Issue of Blood Components and Products to Patient/Acute Care Units

Prior to requesting the transport of blood products, the person administering the product should ensure:

  • The patient has an IV line established with saline and
  • The physician orders for transfusion have been documented and
  • The patient’s consent has been obtained
  • The patient is wearing the RTSIS band (for red cells units)

Transfusion Medicine arranges for the transport of blood components and products to patient/acute care units. The Distribution Services department provides portering services. Products may also be issued to and transported by PCU staff and volunteer personnel. Components/products may also be transported through the pneumatic tube system at SHC.

To request the dispense of a blood component or product, enter a dispense request in SCM or complete a Dispense of Blood Component/Product form (TM1763) with the following: 

  • Patient name (last and first name)
  • Patient MRN
  • Location to where the product is to be taken
  • Product required
  • Volume of product required (number of units)

On receipt of the request, TM staff will advise PCU/ACU staff if preparation of the product will require more than 30 minutes to prepare. Otherwise the component/product will arrive within 30 minutes.

It is of critical importance that the proper steps be followed when issuing blood components and products. It is the responsibility of the Transfusion Medicine staff to ensure that the requested blood product is issued to the proper recipient and that only components or products for which there is a physcian order are dispensed. 

  • The person portering the product may be asked to ensure they are receiving blood products for the assigned patient by reciting back information on the blood product transfusion tag to Transfusion Medicine staff. The Transfusion Medicine staff will correlate the information recited from the tag to that contained on the patient notification and in the laboratory computer system. If the patient demographics and the transfusion tag information are identical, the technologist will dispense the appropriate blood product. Discrepancies shall be resolved before products are issued.
  • The identification of the person portering the product will be recorded. 
  • Products will be issued with a transfusion tag securely attached, indicating the identity of the product the patient for whom they are intended. The transfusion tag will include:

 

  • Patient’s last name, first name
  • Patient’s health record number (medical record number, PHN, Medipatient number or TBCC number)
  • Product type
  • Product unique unit number, pooled unit number or lot number
  • ABO and Rh of the patient for blood components
  • ABO and Rh of the product for components containing red cells and platelets
  • ABO of plasma units
  • Interpretation of compatibility tests for red cell components
  • RTSIS number for red cell components
  • Date and time of issue

Information on transfusion tags may differ as follows:

Condition

Difference

Emergency units issued before the patient’s identification is known

Patient’s name will be the trauma patient name as defined by site ER procedures.

No RTSIS

Plasma protein products issued to stock locations

No tag

Patients with antibodies/ special requirements Specific antibodies will be listed, e.g. Fya, K
Pooled products Number of units in the pool
Crossmatched products Cancellation date

  • The Transfusion Medicine staff will perform a visual check of the blood unit to ensure there is nothing unusual about its appearance.

    Special Notes

    1. One unit of red cells is issued at a time with exceptions for:

    • Patient care units or locations that have a controlled blood product storage refrigerator
    • For transfusion to patients with multiple IV sites established for transfusion
    • Extreme emergency when multiple units may be transfused simultaneously, for example, massive transfusion
    • Products that do not require refrigeration
    • Plasma protein (fractionation) products to be transfused as a single dose
    • 2 units may be issued to FMC and PLC renal dialysis patients for rapid transfusion (30 minutes per unit).

    Blood must NOT be stored in PCU/ACU unit refrigerators except those intended and controlled for this purpose.

    2. Blood transfusions should be completed within 4 hours of removal from a controlled blood product storage refrigerator.

    3. Platelets are stored at room temperature and MUST NOT be placed in any refrigerator.

    4. Products that have reached their expiry date and/or time will not be issued. Short dated products (such as platelets) may be issued past their expiration time provided the physician has been notified that the product is expired and has agreed to the issue of the product. This notification and agreement shall be documented.

    5. Products received from the supplier before the completion of donor testing may be issued with the knowledge and approval of the ordering physician. This shall be documented. Following completion of testing, any abnormal testing results shall be reported to the attending physician or designate. This shall be documented.

    6. Components/products selected for dispense will match the product order, or be approved substitutes. TM staff will contact PCU/ACU staff if the ordered product is not available or if further information or clarification of the order is required.

    Issuing Autologous and Directed Units

    Autologous and directed units shall be issued before issuing other homologous units matched for the patient. A reasonable attempt will be made to ensure that autologous and directed units that have been issued to the OR have been transfused prior to issuing other homologous units.

    Autologous units may be issued after the specimen outdate as long as the patient is still wearing the appropriate RTSIS band. If the RTSIS band has been removed, the pretransfusion testing must be repeated prior to issuing the autologous units.

    Blood Storage Refrigerators in Patient/Acute Care Units

    • PCUs/ACUs in possession of refrigerators designed and operated for the purpose of blood product storage are responsible for the operation, maintenance and repair of the refrigerator.
    • Transfusion Medicine staff will check the operation of the refrigerator alarms, and back-up battery semi-annually.
    • Blood products will only be issued for storage in these refrigerators when Transfusion Medicine is satisfied that the temperature alarms and monitoring systems are operating correctly and that the refrigerator temperature is being maintained according to standards.
    • Temperature for blood product storage refrigerators must be maintained as directed on the "Blood Storage Refrigerator Use and Maintenance" instructions posted on the refrigerator. The refrigerator must be equipped with an audible alarm that will alert staff when the refrigerator has exceeded established temperture limits.
    • When the alarm sounds, follow the directions on the “Blood Storage Refrigerator Malfunctions” instructions posted on the refrigerator. Once the alarm situation has been rectified, notify Transfusion Medicine.
    • Blood products will be issued for patients as close to the time of intended transfusion as possible. PCU/ACU processes must provide for the timely return of untransfused units to Transfusion Medicine.
    • In ER at FMC, SHC and ACH Transfusion Medicine staff maintains an inventory of red cells for emergency transfusion. It is the responsibility of the ER staff to ensure that the documentation indicating the identification of the patient is completed when the units are transfused.
    • Food or other items not intended for patient care are not to be stored in these refrigerators.

    Fridge Locations

    Site Location Comments
    ACH ER Unmatched O Neg only
    ACH OR
    CSS OR  

    FMC

    ER

    Unmatched units only
    FMC 7th Floor PARR  
    FMC  McCaig Tower OR  
    FMC OR 1  
    FMC OR 9  
    FMC PCU 57A  
    FMC PCU 94  
    FMC PCU 151-TBCC Out Patient Clinic  
    PLC OR  
    PLC PCU 18-Specialty Clinic Units must be returned by the end of the day
    RGH Day Medicine Units must be returned by the end of the day
    SHC OR
    SHC Day Medicine Units must be returned by the end of the day
    SHC  ER Unmatched units only