Why do we have to administer blood with in 30 minutes?

[ElinF]

Why do we have to administer blood with in 30 minutes?

I understand why blood has to be returned to the lab with in 30 minutes for storage and possible reissue, but why do we have to administer the blood in that time frame when it can hang for 4 hours? Is there a standard that states this?

Is it a usage issue? In order to keep the transfusion from "going to waste" we give them a time limit?

My boss wants to know and I can't give her an answer.

Thanks!

[Steven Jeff]

Hi ElinF

Blood transfusion does not have to start within 30 minutes - this is being discussed to some degree in a current thread entitled 'Time limit for starting transfusion after issue'

Regards

Steve

Edited February 8, 2011 by Steven Jeff
spelling

[Tonyd]

Why do we have to administer blood with in 30 minutes?

I understand why blood has to be returned to the lab with in 30 minutes for storage and possible reissue, but why do we have to administer the blood in that time frame when it can hang for 4 hours? Is there a standard that states this?

Is it a usage issue? In order to keep the transfusion from "going to waste" we give them a time limit?

My boss wants to know and I can't give her an answer.

Thanks!

Hi

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 !!

With best wishes

Tony

[David Saikin]

Red cells should be infused within 4 hrs of releae from the BB . . . once signed out, you can delay starting as long as you want, as long as the infusion is complete within the 4 hr timeframe. At my institution, 95+% are started within 10 minutes of pickup.

[ElinF]

thanks! i will look at that!

[KKidd]

Our nursing personnel should have an IV established with Saline, the consent signed, and vitals taken before they pick up the blood. It is generally started within 10-15 minutes. I wouldn't want to encourage any delays. It creates fewer opportunities for a slip up.

One time a unit of blood was issued to a patient in dialysis. THe nurse placed the unit on the bed next to the dialysis unit - lots of heat there) and proceeded to get busy with other things. The blood was found on the bed later when the patient was taken back to his room. A young nurse found it and brought it back to the lab. It was O negative and unfortunately I wasn't very kind to him initially as I threw the unit in the biohazard trash with enough force that it starled him. Then I calmed down, apologized and thanked him for returning the unit.

:angered: :shakefist :please:

[Stoogiesfreak]

I think the AABB manual "suggests" products be started within 30 minutes of issue. It stops short of actually mandating that products be started within 30 minutes. We have monitored this for 2 years and have found that 95%+ of all units issued have been started within 10-15 minutes from issue. We do, however, dispose of any units out of the blood bank and not started within 30 minutes. I think this is one of those "gray" areas in the AABB manual.

John

[BrianD]

our understanding is that it is suggested that transfusion begin asap upon removal from the bloodbank and we will not accept blood for re-issue if the 30' window has passed. the nurses tell me that they usually can start infusion withing 10-15' of receipt of the unit since their 'care maps' require completing a check-list (IV line established and patent, no infiltration, etc. ) before the unit is acquired from the blood bank. infusion must be completed within 4 hrs. of the unit being spiked because the product expires at that time.

[L106]

Red cells should be infused within 4 hrs of releae from the BB . . . once signed out, you can delay starting as long as you want, as long as the infusion is complete within the 4 hr timeframe.QUOTE]

This is my interpretation of the regulations also. (And I believe that the time limit is 4 hours from time it left the Blood Bank refrigerator, not 4 hours from time the unit was spiked.)

Donna

[Auntie-D]

Red cells should be infused within 4 hrs of releae from the BB . . . once signed out, you can delay starting as long as you want, as long as the infusion is complete within the 4 hr timeframe.QUOTE]

This is my interpretation of the regulations also. (And I believe that the time limit is 4 hours from time it left the Blood Bank refrigerator, not 4 hours from time the unit was spiked.)

Donna

Agreed

[John C. Staley]

Donna, my interp was always the same as yours, the clock started when the unit left the refrigerator and was placed in the pneumatic tube.

I did a comprehensive audit quarterly of every unit issued during that month. One item was how long it took from the time we pushed the "go" button on the tube system until a nurse documented removing the unit from the tube system and then how long it took them to hang the unit. We were well above 95% within 15 minutes of leaving the bloodbank and hanging the unit at the bedside. and approaching 100% on removing the unit from the tube system within the 15 minute window. One of the things that seemed to help was billing the nursing unit for blood that was wasted do to nursing "ooops". When the managers discovered how much it cost their budget for a single lost unit of blood it suddenly became a very huge priority.

[Malcolm Needs ☆]

WIsh we could do that over this side of the pond John, but the blood here is "free" (and if you believe that, you'll believe anything!).

[Stoogiesfreak]

Good one Malcolm! I once heard that nothing is free.

You made my day with that one!

Regards,

John

[rbayliff]

In regards to delays in starting transfusions, the AABB tech manual states that transfusion services should have set limits before a unit should be considered unsuitable for reissue (usually 30 minutes), but it goes on to say "If the temperature of a refrigerated component rises above 10 C, reissue is not permissible. If a unit has been entered (spiked for transfusion), it may not be returned to the transfusion service for reissue. It must either be infused within 4 hours of the time it was spiked, or it must be discarded. (Page 622, 17th edition)

[jeanne.wall]

ElinF

You have asked a question that is steeped in mystery and assumptions! AABB Standards do not prescribe a time transfusion to be initiated or for that matter when it must be completed. Folks have given you lots of good information, but I thought I’d just share a little history that might help you sort through all the information.

The four hour time frame comes from concerns about bacterial growth in a unit held at room temperature. Since I was around “way back when” folks started to limit the time units of blood could be infused over (obviously I’ve been in blood banking a long time), I can tell you that folks “adopted” the four hour rule based on the outdate of room temperature products manufactured in an open system, which had (and has) a four hour outdate. I’ll add that back in the day, it was a HOT topic for sure. So this assumption about safety has become a fact of life that is now the current standard. There are some variations – folks that measure from removal from the refrigerator or cooler/ or from when the unit is spiked but four hours, however it is measured, has become the standard of care. I think it would be difficult to defend a decision to use a longer time frame, without a tremendous amount of documentation and proof.

As for the “30 minute” rule, it is again an assumption that has become a gold standard – but this standard has been challenged to a certain degree. The 30 minute rule has been used for years (maybe even longer than the 4 hour rule, I think) for the length of time that a unit could be out of blood bank refrigerator and still returned for reissue. That rule has then been used to communicate to nursing that they must either start the transfusion or return the unit to the blood bank within 30 minutes. It has no real science, just a guess about how long it would take a unit of blood to reach 10^oC. The magic 30 minutes to 10 degrees has been challenged and certainly AABB has been asking for some documented proof to demonstrate that the number is accurate for use to determine if a unit may be reissued. Most folks I’ve found have given up on the time a unit is out of the refrigerator and are using temperature to determine if a unit can be reissued (either measuring the temperature or using the temperature dots).

I find it interesting that so many of our “golden rules” are based on best guesses or assumptions that have not been proven. I don’t by the way think that it bad, just interesting. Hope the background helps you find your way through all the information.

Jeanne

[Stoogiesfreak]

Jeanne,

I love it!

Found another that probably started out doing major and minor crossmatches!

Thanks,

John

[jeanne.wall]

Found another that probably started out doing major and minor crossmatches

You are so right - and on a recent AABB assessment I actually got to explain the difference!

[Auntie-D]

Found another that probably started out doing major and minor crossmatches!

I still do an immediate spin tube XM when doing an XM just to confirm ABO compatibility - to confirm I haven't mixed up samples more than anything

Edited November 4, 2011 by Auntie-D

[Stoogiesfreak]

Me too!

John