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Time Elapsed between Issue and Transfusion


BB1956

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We currently have a policy that a unit of blood or product should be transfused within 4 hours.  Does anyone have guidelines as to how much time can elapse between issue and hanging the unit of blood?  A nurse returned a unit a few weeks ago stating she would not hang the unit because it was issued over 30 minutes ago.  Needless to say the product was wasted.    I have not been able to find a standard governing the time between issue and hanging of a unit.  Any one have a procedure or standard for guidance?

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Our policy is the same as yours.  Infused within 4 hours of issue.  If there was something that magically occurred to a unit at the 30 minute mark, all transfusions would be required to be completed within 30 minutes.  My suspicion is that the nurse remembered the old rule that units had to be back into the refrigerator if not started within 30 minutes to be eligible for reissue.  If the unit is started and completed within the 4 hour time frame, then the regulations as they stand are met.

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Our Policy also states the same. RCs to be infused within 4 hours of issue time. We also state on the transfusion forms that units must be started within 30 minutes of issue time to offset most of the reactions. Ward nurses are also told that 4 hours is the maximum time for a unit to be transfused, initially the transfusion must be very slow for first 15-30 minutes, but then it must be completed as fast as patient's hemodynamic (HD) condition can tolerate. For patient's with poor HD condition we halve the units on request.

 

If told from wards that a unit was not started within 30 minutes, we tell them to start transfusion immediately and try & complete it within 4 hours. Any remaining quantity after that time must be discarded.

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That Nurse is thinking of the time-frame a lot of Hospitals giving Nursing as to when they can "return" a unit to the Blood Bank if not used. But even that is controversial (still referenced in Technical Manual as 30 mins., but FDA wants temps. taken). So whatever your Policy for units being "returned" to the Blood Bank (whether 30 mins.; whether you take the temp. upon return to determine if still in range; etc.), I have always told Nursing (i.e. if there has been a delay in starting the transfusion for some reason) that if it is no longer acceptable back "by us," they should keep the unit because they have 4 hours from the time it left the Blood Bank, in which to transfuse. Because the reality is (and what does not make rational sense in this Nurse's response) is that the unit is out at Room Temp. for 4 hours even if the transfusion is started right away. So the fact that she did not start it within 30 mins., may only mean it cannot be returned to the Blood Bank; it does not mean it cannot still be transfused (it just means she has lost part of her 4 hour transfusion window).

And I know I have seen controversial posts here also with regard to "when" the 4 hour clock starts. But in my mind, it starts once the blood product is no longer being stored in the acceptable temperature range (so if not Issued in a Cooler, it starts when Issued from Blood Bank....in my opinion).

Brenda Hutson

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In an open system at room temp expiration is 4 hrs so one could argue that the clock starts when the unit is spiked although I prefer to calculate from issue.  I agree with everyone that the 30 minute time-frame to start the unit is probably derived from the old time to return it.  Still, we don't want them to take units and have them sitting around on the ward tempting someone to hang them on the wrong patient or set them by a heater.  I think nurses should start the unit within 30 minutes or have a good reason why they didn't but the unit does not have to be wasted as everyone above said.

 

Hang on for the next ride.  The latest issue of Transfusion has a long article saying that nothing bad happens to blood even if it is out for 60 minutes at a time several times in its lifespan!  Until the FDA accepts the data our regs won't change, but it is interesting science.  There is also an interesting article on storing plts by cycling them between 4 & 37 degrees every day.  Boy will they be selling a lot of new plt incubators/refrigerators if this one pans out!

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Our policy and Nursing SOP states to start immediately.  If any problems occur, we say to return for evaluation (temperature) and if the product is out of temp range, we give them 4 hours to use the product (from time of issue).  Most of the time, the product is wasted.  If the waste is it due to an error that was preventable, such as calling for it but they are truely not ready to infuse, and then it is wasted due to lack of readiness, we then charge the floor.  If they did not start the product due to other reason, such as patient spiked a temp, going to CT, etc. then the hospital aborbes the cost. Hope that made sense

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Do not exceed four hours when transfusing a unit of red blood cells. If blood must be transfused very slowly, request that the packed cells be ordered as a split unit. Red blood cells left unrefrigerated longer than 30 minutes (temperature exceeds 10° C) must be transfused to the patient within four hours from the time of issue. These units cannot be returned to the Transfusion Service for reissue to another patient.

 

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That Nurse is thinking of the time-frame a lot of Hospitals giving Nursing as to when they can "return" a unit to the Blood Bank if not used. But even that is controversial (still referenced in Technical Manual as 30 mins., but FDA wants temps. taken). So whatever your Policy for units being "returned" to the Blood Bank (whether 30 mins.; whether you take the temp. upon return to determine if still in range; etc.), I have always told Nursing (i.e. if there has been a delay in starting the transfusion for some reason) that if it is no longer acceptable back "by us," they should keep the unit because they have 4 hours from the time it left the Blood Bank, in which to transfuse. Because the reality is (and what does not make rational sense in this Nurse's response) is that the unit is out at Room Temp. for 4 hours even if the transfusion is started right away. So the fact that she did not start it within 30 mins., may only mean it cannot be returned to the Blood Bank; it does not mean it cannot still be transfused (it just means she has lost part of her 4 hour transfusion window).

And I know I have seen controversial posts here also with regard to "when" the 4 hour clock starts. But in my mind, it starts once the blood product is no longer being stored in the acceptable temperature range (so if not Issued in a Cooler, it starts when Issued from Blood Bank....in my opinion).

Brenda Hutson

Ditto, ditto, ditto!  :D

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