The Blood Transfusion Service of Namibia

Document Number: SOP-09-1Page 1 of 4

Author : Sign

Approved : Sign

STANDARD OPERATING PROCEDURE

Collection of a blood donation

Notes to those adapting this to conform to local guidelines

The procedure for the collection of a blood donation may be carried out in a variety of ways, depending on the availability of resources such as blood diversion pouches, needle guards attached to the blood pack and automated mixers for mixing the blood with the anticoagulant during collection.

The procedure described here is based on the following:The phlebotomist wears gloves throughout the procedure; the specimens for testing are collectedfrom the diversion pouch; needle guards are used to prevent needle stick accidents; the mixing of blood and anticoagulant during collection is done manually.

This procedure must be adapted to conform to National Guidelines, to local requirements and to the test systems, validated reagents and calibrated equipment that are available to each organization.

1.Introduction

In order to make the blood donation a pleasant experience for the donor and in order to make the collected blood safe and effective for the recipient, it is necessary to apply attention to detail throughout the procedure.

The environment in which the blood donation clinic is held should be clean, free of dust, light, airy and cool. There should be a clean work area for the handling and inspection of the blood packs, both before and after the collection, and a suitable area for the treatment of a donor in the event of an adverse event.

Most donations will take five to 10 minutes for the actual donation. If the collection takes longer than 10 minutes there will be a reduction in the yield of clotting factors. The Africa Society for Blood Transfusion Step-Wise Accreditation Standards states that the maximum collection time for whole blood intended for production of labile components shall be no longer than 12 minutes for platelets and 15 minutes for cryoprecipitate and FFP.

It is also important to mix the collected blood with the anticoagulant frequently and thoroughly throughout the collection. Failure to do so may result in the formation of small clots and the consumption of clotting factors.

2.Purpose and Scope

This procedure is to be used by authorised personnel in the blood collection clinic for the collection of blood donations.

3.Definitions

3.1.Nil.

4.Materials and equipment required

4.1.Blood bags.

4.2.Specimen tubes.

4.3.Donation Identification Numbers.

4.4.Scissors.

4.5.Plastic artery forceps.

4.6.Blood collection scale.

4.7.Tourniquet.

4.8.Disinfectant solution.

4.9.Swabs.

4.10.Cotton wool.

4.11.Plasters.

4.12.Personal protective equipment.

5.Safety

5.1.All blood should be treated as if it is infectious. The general precautions to be followed are described in the Safety Manual (MAN-02 – Safety manual).

6.Responsible

6.1.Authorised personnel in the blood collection clinic that are assigned to the collection of blood donations are responsible for all the activities described in this procedure.

7.Procedure

7.1.The phlebotomist must wear gloves throughout the donation procedure.

7.1.1.Gloves must be changed after each donor, or if there are any obvious signs of blood contamination or physical damage to the gloves.

7.2.Receive the blood bag and the Medical History Form from the receptionist and confirm that the donor has been approved for donation.

7.3.Check the identity of the donor by asking them to repeat their name and date of birth.

7.3.1.Resolve any discrepancies before proceeding.

7.4.Ask the donor to remove any clothing that may interfere with the donation.

7.5.Ask the donor if they have any preference regarding the arm that will be used for the phlebotomy. Seat the donor in an appropriate chair.

7.6.Check the blood bag that is to be used for the collection:

7.6.1.Check that the bag has not expired.

7.6.2.Check that the bag has not leaked.

7.6.3.Check that the needle cover is correctly in place.

7.6.4.Check that the anticoagulant and the preservative solution (if present) are clear and colourless.

7.6.5.Check that the Donation Identification Number on the blood bag and the Medical History Form correspond.

7.7.If the blood bag fails any of these checks it must NOT be used. Report the problem to the Sister-in-Charge and obtain a replacement blood bag.

7.8.Tie a loose knot in the blood bag tubing, positioning it below the “Y” connection in the tubing.

7.9.Use plastic artery forceps to clamp the tubing between the diversion pouch and the “Y” connection in the tubing.

7.10.Make sure that the white clamp between the diversion pouch and the female Luer port is closed.

7.11.Connect the specimen Luer adapter to the female Luer port.

7.12.Check that the blood bag scale is set to the correct weight for the type of blood bag being used. Adjust the scale if necessary.

7.13.Hang the bag on the scale.

7.14.Apply a tourniquet to the donor’s upper arm and tighten it correctly.

7.15.Give the donor a sponge ball and ask him/her to squeeze it firmly to make the veins more prominent.

7.16.Locate a suitable vein in the antecubital area from which to collect the blood.

7.17.Wash your hands using a suitable disinfectant such as chlorhexidine.

7.18.Clean the donor’s arm in the area selected for the phlebotomy.

7.18.1.If visibly dirty, wash with mild soap and water, and then wipe dry with a single-use towel.

7.18.2.Use a swab wet with a product combining 2% chlorhexidine gluconate in 70% isopropyl alcohol to clean the area, using a circular motion starting in the centre and moving outwards.

7.18.3.Ensure that the skin is in contact with the disinfectant for at least 30 seconds/

7.18.4.Allow the arm to air-dry for at least 30 seconds

7.19.Do NOT touch the site after disinfection.

7.20.Remove the cover from the blood bag needle and quickly inspect the needle for defects.

7.20.1.If the needle is damaged, do NOT use the blood bag. Report the defect to the Sister-in-Charge and obtain a replacement blood bag.

7.21. Perform the phlebotomy.

7.22.Release the clamp between the diversion pouch and the “Y” connection so that the blood flows into the diversion pouch.

7.23.Watch the flow of blood and if the flow is not satisfactory adjust the needle slightly.

7.24.Tape the needle onto the donor’s arm with a short length of tape.

7.25.Loosen the tourniquet slightly.

7.26.When sufficient blood has been collected in to the diversion pouch, clamp the tubing with plastic artery forceps.

7.27.Break the seal at the “Y” connection so that blood flows into the primary bag.

7.28.Record the start time of the phlebotomy on the Medical History form and on the blood bag label. Sign the Medical History Form in the appropriate place as the person performing the phlebotomy.

7.29.Mix the blood and the anticoagulant regularly (for approximately 15 seconds each minute) throughout the blood collection.

7.30.Collect the blood samples from the diversion pouch during the collection.

7.31.During the collection period observe the donor for sweating, pallor or complaints of feeling faint; development of a haematoma at the site of phlebotomy; and changes in the blood flow that may indicate that the needle has shifted and needs to be re-positioned.

7.32.When the requisite volume of blood has been collected, tighten the knot (white tight) below the “Y” connection (i.e. closest to the blood bag) in order to end the collection.

7.33.Clamp the blood bag tubing between the knot and the “Y” connection.

7.34.Use a clean pair of scissors (cleaned in chlorhexidine) to cut the tubing between the clamp and the knot.

7.35.Make a second knot in the tubing ±1 cm from the first knot.

7.36.Release the tourniquet on the donor’s arm.

7.37.Position the needle guard correctly to receive the needle.

7.38.Remove the plaster holding the needle in place.

7.39.Place a swab over the puncture site and gently remove the needleso that it is drawn directly into the needle guard.

7.40.Ask the donor to apply pressure to the swab covering the puncture site and to raise his/her arm.

7.41.Discard the sealed needle guard and needle into a sharp’s container.

7.42.Record the time that the collection was completed on the Medical History Form and on the blood bag.

7.43.If the length of time taken for the donation was more than 12 minutes, tag the blood bag as a “Slow Bleed”.

7.44.Strip the blood bag tubing into the blood bag, and repeat the procedure a second time. Mix the contents of the blood bag thoroughly by inversion before allowing the tubing to refill.

7.45.Check that the donation identification numbers on the blood bag, the Medical History Form and the specimens are the same.

7.45.1.Any discrepancies must be reported immediately to the Sister-in-Charge.

7.46.Check that the site of the phlebotomy has stopped bleeding. If it has, over the site with a plaster.

7.46.1.If the bleeding continues for more than five minutes, report this to the Sister-in-Charge.

7.47.Thank the donor for the donation. Advise them to remain seated for a few minutes to reduce the risk of fainting.

7.48.Place the blood bag and specimens in the appropriate transport boxes.

8.Records and forms

8.1.The Medical History Form must be retained in compliance with the document retention policy.

9.References

9.1.WHO guidelines on drawing blood: best practices in phlebotomy (2010)

10.Revision Summary