Is there any standard that states blood should be started within 30 minutes from time of issue?  We have that statement in our Nursing transfusion procedure but since the 30 minute return time is no longer in place we want the unit to be used after 30 minutes if it is delayed due to IV problems, etc. as long as it can be completed within 4 hours.  Nursing does not want to use if it is past the 30 minute timeframe.

There is no standard that requires a transfusion to be started within a certain time frame from release. 

the only timing that is critical is that the unit needs to be complete within 4 hours of release.

As David said there isn't a BB standard for time frame a transfusion needs to be started but for some reason this time frame is in the nursing policy, theirs is 20 minutes. Where they got this information I don't know. Anyway if blood is sent to the floor and it isn't going to be started in 20 minutes and the floor asked calls the BB (before they actually return it) we tell them if they are going to transfuse and it is will be completed within the 4 hours that it was issued to the floor keep it, otherwise it will be discarded (if temp is greater than 10 degrees)

Our requirement (at Blood Bank insistence) is that the infusion has to begin within 15 minutes of checkout. We had problems with nurses checking out blood products before they made sure that the IV was good and without taking vitals, then wanting to bring the unit back 45 - 60 minutes later. Their policy says check IV and vitals before coming to Blood Bank to pick up units and the short time allowed to start the infusion kind of reinforces that. The number of wasted units dropped significantly after this policy was in place. 

22 hours ago, slsmith said:

 "if blood is sent to the floor and it isn't going to be started in 20 minutes and the floor asked calls the BB (before they actually return it) we tell them if they are going to transfuse and it is will be completed within the 4 hours that it was issued to the floor keep it, otherwise it will be discarded (if temp is greater than 10 degrees)"

We also use the policy shared by slsmith. If there is a delay and they bring it back after 15 minutes, we check the temp. It will probably be over, so they are asked to give in 4 hours or its wasted. An Occurrence report is filed.

We use started within 15 minutes of release.  Our experience is that after 15 minutes, rbc temps are too high to return to inventory.  We do the same as far as if Nursing wants to return but will continue the infusion as soon as they fix "whatever",i.e., keep the unit on the floor.

 

If you set a time, such as less than 30 minutes, and they start the transfusion at 30 minutes, you can be cited by Joint Commission or FDA if they do a trace of that unit - unless there is a deviation from policy report on file.  The 30 minute start time may be in the nursing policy, but when a tracer is performed, the deviation will fall back on the transfusion service to correct.  Although we did ask that the nurses do the preparation before picking up the unit, there would be a phone call saying the start of the transfusion was delayed for some reason. (IV infiltrated while picking up blood is one I remember).  When we started taking temperatures of returned units, we learned they were usually only acceptable to be returned for 15-20 minutes, depending on how they were handled after leaving the Blood Bank.  After much debate, we changed the policy to start the transfusion as soon as possible with the emphasis on completing the transfusion within four hours of leaving the Blood Bank.  We did require them to return the unit to the Blood Bank immediately if, for some reason, the transfusion were cancelled.  

Unless things have changed, I would consider the length of time from issue to completion of the transfusion more important than the time from issue to start.  I'm assuming that a unit still has to have the transfusion completed within 4 hours.  As for start time, that was initially instituted for returned units to be placed back in the refrigerator for reissue and as stated above 30 minutes is way too long.  The 30 minute rule was instituted when blood was issued as whole blood in glass bottles and I doubt in anyone currently following this website ever saw that, me included!  Time to drag a few nursing protocols into the 21st century!

I got to draw a few in glass but never had to xm any that way (therapeutic phlebotomies).

18 hours ago, David Saikin said:

I got to draw a few in glass but never had to xm any that way (therapeutic phlebotomies).

That was my only experience with the glass as well.

3 hours ago, John C. Staley said:

That was my only experience with the glass as well.

Interestingly, I had an aunt who was a head nurse for quite a number of years in Albany NY.  She told me they used to bleed donors into stainless steel bowls and wisk the fibrin out.  She said they never had transfusion reactions. 

Early in my career, we used glass bottles. Since I was familiar with bottles, I got deputized to help my brother-in-law veterinarian collect a blood donation from the family dog.

Isn't it 4 hours from the time the unit is spiked and becomes an open system?  When it is released or issued, it is still a closed system until spiked and the maximum time a room temp closed system is 6 hours.  

Circular of Information states "Transfusion should be started before component expiration and completed within 4 hours."

Doesn't really specify within 4 hours of what???  I'm guessing us blood bankers interpret this to be 4 hours of issue, since it is no longer "maintained in a controlled environment".

We state that they should start the transfusion within 30 minutes, but that is not a "must", just a recommendation of good practice.  If they ask us, we will say that the blood should be infused within 4 hours of issue, but they probably use 4 hours of start of infusion sometimes.  I think this falls under the practice of medicine, although it might matter what the SOP says you are to do.

 

I think the nursing policy determines the time from issue to transfusion start. That time is (or was) often coordinated between nursing and BB as to be acceptable to return the unit within temp. With the advent and common use of temperature indicators attached to the unit, returning these units within temp seems harder. There may be a case for just saying complete transfusion within 4 hours from issue, and no return of units.  Most returns seem to be due to the patient's temp not being taken prior to issue or no consent form. The 4 hours from issue also gives auditors an accurate and easy to find start point.