We are currenly revising our blood products administration policy when I re-read standard 48 V. Blood and blood components.
48.1 Administration seta and . . . .shall be changed after each unit or at the end of 4 hours, whichever comes first.
I always interpreted that to say the 4 hour time period was the determining factor as to how long the tubing could hang. Our currently policy states that 2 units or 4 hours which ever occurs first . . . . . meaning if you can get 2 units completed in 4 hours that was acceptable.
CDC does not state every unit, it states w/in 4 hours of start of infusion. The AABB states at the end of 4 hours. The manufacturer (of the blood tubing) claims the filter is good for multiple units and that policy and procedures should be established by the individual institution.
My question is this: If the tubing should be changed after every unit, what is the research that supports that claim? It seems it would be more of an infection risk to change the tubing every two hours for a patient getting multiple units.
I am hoping someone can clarify this for me.
Thanks.
Sarah Jones RN, MS, ACNS-BC, AOCNS, CRNI
All blood transfusion sets are not the same. Some are acceptable for multiple units while others such as leukoreducing sets must be changed with each unit. Some facilities will prefer to have one unit per set regardless of the type of set being used. The reason is to be able to determine which unit caused a transfusion reaction, if one happens. I would never recommend that a set be changed in the middle of one unit. So if you are certain that you can infuse multiple units through the same set within the 4 hours, and the set manufacturer states their set can be used for multiple units, you can change the set at the end of 4 hours. Just remember that this must coincide with the end of the transfusion of the unit. Using a new set with each unit will not increase your risk for infection, but opening an infusing unit of blood to change the set at the 4 hour period would increase the risk of infection. Some facilities just find it easier to say one unit = one set just to make sure that the set does not extend beyond the max of 4 hours. This may be about as clear as mud, but I hope not. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861