Issuing multiple units to one patient

[BloodbankZ]

Hi I am creating a policy on issuing multiple units to one patient. We already do this for the ER, OR, CVICU, and ICU, and on any emergent need. But now we are getting requests for just general practice. Does anyone know of any AABB, FDA, or CAP standard about this I am having trouble finding one as far as who should and shouldn't get it. I am not in support of doing it just for non patient convenience thanks in advance.

[Dansket]

We do not issue multiple RBC units for non-emergency transfusion unless the units can be infused simultaneously, i.e., more than one existing IV line.

[Dr. Pepper]

I'm assuming they are being issued in a cooler, which is in itself a bit of a compromise in storage (no alarms, possibility of removing it and leaving it around at room temp). I'm not aware of specific regs that forbid the issue of multiple units in properly prepared and validated coolers etc. For me, the big issue would be lack of control and oversight of the units. The more units you have outside of the blood bank the more opportunities there are for bad things to happen to them. You are taking more risks so that nursing does not have the very minor inconvenience of sending a gofer to the lab or requesting a unit be tubed to them a couple of hours after issuing the first one. I would stick to my guns. It's your blood, and the very best place for it to live is your refrigerator.

 

We only issue multiple units in coolers to the OR. We have a contingency to do so in the ED but never do (we don't get trauma patients).  I would do as Dansket does.

Edited September 24, 2015 by Dr. Pepper

[SMILLER]

Same as above, here. 

 

I feel that issuing more than one unit, in most other cases, means that it is likely that the second unit sits on a counter (as in "not being monitored") whilst the first unit is hanging.  I believe that is why we do not allow it routinely.  If they need more than one unit available at any one time, we send them in a cooler.

 

Scott

[BankerGirl]

The only other exception we make on issuing multiple units at one time is for dialysis.  They can transfuse a unit in 15 minutes.  Otherwise, we limit to the above mentioned units.

[David Saikin]

We only do this if they are putting both in at the same time.

[BloodbankZ]

To clarify if we do issue more than one unit they are placed in a cooler with appropriate temp control. Also our coolers are validated for 24 hrs.

[tbostock]

In the AABB Technical Manual, 16th ed, page 617:

Usually, except in the case of an emergency, blood banks allow the issue of only 1 unit at a time.

[mollyredone]

We routinely issue two units for outpatient transfusion in the hospital.  They have Safe-T-Vue devices (irreversible color change) on the units and I validate the coolers annually.  They document on the form or in the computer that the unit is acceptable before transfusing, indicating that the Safe-T-Vue device is still white.  The only other time we issue more than one is to ER for emergency release, massive transfusion or FFP.  These are issued in a box with ice that has been validated by our blood supplier.

[John C. Staley]

Why are the non-emergent areas requesting this?

[AMcCord]

I'm with the 'one unit at a time for non-emergent cases' opinion. Too many ways for things to go wrong.

[Teristella]

For blood/plasma, we don't do it, unless it's going to a bedside procedure of some sort (exchange transfusion), or dialysis, and it goes in a cooler then.

 

We will, however, issue two units of platelets at once, providing the nurse has orders to give both and they will be given back to back or at the same time. We rarely have requests for this except from oncology nurses we see every day who are extremely familiar with transfusion, and we've never had a problem with them. If I wasn't familiar with the nurse, I wouldn't do it.