 hour transfusion window and that they could attempt to transfuse the product within that time frame. Most often they were able to resolve whatever the problem was with the patient and initiate transfusion in a short time frame. We have transitioned to an acceptable temperature when nursing attempts a return of a unit instead of the 30 minute time frame. So far it is working fine.

[John C. Staley]

I'm curioius, what excuse are the nurses using for not being able to start a unit within 20 minutes of the issue of the blood.

I used to do audits on how long it was from the time we put a unit in the pneumatic tube and the time the transfusion was "documented" as having been started. Rarely was it longer than 10 minutes and I used a 15 minute window as the cutoff time for being acceptable.

:eyepoppin:eyepoppin

[Deny Morlino]

I'm curioius, what excuse are the nurses using for not being able to start a unit within 20 minutes of the issue of the blood.

:eyepoppin:eyepoppin

The most common situation I have found is difficulty with the IV site. Second most common is patient has spiked a temp.

[rravkin@aol.com]

I have the same understanding and practice as Steven Jeff; the unit must be returned to the Blood Bank within 30 minutes once out of temp controlled storage; I also understand and practice that the unit must be transfused within 4 hours once the transfusion is started; therefore the transfusion should be started within 30 minutes of issue or returned to the BB within that 30 minute time frame given that this is the time limit where the unit can be outside of temp controlled storage where the transfusion has not yet started. Its a strange dicotomy in that the reason for the 30 minute time frame is to deter bacterial growth in the PC prior to transfusion and yet if the transfusion is started in a maximum time of 30 minutes the very same unit now being transfused can hang at room temperature for a maximum time of 4 hours. A new generation of bacteria grows every 20 minutes. So how can it be that a PC out of temp controlled storage and not transfused for 35 minutes is less safe than a PC, where the transfusion has started within 30 minutes, at, say, 219 minutes at room temperature?? There is the 64 million dollar question?

I have also seen the similar situations that Deny has mentioned where the patient may spike a temp prior to transfusion but unfortunately after issue of PC. Also the IV sites can become coagulated again, unfortunately, after the PC is issued.

[estiner]

According to FDA the temperature of the blood is the critical piece of information - not the time it has been out of the controlled temperature - for the blood to be acceptable back into inventory. The old rule of 30 minutes no longer applies - it now depends on whether the temperature has reached 10 degrees or not. If it reaches 10 degrees, then it cannot be put back into the regular inventory but it can still be transfused within the 4hr limit beginning with the initial issue. We quarantine the unit until nursing can use it and then discard if they cannot meet the 4hr limit. To decrease temperature problems, we insist that nursing take vitals before coming to get unit.

[Steven Jeff]

The old rule of 30 minutes no longer applies.

It still applies in the UK!!

Steve

:)

[Michaele]

We use a 20 minute time limit here. We have for years.

[estiner]

Have you ever done a study to see if 20 min is adequate to make sure the unit does not reach the limit of 10 degrees? We did and were quite surprised how short of time a unit straight from the refrigerator took to get to 10 degrees.

[L106]

No time limit to start transfusion . . . must be transfused within 4 hrs of signing out of blood bank (not starting).

Same here.

[LaraT23]

The nurses are balking at 20 minutes because I am writing them up for violating the Blood bank policy but the nursing policy states 30 minutes. So, we are not in consensus about that time.

I am planning to do a study with some expired units my blood center is sending me. Will let you all.

[tbostock]

Same as David and L106 here.

[Tonyd]

It is good practice to commence the transfusion as soon as possible following removal from 'safe storage', but current guidelines in the UK do not mandate a specific time limit within which to start a transfusion, just that it needs to be completed within 4 hours of removal from safe storage

From a pragmatic point of view, it seems absolutely stupid to waste units that may be started 40 minutes-1 hr after collection, but then completed within the 4-hour window.

The key thing is that the ward should be ready to commence the transfusion before sending for the unit !!

[adiescast]

We transitioned to using the actual temperature of the unit for determining its suitability for re-use after return, but we did not change the nursing procedure. The nurses still use the 30 minute rule for returning blood. It was easier than trying to determine when the blood would exceed temperature for all areas of the hospital, doctor's offices, etc. We have a separate policy for the trauma bay. The trauma bay is kept at 96 F ambient temperature. We did a study and determined that it takes less than 7 minutes for a unit sitting on the counter in the trauma bay to exceed 10 C. We do not accept returned units from the trauma bay for reissue.

We also require units to be transfused within 4 hours. We tell the nurses to start the transfusion as soon as possible after issue or return the blood to us until they are ready, but we do not have a policy for a required time frame to start the transfusion.

[Steven Jeff]

The key thing is that the ward should be ready to commence the transfusion before sending for the unit !!

TonyD is absolutely right here, there is no point in sending for the unit of blood until the ward staff are ready

Steve

[bkrobinson]

We currently use a 30 minutes from time of issue that the unit is to be started and that it must be transfused within 4 hours from leaving the Transfusion Service. We are in the process of updating our process to include temperature upon return within the proper range depending on the produc and no more than 30 minutes.

[C Lumbert]

I took part in a discussion on this issue this morning with our Lab Counsel group. One of the members stated that there is no standard requiring the transfusion to be initiated within a certain time from issue of the product, only that the transfusion be completed 4 hours from spiking the unit. This situation would appear to permit holding blood in the patient care area indefinitely before starting the transfusion. I noted that the Circular of Information for Blood and Blood Products from the ARC and AABB states: "It is undesirable for components that contain red cells to remain at room temperature longer than 4 hours."

If we are required to follow manufacturer's recommendations, would this mean transfusion should be completed within 4 hours of issue from controlled storage?

What time limit is everyone using that a unit must be started after it is issued? Nursing service is balking at our 20 minute limit, which we have had as a policy for 10 years. Our new manager for a couple of the floors says everywhere she has worked for her entire career used 30 minutes. What is the consensus here?

[L106]

The transfusion should be completed with 4 hours from the time the blod left the controlled storaga (ie: refrigerator.) (Not "4 hours from the time the unit was spiked.")

Donna

[JOANBALONE]

Hi Donna,

Do you have a reference for 4 hours from time of issue from Circular of Information, FDA or AABB?

JB

[rravkin@aol.com]

This is a very interesting subject we are talking about here. But I would ask the posters here why is it that the unit of PC's can not be returned to BB inventory if it reaches 10C or if it is out for more than 30 minutes and yet the initiation of the very same unit can be within 4 hours of issue; depending on your practice? What is the logic behind the FDA rules and regs. governing this practice? I think that the FDA, as well as other governing bodies of BB practice, have the goal of patient safety at the for-front of all their rules and regulations. So why is a unit of PC's safe to transfuse within 4 hours of issue and yet not safe to return to BB inventory in 30 minutes or less time if abiding by the 10C temp rule?? Does anyone have any actual articles that they can reference here?

[JohnT]

I'm discussing this very subject at the moment. Does anyone have the reference for these time limits in the UK. Thanks

[Steven Jeff]

But I would ask the posters here why is it that the unit of PC's can not be returned to BB inventory if it reaches 10C or if it is out for more than 30 minutes and yet the initiation of the very same unit can be within 4 hours of issue; depending on your practice?

The reason to return the unit within the prescribed time/temperature range is so that it can be re-cross-matched and issued to another patient. If the return of the unit is outside the time limit/temp it cannot be reutilised on another patient. I cannot at this moment put my hand on the UK regulations but there has been clarifiaction of this requirement in the last 12 months

Regards

Steve

:)

[Malcolm Needs ☆]

I'm not totally sure about this (so don't quote me), but I think it has something to do with the fact that the unit may be issued more than once, and be returned more than once. In such a situation, it is the cumulative time out that matters, and I think that the rule has been put there in case we are unable to track how many times the unit has been out of the fridge (or whatever) for 30 minutes.

I'm not sure that I have put that all that well - but, at least I know what I mean!!!!!!!!!!!!!!!