R.P.S.
HOSPITAL
BLOOD TRANSFUSION POLICY
1.0 POLICY:
Blood and blood products shall be used rationally for transfusion. NACO guidelines on rational use of blood
and blood products transfusion shall be followed for determining blood transfusion for a patient, Drugs
and cosmetics act shall be adhered to. A copy of these acts and guidelines shall be maintained in the
hospital. Informed consent shall be obtained from the patient before blood or blood product transfusion.
Transfusion reaction if any shall be reported. The details of the transfusion reaction shall be recorded in
patient’s file which shall be analyzed by consultant in charge and other concerned personnel. Based on
analysis corrective and preventive action shall be taken. A record of all transfusion reaction shall be
maintained and shall be reflected in monthly report.
2.0 PURPOSE: To define the process of Blood Transfusion.
3.0 DEFINITIONS: Nil.
4.0 ABBREVIATIONS:
NACO- National AIDS Control Organization.
AIDS- Acquired Immune Deficiency Syndrome.
BT- Blood Transfusion.
5.0 SCOPE:
It includes all the patients undergoing blood transfusion.
6.0 RESPONSIBILITY:
7.0 DISTRIBUTION:
Nursing Superintendent/ Nursing Head.
8.0 PROCESS DETAILS:
Sr. No Procedure Steps Responsibility
1 1. There must be consultant’s order for blood transfusion Consultant
specifying:
a. Type of component
b. No. of units to be administered
c. Rate of administration
d. Warming of blood / blood components
e. Medications if any
f. Special procedures such as filters, irradiation
2 Primary Nurse to identify the purpose of blood transfusion. Nursing Staff
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3 Primary Nurse to check the type of B.T. Nursing Staff
Resident Officer to fill up B. T. requisition form, send to Medica
4 Blood Resident l
Storage centre and inform the time limit. Officer
Primary Nurse to ensure blood specimen is submitted to
5 Blood Nursing Staff
Storage centre for cross matching.
6 On receiving the blood, Primary Nurse to ensure checking of Nursing Staff
the blood group and expiry date by Resident Medical Officer.
Blood should be allowed to stand at room temperature for
7 30- Blood Bank
45 minutes before its administration. Assistant
8 Prepare all bedside articles and prepare patient for blood Blood Bank
transfusion. Assistant
9 Explain the patient & relatives about the procedure. Consultant
10 Physical preparation of patient. Nursing Staff
11 Check IV Cannula for blockage or any complication. Nursing Staff
12 Check vital signs Nursing Staff
13 Check site of B.T. Nursing Staff
14 Use of 18 or 20 gauge Intra cath for infusion is recommended. Nursing Staff
15 Primary Nurse & Resident Medical Officer to verify the Nursing Staff & Residential
patient’s name, IP No. on the sticker (attached on the blood Medical Officer
bag) & form received from the blood storage centre in the
patient’s presence, at the bedside, prior to transfusing.
16 The patient must be closely observed and assessed for: Nursing staff
Vital signs
Rate of flow
Signs of circulatory overload
Urinary output
Needle site for signs of infilteration, haemotoma & dislodgement of needle etc.
Any possible transfusion reaction / complication including fever, chills, back pain, dyspnea, hypotension,
hemoglobinuria, bleeding.
Patency of infusion [Link] the patient warm & comfortable with a blanket
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1
7the event of a suspected transfusion reaction, follow the Nursing Staff
following steps:
a. STOP the transfusion immediately
b. INFORM the Resident Medical Officer immediately
c. RECHECK all blood labels and patient
identification
d. DRAW blood sample in a separate tube
e. RECORD the reactions in nursing sheet with time.
f. SUBMIT Blood transfusion reaction form to quality Incharge
Nursing Staff
a. Time of start and completion of B.T.
b. Volume of blood administered
c. The group & type of blood administered
d. Rate of flow
e. Any reactions observed
f. Any medications administered
Nursing Staff
21 SAFETY MEASURES Nursing Staff
1. Follow strict aseptic technique throughout the
procedure.
2. Appropriate filter has to be used for transfusion.
3. Care is to be taken to prevent introduction of air in the
apparatus.
4. No Medications shall be administered simultaneously
with blood or blood components via the same IV line.
5. If any IV fluids are to be given immediately before,
during or after transfusion always use physiologic
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saline to prevent haemolysis of the blood in the
tubing.
8.1 Request for Blood:
a. To ensure patients safety, blood / blood components should not be prescribed unless there is a real
indication.
b. Request should be made by a consultant/Associate consultant/ Clinical Associate/ Registrar.
c. Blood transfusion request form should be filled completely by Duty Doctor.
d. Consent for transfusion should be taken from patient / guardian after explaining the transfusion
requirement or doctor can give consent in case of unaccompanied patients who are incapable of giving
consent.
e. Blood sample should be taken for ABO & Rh grouping and cross matching.
f. The entire request for blood / blood component should be sent to nearby Blood Bank (Nagarmal Modi
Seva Sadan Blood Bank).
8.2 Grouping:
a. All patients should be grouped & serology in case:
i. Any intermediate or major surgery is planned.
ii. Any invasive procedures are planned where a risk exists such that blood transfusion is a possibility.
iii. Transfusion of blood / blood components is planned.
iv. The patient is diagnosed with a medical disease with likelihood of blood /blood components
transfusion requirement.
b. Grouping will be performed by laboratory staff &
confirmed by microbiologist
8.3 Blood reservation:
a. Blood should be reserved before all elective surgeries the procedure will be as under:
i. The requisition for blood and the blood sample will be sent to the nearby Blood Bank (Nagarmal Modi
Seva Sadan Blood Bank).
ii. Cross matching and issue of blood will be done from Nagarmal Modi Seva Sadan Blood Bank.
iii. In case of non-availability of required blood group, the blood requisition sent to other Blood Bank.
iv. 8.5 Procedure before transfusion:
The responsibility for transfusion of blood products rests upon the treating physician. In accordance with
the regulations of the Ministry of Health, two persons are responsible for ensuring the proper
identification of the blood component and the patient. These may be a physician and a nurse/ two
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physicians.
Verification of the unit label, the transfusion form and the patient identification is of paramount
importance in preventing serious transfusion reactions and must be performed without exception.
a) Blood / Blood components should be checked by the doctor and the following details should be
verified: blood bag with patient’s blood group, Name, [Link] for correct identification of recipient.
b) In the comparison process, special attention must also be paid to the unit number and blood type as
mentioned on the blood bag and the transfusion form. If there are any discrepancies, the unit should not
be transfused and returned to the Blood Bank.
c) Informed consent is obtained from the recipient for the said transfusion.
d) Blood must not be warmed by insertion in hot water, microwave or on a radiator.
e) Check BP / Pulse / Temperature and record in the case file before transfusion.
f) Premedication prior to whole blood or packed cell transfusion should be discouraged as it may tend to
obscure a significant transfusion reaction.
g) Medicines to be given before blood transfusion include inj Avil and Inj. Dexamethasone (dexona). In
case of patient receiving multiple transfusions Inj. Lasix, after 2 pints of transfusion.
8.6 Procedure during transfusion:
a) Whole blood / packed cells can be transfused over 3 - 4 hours.
b) FFP / Cryo: FFP/ should be transfused immediately to the patient after receiving, If not used can’t be
stored again, and will not be accepted by the Blood Bank.
c) All blood products should be administered through a blood filter IV Cannula.
d) Blood giving set must be changed every 2 units.
e) Monitoring of vitals can be done by nurses.
f) Visual observation is often the best way of accessing the patient during transfusion. Record base line
observations at the start of each unit and of each transfusion. Temperature / Pulse, BP should be
measured 15 minutes after the start of each unit and hourly thereafter.
g) Monitor rate of flow of blood to ensure transfusion progress, under no circumstances any drug should
be administered through the same IV line.
h) The information on the blood transfusion form must be completed. The date and start-time for the
transfusion should be entered. Signatures are required from those verifying the identification of the
patient and blood unit. During the transfusion, the patient should be observed for signs or symptoms of a
transfusion reaction.
i) The duration of the transfusion should not exceed four hours.
j) At the conclusion of the transfusion, the date and time should be entered and any information
pertaining to an adverse reaction should be noted. In the event of a reaction, the form should indicate the
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nature of the reaction and should be returned to the Blood Bank.
8.7 Management of transfusion reactions:
Blood Transfusion reaction occurring during transfusion.
Step 1 - Stop transfusion.
Step 2 - Keep IV line open with 0.9 % NaCl.
Step 3 - Notify attending physician .
Step 4 - Recheck the patient identification and blood label on the blood component bag.
Step 5 - Send freshly collected post - transfusion sample of blood (preferably from opposite arm) and
sample of urine.
Step 6 - Send the residual blood component unit along with administration set to blood bank
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