P17 Bedside Practice of Blood Transfusion ‐ Where is the Evidence?

Abstract

Background There have been no systematic reviews of the routine ‘bedside practice’ of blood transfusion. There are national guidelines, but local practice varies. Nursing staff are increasingly requesting details of the evidence that underpins the guidelines. Transfusion practitioners from the four UK blood transfusion services working with the NBS Systematic Review Initiative have systematically reviewed the evidence for practice in four key areas of bedside blood transfusion.Methods Relevant evidence was identified through comprehensive searches of electronic databases: Medline; Embase; Cinahl; The Cochrane Library; websites of international blood transfusion societies and the websites of the US Centres for Disease Control and Prevention, English National Patients Safety Agency and the NHS Serious Hazards of Transfusion Scheme. Reference lists of relevant papers were scanned and contact was made with transfusion medicine clinicians and scientists to identify additional evidence. All identified papers were assessed for project eligibility: eligible papers were quality assessed and data extracted by two members of the project team, working independently of each other.Results The searches yielded approx. 6000 hits. Relevant evidence was identified for one area: co‐administration of drugs with blood (approx. 50 papers). Indirectly relevant evidence was identified for the maximum time that a unit of blood can be safely left out of refridgeration (approx. six papers). No relevant published information was identified for the frequency of change of blood administration or for the relative safety of 1 versus 2 person checking blood prior to infusion.Conclusions For three of the four areas despite minimal restrictions on study design there was little relevant published evidence to underpin practice. Where evidence does exist, it is not necessarily directly related to bedside blood transfusion practice or is ‘out‐of‐date’. The principal recommendation from this project is the need to undertake directly relevant primary research, including assessing the bacterial contamination of blood during the transfusion process and a national randomised controlled trial of the safety of 1 versus 2 person checking.