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4 hours to transfuse


Cliff
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I think we can all agree that products must be transfused within 4 hours.  I cannot find when this 4 hour window starts.

Does it start from the time the transfusion starts?

What if it took 45 minutes from the time it left a controlled environment to the time it started?  Do I only have 3:15 left?

Do you have a policy on when the 4 hour time starts?  I'd like to propose it's from the time it leaves the controlled environment.  This would be a huge change for an organization as large as us, I want to make sure I'm not missing something.

Thanks

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Hi Cliff.  We do 4 hours from the time the unit leaves the blood bank.   We use a electronic time stamp to document this time on the blood administration tag that is attached to the unit.  We teach the nurses that they have 4 hours from this time to complete the transfusion.   This does not apply if we send products in a cooler.   

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The Circular of Information for the use of Human Blood and Blood Components has information regarding transfusion within 4 hours.  Here is an excerpt:  "Transfusion should be started before component expiration and completed within 4 hours."  And another, "The initial portion of each unit transfused should be infused cautiously and with sufficient observation to detect onset of acute reactions. Thereafter, the rate of infusion can be more rapid, as tolerated by the patient’s circulatory system. It is undesirable for components that contain red cells to remain at room temperature longer than 4 hours. If the anticipated infusion rate must be so slow that the entire unit cannot be infused within 4 hours, it is appropriate to order smaller aliquots for transfusion."

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6 minutes ago, tcoyle said:

The Circular of Information for the use of Human Blood and Blood Components has information regarding transfusion within 4 hours.  Here is an excerpt:  "Transfusion should be started before component expiration and completed within 4 hours."  And another, "The initial portion of each unit transfused should be infused cautiously and with sufficient observation to detect onset of acute reactions. Thereafter, the rate of infusion can be more rapid, as tolerated by the patient’s circulatory system. It is undesirable for components that contain red cells to remain at room temperature longer than 4 hours. If the anticipated infusion rate must be so slow that the entire unit cannot be infused within 4 hours, it is appropriate to order smaller aliquots for transfusion."

Thanks, I did read this but did not take it as a strict rule that it must be infused within 4 hours after leaving it's controlled environment.  I need something more substantial than "undesirable". :)

Regardless, I may make the suggestion we change to 4 hours from the time it leaves it's controlled environment.

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A closed system room temp product expires in 6 hours.  An open system room temp blood product expires in 4 hours.  In most cases the blood product, ie RBC unit, doesn't become an open system until it is spiked.  If your policy is to start the transfusion within 30 to 60 minutes from issue, then you would still comply with the regulations if the total time of the transfusion, from spike to completion is no longer than 4 hours. The 4 hour time limit is easier to comply when the RN is keeping track of the time it starts until completion, not when it is issued since that time is likely only documented in the blood bank computer. 

John Van Patten, MT(ASCP)SBB  

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We had TJC tell us that the transfusion start time is when the blood reaches the patient's vein so we use 4 hours after that.  That start time is more pertinent to calculating how long the nurse must stay with the patient at the beginning of the transfusion.  If the blood takes 8 minutes to reach the vein after spiking then the nurse may only stay with the patient for the first 7 minutes of donor exposure which probably isn't long enough. 

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