What should be included in a transfusion-related trolley?

Essential Components of a Transfusion-Related Trolley

A transfusion-related trolley should include blood component administration sets with integral 170-200 μm filters, blood warming equipment, pressure infusion devices, and monitoring equipment to ensure safe and effective blood component administration. 1

Core Equipment Requirements

Blood Administration Sets and Filters

• Blood component administration sets incorporating a 170-200 μm integral mesh filter 1
• Clean giving sets for platelet administration (separate from those used for red cells to prevent platelets sticking to red cells) 1
• 40 μm filter for cell salvage situations where bone fragments may contaminate the surgical field 1

Infusion and Warming Devices

• Blood warming equipment with visible thermometer and audible warning 1
• Rapid infusion devices (capable of 6-30 L/h flow rates) 1
• External pressure devices for emergency rapid transfusion 1
• Compatible administration sets for the specific infusion devices used 1

Monitoring Equipment

• Equipment to monitor patient vital signs during transfusion
• Temperature monitoring equipment to detect febrile reactions
• Blood pressure monitoring equipment to detect hypertension (TACO) or hypotension 1

Medications for Managing Transfusion Reactions

• Antipyretics (e.g., paracetamol) for febrile non-hemolytic transfusion reactions 1
• Antihistamines for allergic reactions 1
• Diuretics for managing TACO in at-risk patients 1
• Tranexamic acid (1g bolus dose with potential additional 500 mg/h infusion) 1

Documentation and Verification Materials

• Pre-administration checking documentation
• Patient identification verification materials
• Blood component compatibility verification forms
• Transfusion reaction reporting forms

Purpose-Oriented Organization

Organizing the trolley in a purpose-oriented manner significantly improves efficiency by reducing time spent on procedure preparation. Research shows this approach can reduce collection time by more than 50% compared to standard trolley organization 2.

Special Considerations

For Massive Hemorrhage

• Rapid infusion devices with blood warming capability 1
• Pressure devices with large-gauge venous access cannulas 1
• Equipment for monitoring coagulation status

For Pediatric Transfusions

• Specialized equipment for pediatric components 1
• Weight-based dosing charts
• Slower infusion rate monitoring equipment

Common Pitfalls and How to Avoid Them

1. Improper warming of blood components: Never warm blood using improvised methods (microwave, warm water, radiator). Only use approved blood warming equipment with temperature monitoring 1

2. Failure to identify transfusion reactions: Include monitoring equipment and reaction management protocols on the trolley to enable prompt identification and management of reactions 1, 3

3. Inadequate filter use: Always ensure appropriate filters are available and used correctly to prevent complications 1

4. Poor organization leading to delays: Purpose-oriented organization of trolley contents can significantly reduce time to locate and prepare necessary items 2

5. Inadequate monitoring for TACO: Include equipment for monitoring signs of TACO, which is now the most common cause of transfusion-related mortality 1

By ensuring these components are readily available on a transfusion trolley, healthcare providers can deliver blood components safely and efficiently, reducing the risk of complications and improving patient outcomes.