The regulations on clinical blood transfusion management are as follows: Chapter I General Provisions
Article 1 In order to meet the needs of clinical emergency blood use, these rules are formulated in accordance with the People's Republic of China (PRC) Blood Donation Law, the Ministry of Health's Technical Specification for Clinical Blood Transfusion, the Measures for the Administration of Clinical Blood Use in Medical Institutions and the Notice of the Provincial Health Department on Printing and Distributing the Examination Rules for the Management of Clinical Blood Use in Medical Institutions in Zhejiang Province (for Trial Implementation).
Chapter II Application for Blood Transfusion
Article 2 To apply for blood transfusion, the attending physician shall fill in the Application Form for Clinical Blood Transfusion one by one, and submit it to the Blood Transfusion Department for blood preparation together with the blood sample of the recipient before the scheduled blood transfusion. A small amount of bleeding (the amount of bleeding is less than 400 ml) can be replaced by crystalloid fluid or colloid fluid to maintain blood volume.
Article 3 Before deciding on blood transfusion treatment, the attending physician should explain the adverse reactions of allogeneic blood transfusion and the possibility of blood-borne diseases to the patients or their families, obtain the consent of the patients or their families, sign the consent form of blood transfusion treatment, and keep it in the medical records. Emergency blood transfusion should be reported to the functional department of the hospital or the competent leader for approval and filing, and included in the medical records. Those who apply for more than 2000 ml of blood should fill in a large number of blood transfusion application forms and report them to the medical department for examination and approval; More than 3000ml, must be approved by the dean in charge of medical treatment, and reported to the Municipal Health Bureau through the medical department. In case of emergency, blood transfusion can be given first, and then supplemented after going through the examination and approval procedures.
Article 4 Patients applying for blood transfusion shall be examined before blood transfusion. Blood group identification, antibody screening and pre-transfusion examination should be done for the first blood transfusion; Patients who have received blood transfusion should indicate ABO blood type and Rh blood type on the blood transfusion application form. If the last blood transfusion lasts more than 3 days, antibody screening should be carried out; For this new admission, antibody screening and pre-transfusion examination (four indicators of blood-borne diseases: hepatitis B surface antigen, hepatitis C antibody, syphilis antibody and AIDS antibody) should be carried out. Outpatients were examined before blood transfusion within 3 months 1 time.
Article 5 Autologous blood transfusion, homologous blood transfusion or blood matching should be adopted for patients with Rh negative and other rare blood group diseases. 、
Sixth blood transfusion application should strictly grasp the indications of blood transfusion.
Chapter III Collection and Inspection of Blood Samples of Recipients
Article 7 After the blood transfusion is confirmed, the medical staff shall hold the blood transfusion application form, affix the test tube with the same application number, check the patient's name, hospitalization number, gender, age, medical record number, ward (emergency), bed number, blood type and diagnosis face to face, and collect blood samples. When taking blood, it is not allowed to take blood directly from the transfusion tube or limb on the transfusion side, so as to avoid blood dilution, reduce antibody titer and cause blood matching errors. After blood collection, pay attention to unplug the needle and then inject the blood into the test tube to prevent hemolysis. Pay attention to mixing anticoagulant evenly after collection to prevent blood agglutination. When the blood transfusion application form is attached to the test tube, attention should be paid to exposing the upper edge of the blood so that the blood transfusion personnel can observe the blood sample.
Article 8 After blood collection, the medical staff or the person in charge in the outpatient and emergency wards shall send the blood sample of the recipient and the blood transfusion application form to the blood transfusion department. Non-emergency patients should do blood group identification before blood transfusion to avoid taking wrong blood samples and cross-matching blood during blood transfusion. The two sides check item by item, and the blood transfusion department will keep it for later use after it is qualified.
Article 9 Blood samples of blood matching experiments of recipients must be collected within 3 days before blood transfusion (including the day when blood samples are collected), and those that exceed 3 days must be collected again.
The fourth chapter cross matching blood
Article 10 Blood samples of blood matching experiments of recipients must be collected within 3 days before blood transfusion (including the day when blood samples are collected), and must be collected again after more than 3 days. Every time a platelet transfusion patient needs to collect blood samples.
Article 11 Blood transfusion department should check the blood transfusion application form, blood samples of recipients and blood donors one by one, check ABO blood types (positive and negative stereotypes) of recipients and blood donors, and routinely check the Rh(D) blood type of patients (except for the Rh(D) test in emergency blood transfusion of emergency rescue patients), and cross matching can be carried out only after it is confirmed. Blood matching operation is carried out according to standard operating procedures.
Article 12 Those who have prepared blood for operation, have a history of blood transfusion, have a history of pregnancy and need multiple blood transfusions in a short period of time should be screened for antibodies in time after receiving blood samples from patients.
Chapter V Blood Collection (Blood Distribution Management)
Thirteenth after the blood matching is qualified, the medical staff or department shall designate a person to take blood from the blood transfusion department, and the family members of the patient shall not take blood.
Article 14 Both sides of blood collection and blood matching must check the patient's name, gender, medical record number, ward (emergency), bed number, blood type, blood donor's name, blood type, blood volume, blood collection date, expiration date, blood matching experimental results and preserved blood appearance. It can only be signed by both parties after it is accurate.
Fifteenth blood bags in any of the following circumstances, not to send blood:
1. The label is damaged and illegible;
2. The blood bag is damaged and leaks blood;
3. There are obvious clots in the blood; 、
4. The plasma is chylous or dark gray;
5. There are obvious bubbles, flocs or coarse particles in plasma;
6. Without shaking, the interface between plasma layer and red blood cells is unclear or hemolysis appears at the interface;
7. The red blood cell layer is purplish red;
8. Expiration or other circumstances that need to be verified.
Article 16 After the blood is sent out, the blood samples of the recipient and the donor shall be kept in 2? Store in the refrigerator at 6℃ for at least 7 days, so as to trace the causes of adverse reactions of blood transfusion.
Article 17 Blood shall not be returned after it is sent out.
Chapter VI Blood Transfusion (Blood Transfusion Management)
Article 18 Before blood transfusion, two nurses or medical personnel check the contents of the cross matching report and the label of the blood bag, and check whether the blood bag is damaged or leaked, and whether the appearance quality of the blood is abnormal. Only when it is accurate can blood transfusion be carried out.
Article 19 During blood transfusion, the medical staff in charge of blood transfusion should bring the medical records to the patient's bed and check the patient's name, hospitalization number, gender, age, medical record number, emergency room (ward), bed number, blood type, etc. To confirm that they are consistent with the blood matching report. After the blood test again, blood transfusion instruments that meet the standards should be used for blood transfusion.
Twentieth retrieved blood should be used as soon as possible, and blood should not be stored. Before blood transfusion, gently mix the components in the blood bag to avoid severe shock. Other drugs should not be added to the blood. If dilution is needed, only intravenous saline can be used.
Twenty-first before and after blood transfusion with intravenous injection of normal saline to flush the blood transfusion pipeline. When different blood donors transfuse blood, after the first bag of blood is transfused, use intravenous saline to clean the infusion set, and then continue to transfuse the next bag.
Twenty-second in the process of blood transfusion, we should slow down first, and then adjust the infusion speed according to the amount of blood loss, anemia degree, illness, age, etc., and closely observe whether the recipient has any adverse reactions to blood transfusion. If there is any abnormality, the blood transfusion should be slowed down or stopped immediately, and the venous access should be maintained by intravenous injection of normal saline. Immediately notify the doctor on duty and the personnel on duty in the blood transfusion department to check, treat and rescue in time, find out the reasons and make records.
Article 23 After blood transfusion, the medical staff will post the blood transfusion record sheet (cross matching report) on the medical record. Medical staff should fill in the blood transfusion reaction declaration form item by item and return it to the blood transfusion department for preservation or recording in medical records. If there is no response, the blood transfusion equipment will be destroyed and disinfected after 24 hours of storage.
Twenty-fourth to carry out their own blood transfusion. For patients undergoing elective surgery, if the patient's physique meets the standard, it is necessary to mobilize the patient to carry out autologous blood transfusion, and if the surgical patient meets the standard of diluted autologous blood transfusion, it is necessary to carry out diluted autologous blood transfusion; Patients with large amount of bleeding should take recovered autologous blood transfusion and truly implement blood protection measures.
Twenty-fifth actively publicize and mobilize patients and their families to carry out elective surgery and mutual blood storage. The ward is publicized by the attending physician, and the relatives and friends of patients who need blood transfusion are mobilized to donate blood before operation.
Chapter VII Management of Adverse Reaction of Blood Transfusion
Twenty-sixth in the process of blood transfusion should be slow before fast, and then adjust the infusion speed according to the amount of blood loss, anemia degree, illness and age, and closely observe whether the recipient has any adverse reactions to blood transfusion.
Twenty-seventh abnormal situation should be handled in a timely manner:
1. Stop blood transfusion immediately and maintain venous access with intravenous saline;
2. Immediately report to the doctor on duty and the personnel on duty in the blood transfusion department, find out the reason in time, actively treat and rescue, and make records.
Article 28 If the transfusion reaction is suspected to be hemolytic or bacterial contamination, the transfusion should be stopped immediately, and the venous access should be maintained by intravenous injection of normal saline. Report to the doctor on duty and the personnel on duty in blood transfusion department immediately, and report to the superior doctor in time. In the active treatment and rescue at the same time, should do the following inspection:
1. Check the blood application form, blood bag label and cross matching experiment record;
2. Check ABO blood group, Rh(D) blood group, irregular antibody screening and cross matching experiment (including saline phase and non-saline phase experiment) of blood recipients and donors, and recheck ABO blood group, Rh(D) blood group, irregular antibody and cross matching experiment with blood samples of blood recipients and donors, newly collected blood samples and blood samples in blood bags.
3. Immediately draw the blood of the recipient and add heparin anticoagulant, separate the plasma, observe the color of the plasma, and determine the content of free hemoglobin in the plasma;
4. Immediately draw the blood of the recipient, and detect the serum bilirubin content, plasma free hemoglobin content, plasma haptoglobin determination, direct anti-human globulin test and related antibody titers. If special antibodies are found, further identification is needed;
5. If there is a suspected bacterial contamination transfusion reaction, take blood from the blood bag for bacteriological examination;
6. Test blood routine, urine routine and urine hemoglobin content as soon as possible;
7. When necessary, 5? Serum bilirubin was measured after 7 hours.
Article 29 The procedures for handling transfusion adverse reactions include: immediately stopping transfusion, replacing infusion tube, replacing normal saline, reporting to doctor, taking medicine according to doctor's advice, closely observing and making records, filling out transfusion reaction report card when necessary, reporting to transfusion department, keeping blood bag when serious reaction is suspected, and collecting blood samples from patients and sending them to transfusion department.
Chapter VIII Component Blood Transfusion
Article 30 advantages of component blood transfusion: multiple uses for one blood, saving blood, high product concentration and purity, good curative effect, and minimizing adverse reactions and infectious diseases caused by blood transfusion.
Article 31 The purpose of component blood transfusion:
1. To supplement blood volume, albumin can be used;
2. In order to supplement the oxygen carrying capacity, red blood cell suspension can be used and red blood cells can be washed.
3. Supplement coagulation factors to correct bleeding, including transfusion of platelets, fresh plasma and cryoprecipitate;
4. To correct immune insufficiency and improve immunity, transfer factors, interferon and gamma globulin can be used.
Article 32 the principle of component blood transfusion:
1. Strictly grasp the indications of blood transfusion. Blood cell destruction or hematopoietic dysfunction may require blood transfusion. The quantity and type of blood transfusion depend on the patient's ability to recover blood components, the life span of blood components and the needs of diseases. Never transfuse whole blood, and it is forbidden to transfuse comfort blood to patients who can or cannot transfuse.
2. Patients who are suitable for blood components should never lose whole blood. Clinically, 90% of blood transfusion patients need a certain component, which is not suitable for whole blood transfusion;