Version October 24, 2008 , Revised 3/16/09

3 PROCEDURE FOR OBTAINING AND TRANSFUSING BLOOD DURING AN EMERGENCY

 

Experienced personnel are available in the Blood Bank on a 24-hour basis to assist with the provision of blood and blood components during emergencies.

Only Blood Bank employees are allowed access to the blood inventory, or are permitted to issue blood for transfusion.

To Request Blood During an Emergency

Step	Action
1.	Call 6-6888
2.	Describe the urgency of the situation
3.	Provide the patient's name and medical record number
4.	Indicate the blood component and amount required
5.	Provide the patient’s age and sex
6.	Indicate the location of the patient
7.	Verify or correct when orders are read back to assure accuracy.

 

If blood is not currently available, the technologist can then determine the extent to which compatibility testing can be performed. As the amount of compatibility testing decreases, the possible risk of transfusing incompatible blood increases. Depending on the availability of a specimen and current status of testing blood may be released as

• Uncrossmatched red blood cells
• Type specific blood
• Testing in process but antibody screen, crossmatch or antibody identification incomplete; antigen negative blood unavailable

Emergency Release Documentation

• The Transfusion Record Form of emergency released units will contain the caution that the blood is being released on an emergency basis.
• The physician authorizing the emergency release must sign the Emergency Request section of the Blood Bank Requisition Form and return it to the Blood Bank.
• Blood specimens and requisitions must be appropriately labeled. Many hemolytic transfusion reactions have occurred under emergency conditions when routine patient identification procedures are ignored or circumvented.
• The Blood Bank will complete testing and notify the physician of the results of testing.
• Temperature monitors are attached to assist staff in determining if blood has been properly stored. The beads in the R & D indicator will have moved from the rounded end of the indicator if the blood has not been maintained below 10 C.

 

GROUP O RED BLOOD CELLS WITHOUT COMPATIBILITY TESTING

• Group O Red Blood Cells are issued when a blood sample cannot be supplied, and/or the patient's blood is not available in the Blood Bank for typing.
• A blood sample should be drawn for typing and crossmatching before transfusion is initiated.
• Transfusion with group O Red Blood Cells usually does not preclude subsequent transfusion with group and type specific blood. The use of type specific blood in these situations, rather than group O Red Blood Cells, conserves group O Red Blood Cells for those patients who must receive it.

Location of Units Labeled for Emergency Release

Location	Number of Units	ABO/Rh Type
Blood Bank	6	O Positive
Blood Bank	6	O Negative
Emergency Department Laboratory	6	O Positive
Emergency Department Laboratory	2	O Negative
Survival Flight - ER Lab	2	O Negative
Delivery Room	2	O Negative
Pod A	1	O Negative
Holden	1	O Negative

If used

• notify the blood bank and
• submit a completed requisition with the emergency release section of the form signed.

If additional units are needed call the blood bank at 6-6888.

The blood bank will 1) complete compatibility testing, 2) maintain records of the recipient of the blood components and 3) replace the units in the blood refrigerator.

IMMEDIATELY PRIOR TO BLOOD TRANSFUSION

Pretransfusion Vital Signs Documentation

* Record the patient's blood pressure, pulse, respirations and temperature in the chart or on the transfusion record form to provide a baseline

* Verify the physicians's orders for transfusion and if any ordered pretransfusion medications have been administered

* Perform bedside verification of patient and component using the

- labels on the bag

- Transfusion Record Form and

- patient's attached positive patient identifiers.

Two qualified individuals must

1	If the patient is able to communicate: ask the patient to state his or her name. Verify patient and component identification information.
2	Enter the patient's name and CPI number on the Transfusion Record Form
3	Verify the blood type, donor number and component name.
4	Verify that the product is not outdated.
5	Sign the Transfusion Record Form before the blood transfusion is initiated (both individuals).
6	The person who hangs the blood must record the date and time the transfusion was started.
7	Record the date, time and component in the patient's medical record using UM-CareLink or paper Transfusion Record Form per unit policy (refer to unit policy and Procedure).

NEW PATIENT BLOOD SPECIMEN REQUIRED - TYPE SPECIFIC BLOOD NEEDED BEFORE CROSSMATCH CAN BE COMPLETED

• Approximately 10-15 minutes are required after receipt of the patient's specimen before ABO and Rh type specific blood can be supplied.
• Determinations of blood group by other facilities cannot be used.

TYPE AND SCREEN PERFORMED WITHIN PRECEDING 72 HOURS

• Unless the patient has an unexpected antibody directed against red cells, approximately 20 minutes are required to provide crossmatched blood.

 

BLOOD COMPONENTS FOR PATIENTS BEING TRANSPORTED TO UNIVERSITY OF MICHIGAN HOSPITALS

Units from other facilities may be used for immediate transfusion in the Emergency Department and the Operating Room if they have been appropriately stored and labeled for the intended recipient.

• Untransfused units that are not needed for immediate transfusion should be sent to the Blood Bank in their original shipping container.
• Do not store blood components from other facilities in patient care unit refrigerators.
• Forward completed Transfusion Record Forms for units transfused in transit to the Blood Bank. The Blood Bank will notify the original institution of the disposition of the components.
• If the previous transfusion occurred elsewhere, provide the name of the transferring hospital to Blood Bank personnel, as this information will often prove to be of value in resolving such problems. Previously transfused blood may complicate the determination of the patient's true group and type.

BLOOD COMPONENTS FOR PATIENTS BEING TRANSPORTED FROM UNIVERSITY OF MICHIGAN HOSPITALS

• The Blood Bank will provide components, packed in a transport container.
• During transport Red Blood Cells must be cooled with wet ice.