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Blood product procedures and administration during Hemodialysis (3.6)

Blood product procedures and administration during Hemodialysis (3.6) - Policies, Clinical, UWHC Clinical, Department Specific, Hemodialysis

3.6

University of Wisconsin Hospital and Clinics
Inpatient Hemodialysis
Department 55400

TITLE: Blood product procedures and
administration during Hemodialysis.

POLICY #3.6
REVISED: October 1, 2017
Page 1 of 4
Nurse Manager: Joan Watson, MS, RN
Director: Ann Malec, DNP, RN, NEA-BC
Medical Director: Alex Yevzlin, MD


I. PURPOSE

Provide guidance on the administration of specific blood products, components or derivatives
safe to administer while on dialysis.

II. GENERAL INFORMATION

A. The following blood products require pre-transfusion lab testing are dispensed through
blood bank and are safe to administer while on dialysis: packed, leukocyte reduced and
washed red blood cells (RBCs) and fresh frozen plasma (FFP).
B. Albumin and plasma protein fraction (PPF) are considered blood derivatives, do not
require pre testing and are dispensed through Pharmacy and are safe to administer while
on dialysis for hypotension or as a plasma expander.
C. All other blood products, e.g. platelets, cryoprecipitate, should NOT be administered
during dialysis due to clotting/clogging of the extracorporeal circuit.
D. If questions regarding blood product administration consult with the Nephrology
Fellow/Attending.

III. POLICY
A. Hemodialysis Registered Nurse (RN) can obtain blood samples for type and
screen/crossmatch and can administer blood and/or blood products safe to administer
while on dialysis after demonstrated competency.
B. For details regarding blood sampling, product dispensing, verification and administration
refer to Policy 2.2.6 Blood and Blood Component Transfusion (Requiring Pre-
Transfusion Testing).
C. The credentialed provider placing the order for blood/blood product should make
arrangement with the nephrology consulting service, hemodialysis charge nurse and/or
hemodialysis (RN) responsible for care to administer the blood product during dialysis
treatment. The authorizing order to transfuse will specify the blood product, number of
units or volume.
D. RBCs and FFP are routinely administered in less than (1) one hour through the venous
line using the Alaris® pump. If there is a need to process the blood through the dialysis
filter, i.e., removal of potassium or citrate is indicated. These products can be
administered through the arterial line however this may lead to increase clotting of the
extracorporeal circuit.

Page 2 of 4
E. Albumin and PPF are routinely administered through the arterial line do not require a
pump can be infused rapidly over 5-10 minutes and the RN must stay with the patient
during administration.
F. Blood prime is indicated for children less than <10 kg and is ordered in mL of volume to
be transfused. The volume is calculated based upon the tubing size and dialyzer used in
the extracorporeal circuit.

IV. Equipment:
A. RCBs or FFP are transfused through a standard Y type blood administration set.
B. Albumin and PPF tubing is included with the product when dispensed.
C. Leukocyte removal filter if needed is good for (1) one unit and will be issued with the
transfusion.
D. Normal Saline
E. Alaris pump
F. Personal Protective Equipment (PPE)

IV. PROCEDURE LIST
A. Transfusion of Packed, Leukocyte Reduced and Washed RBCs and/or FFP
B. Albumin Prime
C. Blood Prime
D. Albumin (PPF) Administration during dialysis

IV. PROCEDURES

Transfusion of Packed, Leukocyte Reduced and Washed RBCs and/or FFP

A. Follow the procedures outlined in Policy 2.2.6 Blood and Blood Component Transfusion
(Requiring Pre-Transfusion Testing) for blood sampling, product dispensing, verification
and administration.
B. Special consideration for Hemodialysis
1. After priming the blood administration tubing on the Alaris pump, attach the
tubing to the extracorporeal circuit using aseptic technique.
2. Port options include:
a. Venous chamber, (preferred)
b. Locksite™ of Fresenius normal saline administration line
c. Arterial chamber of the Gambro Phoenix cartridge
3. Begin the transfusion at a rate of 150 -200 cc.hr. Stay with the patient for the first
five (5) minutes of the transfusion then close observation for the next ten (10)
minutes. Monitor for signs and symptoms of transfusion reaction.
4. If no reaction, after the first 15 minutes increase the rate as tolerated. Red blood
cells can be administered in less than 1 hour on hemodialysis.
Albumin Prime

A. Perform prime of the extracorporeal circuit per HD Policy 3.0 Hemodialysis treatment
using the Fresenius 2008 Series K &T Machines.

Page 3 of 4
B. Prime the extracorporeal circuit with albumin after orders are verified, bar code scanning
is performed, all alarm/system checks are completed, just prior to patient connect.
1. Spike the albumin minibag and remove air from the administration tubing.
2. Attach the albumin administration tubing to the Locksite™ port of Fresenius
normal saline administration line.
3. Clamp the normal saline administration line above just above the Locksite™ port.
4. Stop the blood pump and clamp the arterial and venous blood lines of the
extracorporeal circuit.
5. Attach the arterial line to the patient’s access. Keep the arterial blood line
clamped.
6. Maintaining aseptic technique, place the venous line with recirculator attached
into the priming bucket.
7. Open all clamps to the albumin administration line and turn the blood pump on
slowly and fill the arterial chamber, dialyzer and venous chamber with albumin.
8. Clamp the venous blood line of the extracorporeal circuit when the albumin
reaches the venous chamber.
9. Remove the recirculator and attach the venous blood line to the patient’s access.
10. Initiate hemodialysis following the patient connect procedure as outlined in HD
Policy 3.0 Hemodialysis treatment using the Fresenius 2008 K® Machine.
11. If additional albumin remains in the minibag it can be administered immediately
following initiation of hemodialysis. The blood pump speed must be greater than
100 and the RN must pay constant attention to the albumin administration
line as not to introduce air into the extracorporeal circuit.

Blood Prime

A. Perform prime of the extracorporeal circuit per HD Policy 3.0 Hemodialysis treatment
using the Fresenius 2008 Series K &T Machines.
B. Prime the extracorporeal circuit with blood after the transfusion is verified per Policy
2.2.6 Blood and Blood Component Transfusion (Requiring Pre-Transfusion Testing), all
alarm/system checks are completed, just prior to patient connect.
1. After priming the blood administration tubing, attach the blood administration
tubing to the Locksite™ port of Fresenius normal saline administration line using
aseptic technique. Keep this line clamped until ready to start the prime.
2. Clamp the normal saline side of the Y set, spike the blood bag.
3. Clamp the normal saline administration line above just above the Locksite™ port.
4. Stop the blood pump and clamp the arterial and venous blood lines of the
extracorporeal circuit.
5. Attach the arterial line to the patient’s access. Keep the arterial blood line
clamped.
6. Maintaining aseptic technique, place the venous line with recirculator attached
into the priming bucket.
7. Open all clamps to the blood administration line and turn the blood pump on
slowly. Fill the arterial chamber, dialyzer and venous chamber with blood.
8. Clamp the venous blood line of the extracorporeal circuit when the blood reaches
the venous chamber.

Page 4 of 4
9. Remove the recirculator and attach the venous blood line to the patient’s access.
Initiate hemodialysis following the patient connect procedure as outlined in HD
Policy 3.0 Hemodialysis treatment using the Fresenius 2008 K® Machine.
10. If additional blood volume remains in the transfusion it can be administered
immediately following initiation of hemodialysis. The blood pump speed must be
greater than 100 and the RN must pay constant attention to the blood
administration line as not to introduce air into the extracorporeal circuit.

Albumin (PPF) Administration during dialysis

A. Perform all bar code scanning prior to administration.
1. Spike the albumin minibag and prime the administration tubing being careful to
remove all air from the tubing.
2. Attach the albumin administration tubing to the Locksite™ port of Fresenius
normal saline administration line.
3. Clamp the normal saline administration line above just above the Locksite™ port.
4. Open all clamps to the albumin administration line with blood pump speed greater
than 100. The RN must pay constant attention to the albumin administration
line as not to introduce air into the extracorporeal circuit.
5. Clamp the albumin administration line when administration is complete and
remove the tubing from the Locksite™ port.

V. RESOURCES
o Policy 2.2.6 Blood and Blood Component Transfusion (Requiring Pre-Transfusion
Testing)
o Pasko, D.A., Mottes, T.A., Mueller, B. A. (2003) Pre dialysis of blood prime in
continuous hemodialysis normalizes pH and electrolytes. Pediatric Nephrology 18: 1177-
1183.


REVIEWED: July 2014
JMW6/1/13