Spiked units of blood - return/reissue question

[Amber Gaucher]

A unit of blood was spiked for transfusion and approx 40mL was transfused to the patient. The patient's husband noticed that the blood was not being put through a warmer per the Dr's orders (she has a very strong cold that reacts at 37C with multiple reactions in the past). The transfusion was dc'd with the hopes that the RN could collect the blood warming equipment and restart the unit. 
 

While she was trying to get the equipment together the question came up:

 

Should the unit be kept down in the blood bank or on the floor? 

 

My understanding is that blood cannot be reissued if the unit has been spiked (per AABB standards). However, there is no storage on the floor for the unit and we're not even sure if the blood should be put back into a refrigerator or if that would impact the quality of the product with the fluctuation of temperature. 

 

Any suggestions on where the documentation is regarding situations like this or what you do at your hospital? 

Thanks in advance!

[David Saikin]

the unit would need to be transfused within the prescribed period of time whether you took it back for the refriig (you really shouldn't and why would you cool it down just to warm it up again?) or just left it with the patient.  Don't take it back as it needs to be infused in less than 4 hours from the spike anyway (or less depending on the MDs orders for transfusion time)..

[R1R2]

we would not accept it back.  We would advise that any blood left after 4 hours of starting the transfusion be discarded. 

[Dr. Pepper]

I'm with David. It's an odd situation, though. It's fine to leave the blood sitting there on the nursing unit so long as they can finish it up within 4 hours, but, per AABB, it can't go back to the blood bank then back to the floor.

[tbostock]

We would make them keep it up there and complete it within 4 hours from issue.

Could be a reportable incident because the physician's order wasn't followed??

[John C. Staley]

Once again I'm forced to agree with David.  Keep it with the patient and complete the transfusion within 4 hours.  One question, did they disconect the unit from the IV set or just turn off the flow?  Not being familiar with the type of blood warming equipment in use at your facility I wonder about the process involved in stopping the blood, installing or attaching or what ever, the blood warmer and then restarting the blood flow.  I personally would not want to pull the spike from the unit and insert something else.  For some reason that would make me very uncomfortable.  Must be that paranoid blood banker lurking inside me! 

[JoyG]

I agree with everyone.  We would not accept it back, just infuse within 4 hours or physicians orders.

[AMcCord]

Ditto - we would do the same as everyone else.

[cthherbal ☆]

I agree with all, and also Terri that this is a reportable incident since the error reached the patient before it was detected. Good eyes by the family member.

[SMW]

Blood administration is not considered to be manufacturing so the example provided would not be an FDA reportable event.  See excerpt from FDA BPD reporting webpage

http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/ucm073455.htm#EXAMPLESOFREPORTABLEANDNON-REPORTABLEEVENTSBYMANUFACTURINGSYSTEM  

 

For transfusion services, non-reportable events may also include:

• Inappropriate administration practices by the hospital staff in transfusing the patient;

 

[AMcCord]

 

Blood administration is not considered to be manufacturing so the example provided would not be an FDA reportable event.  See excerpt from FDA BPD reporting webpage

http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/ucm073455.htm#EXAMPLESOFREPORTABLEANDNON-REPORTABLEEVENTSBYMANUFACTURINGSYSTEM  

 

For transfusion services, non-reportable events may also include:

• Inappropriate administration practices by the hospital staff in transfusing the patient;

 

 

It would, however, be a reportable occurrence for your hospital quality system....or it certainly should be. It's the kind of thing that Joint Commission would be interested in as well.

Edited October 31, 2013 by AMcCord

[David Saikin]

It would, however, be a reportable occurrence for your hospital quality system....or it certainly should be. It's the kind of thing that Joint Commission would be interested in as well.

I agree with AMcCord . . .  not reportable to the feds but it should spark an internal event process.

[EDibble]

A unit of blood was spiked for transfusion and approx 40mL was transfused to the patient. The patient's husband noticed that the blood was not being put through a warmer per the Dr's orders (she has a very strong cold that reacts at 37C with multiple reactions in the past). The transfusion was dc'd with the hopes that the RN could collect the blood warming equipment and restart the unit. 

 

While she was trying to get the equipment together the question came up:

 

Should the unit be kept down in the blood bank or on the floor? 

 

My understanding is that blood cannot be reissued if the unit has been spiked (per AABB standards). However, there is no storage on the floor for the unit and we're not even sure if the blood should be put back into a refrigerator or if that would impact the quality of the product with the fluctuation of temperature. 

 

Any suggestions on where the documentation is regarding situations like this or what you do at your hospital? 

Thanks in advance!

By a strong cold that reacts at 37C I assume you mean invitro? This phrasing confuses me, but maybe it is because it is Friday afternoon....