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306 Section VIII ■ Transfusions

c. Small volume transfusion of ≤15 mL/kg of RBCs

stored to maximum outdate, delivers approximately

0.3 mEq/kg of K+

, and does not pose a significant

risk to most neonates when transfused slowly over

2 to 4 hours (2,24).

d. Use of split RBC packs effectively limit donor exposures, and are safe for use in neonatal small volume

transfusions up to the outdate of 35 or 42 days

(2,25,26). This practice requires sterile connecting

devices, and either transfer packs or syringe sets that

permit multiple aliquots to be removed (Figs. 43.1

and 43.2).

4. Verify whether cross-matched product is necessary or

un–cross-matched product is adequate.

5. Confirm that restrictions have been adhered to on

blood product and transfusion tag.

a. CMV: Tested/untested

b. Irradiated: Yes/no

c. Directed (familial) donation: Yes/no

d. RBC antigen-negative: Yes/no

e. Sickle tested-negative: Yes/no

f. Other restrictions specified: Yes/no

6. Verify appropriateness of blood selected for patient by

comparing blood product and unit tag (integral to

blood unit) information and patient identification. Barcode reading devices are advisable.

a. Blood unit tag and blood bag

b. Patient hospital or medical record number

c. Patient identification by armband or footband

d. Blood group and type of both donor and recipient

e. Expiration date and time and restrictions on unit

and order

f. Restrictions as ordered by physician or by institutional guidelines

7. Warming RBCs

a. There is no need to warm small-volume PRBC aliquots, particularly if the transfusion is given over 2

to 3 hours.

b. RBCs may be warmed by placing the syringe beside

the infant in the warm-air incubator for 30 minutes

prior to transfusion.

c. Inappropriate warming by exposure of blood to heat

lamps or phototherapy lights may produce hemolysis. Shielding the RBC component and tubing from

UV light is recommended (27,28).

8. Adhere to sterile technique throughout procedure.

9. Some syringe sets have 150 micron inline filters

attached such that they are filtered during the blood

bank’s aliquoting process (2). If prefiltered RBCs are

provided by the blood bank in a syringe, attach tubing

directly to syringe.

10. If RBCs are provided in a bag, use large-bore needle

(18-gauge or larger) to withdraw volume into syringe.

Filter should be placed between bag and syringe

(Fig. 43.1).

11. Prime tubing with blood. Clear syringe and tubing of

bubbles, and mount into infusion device.

12. Verify patency of vascular access.

13. Clear line into patient with normal saline.

14. Record and monitor vital signs.

15. Determine spot glucose test. Repeat hourly as needed.

16. Begin transfusion at controlled rate: 3 to 5 mL/kg/h.

17. Gently invert container of blood every 15 to 30 minutes

to minimize sedimentation.

18. Stop transfusion if any adverse change in condition

occurs.

19. At end of infusion, clear blood from line with saline.

20. Check recipient hemoglobin and hematocrit, if necessary, at least 2 hours after transfusion.

21. If posttransfusion hematocrit/hemoglobin is not up to

expected level, consider