All transfusions should be planned during business hours, whenever possible, for patient safety. Only emergency transfusions should be entertained after hours.
The following is only a guide for administration of blood components as individual hospital guidelines should be followed.
- Staff should be vigilant in the checking procedure to ensure that the right blood is given to the right patient. The bedside check is a vital step in preventing transfusion error.
- Patients receiving a blood transfusion must be monitored for signs of potential complications of transfusion, and blood transfusions administered in an environment where any suspected problems can be dealt with swiftly and appropriately.
- Inspect and ensure the pack is not compromised and that there are no clots, unusual discolouration or turbidity prior to use.
- Mix components thoroughly by inversion.
- A standard blood giving set incorporating a filter (170 to 200 µm) should be used for all blood components, these filter out large clots and aggregates and ensures an effective transfusion flow rate.
- Change blood administration set every 12 hours if continuing to transfuse; or with new IV fluids; or with platelet transfusion; or on completion of transfusion, whichever comes first. One blood administration set may be used for multiple packs of red cells provided flow rate remains adequate and manufacturer's recommendations are not exceeded.
- Platelets must be transfused through a new blood administration set. In the setting of massive/rapid transfusion when platelets and plasma are both required they may be transfused sequentially through the same IV administration set.
- Platelets must not be transfused through a blood administration set which has been used for red cells, as red cell debris in the inline filter may trap infused platelets.
- Red cells may follow platelets through the same blood administration set, but not precede platelets.
- Microaggregate filters (pore size 20-40 microns) are intended to remove microscopic debris from stored red blood cells. There is no evidence from controlled trials that their use at the bedside offers clinical benefit and their use is not generally recommended.
- All equipment used to administer blood components including plasma thawing devices, intravenous fluid pumps and blood warmers should be operated according to the manufacturer’s instructions and be designated safe and appropriate for blood transfusion.
- Equipment should undergo constant monitoring, calibration and maintenance.
- Local health service policy should indicate whether blood warmers can be used, including in which situations they are appropriate. The device must be validated by the manufacturer for the administration of blood products and used exactly as specified by the manufacturer.
- Do not prime, add or infuse medications or solutions through the same tubing with blood components, except 0.9% Sodium Chloride Injection. ABO-compatible plasma, 4% Albumin or other suitable plasma expanders may be used only upon approval of the patient’s physician.
- Electrolyte solutions containing calcium, such as Haemaccel®, Hartmann's solution, lactated Ringer's solution must never be added to or administered through the same intravenous line as blood components containing citrated anticoagulant.
Priming or flushing blood administration sets with a small amount of 0.9% sodium chloride (normal saline) between red cell packs is not evidence-based and may be unnecessary. However 0.9% sodium chloride (normal saline) may be required to maintain access if the next red cell unit is not readily available.
- Transfuse one unit at a time. Administering two different types of blood components concurrently (such as platelets and plasma) is not recommended in routine practice because in the event of an adverse reaction it is difficult to ascertain which component was responsible. However, this may be unavoidable in an urgent massive transfusion episode.
- Start transfusion within 30 minutes of removing a blood component from its approved storage. You must complete transfusion of a particular unit prior to its expiry or within 4 hours, whichever is sooner.
- The infusion rate for blood products depends on the clinical context, age and cardiac status of the patient. In stable, non-bleeding adult patients typical administrations details are:
- Red cells: 1-3 hours
- Platelets: 15-30 minutes
- Fresh frozen plasma: 30 minutes
- Cryoprecipitate: 30-60 minutes per standard adult dose
- After completion of the transfusion blood administration sets may be flushed with normal saline to ensure that the patient receives all of the blood. The minimum volume of normal saline required to prime the IV line should be used though taking into account the individual circumstances of the patient (for example in the neonate; or patients at risk of fluid overload or on fluid restrictions).
For more details on specific aspects of blood component administration, consult the Guidelines for the Administration of Blood Components.
- ANZSBT/RCNA Guidelines for the administration of blood products. 2nd edition, 2011.