How can we improve the clinical implementation of blood management?
An effective approach in the clinical implementation of blood management is to identify areas of greatest impact that will provide measurable improvement in patient outcomes with realized cost savings. Consider high-volume blood utilization departments such as orthopedics, cardiac surgery, and medicine. 21
Who should be involved in blood management?
Medical and nursing leadership must be actively involved in endorsing and advancing a blood management program. Execution of blood management will continue to evolve as new research is completed and delivery models are tailored to specific healthcare systems.
What are the three areas of blood management?
It identifies and discusses these three areas of blood management: methodology, implementation, and nurses' direct-care practice. Anemia isn't a disease but a sign of an underlying illness or condition. Anemia falls into three major categories: nutritional deficiency, acute or chronic blood loss, and anemia of chronic disease.
What are the functions of blood management?
This evolution has broadened the scope of clinical application and now includes the functions of blood utilization, practice variability, and optimal use of blood products. Blood management consists of prevention, early identification, and treatment of anemia coupled with the best possible transfusion practices.
What do you use blood samples for?
During venipuncture, a lab professional, known as a phlebotomist, will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out.
What conditions require therapeutic phlebotomy?
Therapeutic phlebotomy may be indicated for hemochromatosis, polycythemia vera, porphyria cutanea tarda, and polycythemia secondary to arterio-venous fistulae, cyanotic congenital heart disease or cor pulmonale.
What are the 3 methods we have use for phlebotomy?
Three popular methods of blood collection are:Arterial Sampling.Venipuncture Sampling.Fingerstick Sampling.
What are the most common practices of phlebotomy?
Infection prevention and control practices.Perform hand hygiene and put on gloves. ... Disinfect the entry site. ... Take blood. ... Fill the laboratory sample tubes. ... Draw samples in the correct order. ... Clean contaminated surfaces and complete patient procedure. ... Prepare samples for transportation. ... Clean up spills of blood or body fluids.More items...
Why would someone need a phlebotomy?
Phlebotomy is when someone uses a needle to take blood from a vein, usually in your arm. Also called a blood draw or venipuncture, it's an important tool for diagnosing many medical conditions. Usually the blood is sent to a laboratory for testing.
Where is therapeutic phlebotomy done?
It can be done in a physician's office, hospital, or at a blood donation center. It is very similar to donating blood. A needle is placed in a large blood vessel, typically in the elbow crease, to remove blood.
What types of samples might be collected from patients to use for laboratory testing?
Most often, all that is required is a blood sample. However, samples of urine, saliva, sputum, feces, semen, and other bodily fluids and tissues also can be tested. For some samples, they can be obtained as the body naturally eliminates them.
How do you give a patient a blood sample?
Ask the patient to make a fist; avoid “pumping the fist.” Grasp the patient's arm firmly using your thumb to draw the skin taut and anchor the vein. Swiftly insert the needle through the skin into the lumen of the vein. The needle should form a 15-30 degree angle with the arm surface. Avoid excess probing.
What are the 4 phlebotomy techniques?
Results. Four different ways of taking blood were observed: cannulation and a syringe (38%), cannula with evacuated tube and adaptor (42%), syringe and needle into vein (14%) and evacuated tube system used conventionally (6%).
Why do hospitals draw blood?
When you're in the hospital, you may have blood drawn for two common tests. A complete blood count (CBC) checks your blood for signs of infection, immune system problems, bleeding problems, and anemia (low iron). A blood chemistry panel gives your doctor information about your muscles, bones, heart, and other organs.
What is therapeutic phlebotomy procedure?
Therapeutic phlebotomy is a blood draw that's done to treat a medical problem, such as having too much iron in your blood. With therapeutic phlebotomy, more blood is drawn than during a regular blood draw. Your doctor will decide how much blood will be drawn based on the reason you're having the procedure.
Why are syringes often used to obtain blood from geriatric patients?
The use of smaller gauge needles helps prevent trauma to small, fragile veins that frequently collapse in the geriatric patient.
What is the threshold for RBC transfusion?
Upon entering an order for RBC transfusion, the intern received an interruptive BPA, which stated that “Strong evidence suggests that in hemodynamically stable, non-bleeding patients, an Hb threshold of 7 g/dL (or 8 g/dL in acute coronary syndromes after cardiac surgery) can decrease transfusion requirements and avoid adverse outcomes.” There was an option to remove the transfusion order or proceed with the order if clinically indicated. The intern reviewed the case with his senior resident, which prompted a discussion of the evidence that a restrictive transfusion strategy (transfusion when Hb level is <7 g/dL) significantly improved outcomes in patients with acute upper GI bleeding when compared with a liberal strategy (transfusion when Hb level is <9 g/dL). 17 The intern removed the transfusion order. The patient remained hemodynamically stable and did not require any further RBC transfusions.
What is restrictive transfusion?
Restrictive transfusion practice is a key element of PBM, incorporating the principle of giving RBC transfusions only when the potential benefits are deemed to outweigh potential risks, along with a goal of minimizing the use of RBC units. 2 Improving blood safety and promoting restrictive blood transfusion practices first gained impetus in the 1980s in response to the recognition that hepatitis C virus and HIV were transmitted by blood transfusion. 4 Since then, despite substantial advances in safety with respect to infections transmitted by transfusion, evidence has accumulated to indicate that RBC transfusion continues to be associated with other short- and long-term adverse patient outcomes. Institutional experience and national databases indicate that a restrictive RBC transfusion approach and other measures to minimize the use of RBC transfusion, such as detection and management of preoperative anemia, 2 began to have an impact as best practices when RBC transfusions began to decline annually in the United States starting in 2010. 4
What blood pressure was hematemesis?
A 64-year-old woman presented to the emergency department with hematemesis. On presentation, she had a systolic blood pressure of 70 mm Hg and heart rate of 140 beats per minute (bpm). Her hemoglobin (Hb) concentration was 6 g/dL. She received 2 L of crystalloid fluids and was transfused with 3 units of packed red blood cells (RBCs). Emergent upper endoscopy revealed a bleeding gastric peptic ulcer that was clipped. She was transferred to the intensive care unit where she was evaluated by the on-call medicine intern. She denied any current chest pain, shortness of breath, lightheadedness, dizziness, or hematemesis. Her blood pressure was now 130/80 mm Hg and her heart rate was 80 bpm. Her Hb was 8.1 g/dL. Unaware of evidence suggesting that a restrictive transfusion strategy would be appropriate in the setting of acute upper gastrointestinal bleeding, the admitting intern ordered a transfusion of 1 unit of packed RBCs. How can clinical decision support (CDS) reduce such inappropriate transfusions?
What is blood banking?
Blood banking is the process that takes place in the lab to make sure that donated blood, or blood products, are safe before they are used in blood transfusions and other medical procedures. Blood banking includes typing the blood for transfusion and testing for infectious diseases.
What tests are done in the lab after blood donation?
A certain set of standard tests are done in the lab once blood is donated, including, but not limited to, the following: Screening for any unexpected red blood cell antibodies that may cause problems in the recipient. Screening for current or past infections, including:
Why is leukocyte reduced blood filtered?
Leukocyte-reduced blood has been filtered to remove the white blood cells that contain antibodies that can cause fevers in the recipient of the transfusion . (These antibodies, with repeated transfusions, may also increase a recipient's risk of reactions to subsequent transfusions.)
What is the function of plasma?
Plasma serves many functions, including the following: Helps to maintain blood pressure. Provides proteins for blood clotting.
Why is irradiation performed?
Irradiation to blood cells is performed to disable any T-lymphocytes present in the donated blood. (T-lymphocytes can cause a reaction when transfused, but can also cause graft-versus-host problems with repeated exposure to foreign cells.)
Which blood cells carry oxygen to the tissues in the body?
Red blood cells. These cells carry oxygen to the tissues in the body and are commonly used in the treatment of anemia. Platelets. They help the blood to clot and are used in the treatment of leukemia and other forms of cancer. White blood cells. These cells help to fight infection, and aid in the immune process. Plasma.
How old do you have to be to donate blood?
Must be at least 16 years of age, or in accordance with state law. Must pass the physical and health history exam given before donation. Some states permit people younger than 16 or 17 years to donate blood, with parental consent.
What is the most common type of blood transfusion?
The most common type of blood transfusion is blood that is donated by another person (allogeneic).
What is an RBC transfusion?
RBC transfusions are indicated in patients with anemia who have evidence of impaired oxygen delivery. For example, individuals with acute blood loss, chronic anemia and cardiopulmonary compromise, or disease or medication effects associated with bone marrow suppression may be candidates for RBC transfusion.
How long after a blood transfusion can you have a reaction?
A blood transfusion reaction may occur 24 to 48 hours post-transfusion. Each separate unit presents a potential for an adverse reaction. Follow emergency transfusion guidelines when dealing with an emergency blood or blood product transfusion.
How often is blood tubing changed?
Specific blood administration tubing is required for all blood transfusions. Blood tubing is changed every 4 hours or 4 units, whichever comes first. See agency policy for using EID for the administration of blood products. Intravenous immunoglobulin (IVIG) is only compatible with D5W.
Where do you report transfusion errors?
All transfusion reactions and transfusion errors must be reported to the hospital’s transfusion services (blood bank). It is imperative to know what signs and symptoms to look for, and to educate your patient on what to report and when to report potential transfusion reactions.
Do you need consent for blood transfusion?
Consent is required for the transfusion of blood and blood components and products. All blood products must have a consent form signed prior to the transfusion.
Do all health care providers have to complete specific training for safe transfusion practices?
All health care practitioners who administer blood or blood products must complete specific training for safe transfusion practices and be competent in the transfusion administration process. Always refer to your agency policy for guidelines for preparing, initiating, and monitoring blood and blood product transfusions. These guidelines apply to adult patients only.
What are the stages of blood management?
For the purposes of describing the incremental onset of our patient blood management program, we have defined four stages over time, which are (1) pre-patient blood management, before any activities began; (2) early patient blood management, when education on evidence-based transfusion practice at The Johns Hopkins Hospital campus began, and tranexamic acid at The Johns Hopkins Bayview campus was introduced; (3) post-patient blood management , when harmonized transfusion guidelines across the health system, a “Why Give 2 When 1 Will Do?” single-unit transfusion campaign, data dashboards, audits for transfusion guideline compliance with feedback, and an early version of clinician decision support for hemoglobin triggers were implemented; and (4) enhanced patient blood management, when the Epic (USA) electronic record was launched with improved decision support and best-practice advisories notifying clinicians about out-of-guideline orders, as well as enhanced guideline compliance audits with feedback sent to all departments and providers. These patient blood management intervention phases are illustrated in figure 1.
How does a comprehensive patient blood management program help orthopedic patients?
The results of this study demonstrate that for orthopedic surgery patients, a comprehensive patient blood management program is a successful method for significantly reducing blood use, while maintaining or improving clinical outcomes. Even after age and risk adjustment in the post-patient blood management cohort, patients did just as well or better with a lower hemoglobin trigger and target, resulting in an overall decrease in the percentage of patients transfused and erythrocyte units transfused per patient. Importantly, morbidity, length of stay, and readmission rates all improved, while mortality was unchanged. It is likely that with the overall low incidence of mortality (about 2 per 1,000 patients), the sample size was too small and/or the patients too healthy to assess mortality. Regarding age, the older patients showed more benefit than younger patients with the changes in transfusion practice, perhaps because both morbidity and readmissions occurred with about half the frequency at baseline in the younger subgroup. The finding that older patients do as well or better with a restrictive transfusion strategy than with a liberal strategy is also supported by clinical trials in orthopedic 27 and cardiac surgery. 29
Is 7 g/dl hemoglobin safe for orthopedic patients?
In a retrospective study, patient blood management was associated with reduced blood use with similar or improved clinical outcomes in orthopedic surgery. A hemoglobin threshold of 7 g/dl appears to be safe for many orthopedic patients.
Why do we need blood donations?
A common need for blood donations is after a major disaster causing excessive bleeding has occurred such as a road traffic accident of a natural or another disaster.
How often should I get a blood transfusion for thalassemia?
Iron chelators are also taken to prevent iron build-up. Blood transfusions are typically needed every 2 to 4 weeks. Sickle cell disease is another inherited red blood cell disorder.
What is anemia transfusion?
The transfusion immediately treats the anemia by providing blood with iron that can be used by the recipient. However, this is a temporary solution. Other treatments will be needed to resolve the illness. Aplastic anemia: It is a form of anemia resulting from bone marrow failure.
What is hemophilia clotting factor?
Plasma Disorders. Hemophilia is an inherited disease in which the patient has a low level of one of many clotting factors ( clotting factor VIII, IX or XI) found in plasma. This prevents individuals with hemophilia from clotting resulting in excessive bleeding from even minor injuries.
What is the term for a disease in which the bone marrow produces a low number of fully matured
A myelodysplastic syndrome is a group of diseases in which bone marrow produces a low number of fully matured or functional white blood cells, red blood cells, and platelets, which can result in symptoms similar to anemia.
What are the causes of anemia?
Chronic Diseases that cause anemia: Anemia can be caused by several diseases including chronic infections, inflammatory, and autoimmune diseases such as Chron’s disease, systemic lupus, rheumatoid arthritis. Blood transfusions may be provided to treat severe anemia symptoms resulting from these conditions.
What is the purpose of transfusions?
These transfusions provide blood cells that the recipient cannot produce on their own. The number of transfusions that a recipient can obtain is limited by antibodies that they may develop against the transfused blood and the accumulation of iron.
What is the best practice for blood transfusion?
Unless in an emergency, a blood transfusion consent and blood typing and cross-matching is needed prior to blood administration. Checking blood products against the order and using two patient identifiers is critical.
Why do nurses administer blood products?
Blood is given to correct blood loss, treat shock, and increase blood volume. Administering blood products is a common practice for nurses. However common, this practice is not without risks. Nurses need to understand and adhere to safe administration practice of blood products to reduce the risk of transfusion reactions.
What are the symptoms of a non-hemolytic reaction?
Pain, anxiety, hematuria, fever, headache, pruritus, rash or hives, nausea, and respiratory difficulties are common for non-hemolytic reactions. The aforementioned symptoms, as well as bleeding, hypotension, and oliguria can be associated with hemolytic reactions.
How long do you have to stay with a patient during a transfusion?
Baseline vital signs should be taken just prior to initiating the transfusion, and the nurse must stay with the patient during the first 15 minutes of transfusion, to monitor for any immediate reaction.
Do nurses administer blood?
Across the country, nurses administer thousands of blood transfusions every day . To safely administer blood products, it is important to follow your facility’s policy and procedure for blood administration . In some instances, in spite of all best efforts; transfusion reactions still occur.
Is blood transfusion a hemolytic reaction?
Blood transfusion reactions can be non-hemolytic or hemolytic (American Association of Blood Banks [AABB], 2017; Bachowski et al., 2017). When preparing to administer blood to a patient, nurses should always refer to policy and procedure specific to the facility where they work.
What is blood management?
Blood management consists of prevention, early identification, and treatment of anemia coupled with the best possible transfusion practices. A blood management program translates these standards into clinical practice. A robust body of evidence supports the need for blood management programs.
What do nurses do before blood is obtained?
Before blood is obtained from the blood bank, nurses must make sure they're following policies and procedures ensuring safety and proper administration of all blood products. (See Using best practices for blood transfusions and Practice guide for nurses .)
What is blood transfusion?
BLOOD TRANSFUSIONS to treat anemia can have a significant impact on patient outcomes. Because transfusion practices vary among healthcare providers, many clinicians question the best practice for blood product use. Blood management is defined as a patient-centered standard of care in which strategies and techniques are used to reduce, eliminate, ...
What is anemia tolerance?
A blood transfusion is a human tissue transplant. Anemia tolerance is based on the assessment of signs and symptoms. Provide clinical information related to anemia tolerance when reporting lab values. Verify blood products at the patient's bedside according to facility policy and procedure.
What is the role of a nurse in a patient's health care?
Nurses play a crucial role in recognizing the signs and symptoms associated with decreased oxygen states due to low hemoglobin levels. Nurses are responsible for notifying the healthcare provider of a patient's hemoglobin and hematocrit, but they must report the whole patient picture and not just the lab values.
Can nurses implement blood management?
Individual nurses can implement blood management strategies into nursing practice, but changing habits to elevate the standard of care requires a multidisciplinary team approach. Use this article as the impetus for enacting practice change.
What are the main components of blood?
Blood disorders can affect any of the three main components of blood: 1 Red blood cells, which carry oxygen to the body's tissues 2 White blood cells, which fight infections 3 Platelets, which help blood to clot
What are the treatments for thrombocytopenia?
Treatments may include blood transfusions, chemotherapy and stem cell transplant. Blood Disorders Affecting Platelets. Blood disorders that affect the platelets include: Thrombocytopenia : A low number of platelets in the blood; numerous conditions cause thrombocytopenia, but most do not result in abnormal bleeding.
What is the treatment for aplastic anemia?
Medications, blood transfusions, and even a bone marrow transplant may be required to treat aplastic anemia. Autoimmune hemolytic anemia: In people with this condition, an overactive immune system destroys the body's own red blood cells, causing anemia.
What are the causes of red blood cells?
Blood disorders that affect red blood cells include: Anemia: People with anemia have a low number of red blood cells. Mild anemia often causes no symptoms. More severe anemia can cause fatigue, pale skin, and shortness of breath with exertion. Iron-deficiency anemia: Iron is necessary for the body to make red blood cells.
What are the two types of blood cells that carry oxygen to the body?
Red blood cells , which carry oxygen to the body's tissues. White blood cells, which fight infections. Platelets, which help blood to clot. Blood disorders can also affect the liquid portion of blood, called plasma. Treatments and prognosis for blood diseases vary, depending on the blood condition and its severity.
Where is red blood cell infection most common?
Periodically, the red blood cells rupture, causing fever, chills, and organ damage. This blood infection is most common in parts of Africa but can also be found in other tropical and subtropical areas around the world; those traveling to affected areas should take preventive measures.
Can red blood cells cause clots?
Severe pain and organ damage can occur. Polycythemia vera: The body produces too many blood cells, from an unknown cause. The excess red blood cells usually create no problems but may cause blood clots in some people.
