Medical care of donors and collection of blood are important functions of a transfusion centre. A pleasant experience during collection ensures regular donation.
Proper venepuncture has an important role in ensuring safety of blood. Medical or para medical staff who perform and supervise the venepuncture must be skilled so as to minimize the discomfort to the donor. An imperfect technique may discourage the donor from becoming a regular donor.
The donor’s well being depends upon professional competence, reassurance to the donor and a skilled venepuncture technique using sterile closed system of blood collection
Donor Room
The phlebotomy room should be separate, clean, well-aerated and air-conditioned.
The height of the donor beds should be 3 feet. Beds should be covered with a soft mattress and a clean sheet.
Equipment and Chemicals
- Blood collection bags with anticoagulant (The bags should be designed to prevent contamination. Plastic bags with CPD/CPDA-1 are most commonly used.)
- Weighing scale to weigh the blood bag during collection
- Sphygmomanometer
- Weighing machine, thermometer, artery forceps
- Sterile cotton swabs, savlon, iodine and methylated spirit (Each of these must be placed in clean lapelled containers.)
- Tube sealer with clips
- Medicated dressing (Band-aid)
- Emergency kit
Intravenous fluids, ampoules of adrenaline, dexamethasone, calcium gluconate, mephentamine, oxygen cylinder with regulator and mask
- Test tube stand by bedside to hold tubes.
Identification of Donor
Before starting the phlebotomy, identify the donor by a donor number. Attach the donor number to the blood bag and pilot tubes. The date of collection and expiry; and the blood group of donor if tested, should be written on the blood bag label.
Inspection of the bag
All blood bags must be inspected before starting the blood collection procedure. The anticoagulant must be clear. Look for any leaks, breaks, turbidity or any change in colour of the anticoagulant, fungal. growth over the bag, or under the label or an abnormally large air bubble. Check the intact ports and a sealed needle.
Volume of blood.
The volume of blood collected is proportionate to the anticoagulant (49 ml of CPDA-1 for 350m1 blood and 63 ml CPDA-1 for 450m1 blood).
Procedure of Venepuncture
- Make the donor lie down comfortably.
- Selecting the vein
- Inspect both arms in the antecubital fossa (first left and then right) to select a suitable vein. The selected vein should be large and firm, but not very superficial, slippery or mobile.
- Apply a sphygmomanometer cuff and inflate to 80-100 mm Hg to select a vein. Ask the donor to make a first which will help in selecting the vein. Release the cuff pressure and ask the donor to loosen the tight first, after selecting the vein.
Pressure applied for too long before the venepuncture causes margination of platelets and blood collected during this period will show a lower platelet count. A platelet preparation from blood collected in this manner may have less number of platelets. Therefore pressure may be released after selection of vein and raised again just before venepuncture, after thorough cleaning of the arm has been done.
- Cleaning the Venepuncture site :
Clean 4-5 cm of area around the selected vein in a concentric centrifugal (spiral) pattern starting from the venepuncture site as the centre.
- Apply 15% chlorhexidine (Savlon) as the antiseptic and detergent solution to remove the dirt from the donor arm.
- Remove the foam with a dry, sterile swab and apply tincture iodine. Allow the solution to dry.
- Remove the iodine with methylated spirit.
- Do not touch the cleaned area after preparation.
- Application of local anaesthetic agent (2% lignocaine) at this stage is optional depending upon the donor acceptability to the venepuncture.
- Put a loose knot just near the needle end of the tubing, which enables the needle to be easily disconnected from the tubing after blood collection.
- Raise the cuff pressure to 60mm Hg, break the seal and insert the needle held at an angle of 45?C with bevel upwards into the vein. Push a little way into the vessel lumen to avoid displacement. Anchor the needle hub with a plaster on the donor arm.
- Never leave the donor unattended during the process of blood collection.
- Ask the donor to open and close the first to increase the blood flow during collection of blood.
- Mix the blood and anticoagulant gently and periodically during collection of blood either manually or using automated mixing equipment.
- Monitor the volume of blood being drawn using a balance (imI blood = 1.059, 350 ml blood = 367 g and 450 ml = 472 g + weight of empty bag). Monitoring of volume alone with mixing of anticoagulant with the blood may also be done by automated blood mixer.
- When the appropriate amount has been collected, clamp the tubing with artery forceps and deflate the cuff. Place a sterile swab at puncture site and withdraw the needle.
Care of the collected blood unit
- At the processing table, loosen the artery forceps and apply light pressure on the bag to transfer 5-6 ml of blood in each of the two pilot tubes. Also collect 2-3ml of blood in EDTA vial for complete haematological workup of the donor, for quality control of the pre-donation screening.
- The needle may be directly placed in the pilot tubes to avoid any accidental puncture. A hand guard or a wooden barrier with two holes to hold the pilot tubes may be used to safeguard against any accidental needle piercing. The wooden barrier, may be a circular disk of 8-10 cm which protects the fingers from being pierced by the needle.
- Tighten the knot and cut the tubing distal to the knot to separate the needle. The needle must be put in a puncture proof container (aluminium box or bread box) containing 10% liquid bleach or 2% activated glutaraldehyde. The tubing may be stripped using a stripper, cutter and sealer forceps to mix the blood in the tubing with the anti-coagulated blood. Seal the tubing into 4-5 segments by means of knots, aluminium rings or electronic tube sealer.
Care of the donor
- The donor should be under constant observation. After the phlebotomy he should remain on the couch for a short while.
- Ask the donor to raise the arm and open the first. Apply firm pressure on the venepuncture site with 2-3 fingers of the other hand, till the bleeding stops. Never ask the donor to fold the arm over the swab, as it may give him a false sense of security and blood may keep oozing from the venepuncture site causing a haematoma.
- When the oozing stops, apply a medicated dressing such as band-aid.
The time of collection of blood should be minimized, specially if blood is to be used for component preparation. This will ensure an optimal yield of coagulation factors.
If it takes more than 8-10 minutes for the collection of blood in a bag, do not use it for component preparation as an interrupted slow flow due to a traumatized venepuncture may cause release of tissue factors and initiate the coagulation process with depletion of coagulation factors.
Instructions to donors
- Drink more fluids than usual in the next 4 hours.
- Do not smoke for half an hour and do not consume alcohol for next 24 hours.
- Avoid strenuous exercise for 24 hours.
- If feeling faint or dizzy, lie down or sit with the head between the knees. If the symptoms persist the donor should report to the blood bank or consult a doctor immediately.
- Drivers or pilots may not report for duty for next 24 hours. (to avoid any fatalities due to delayed faint)
- If the phlebotomy site bleeds, apply pressure. Remove the band-aid after 5-6 hours.
Post donation care
The resting period of 15-20 minutes after blood collection is actually the time to observe the donor for any donor reaction.
The resting period is also of special significance in regard to the prevention of the delayed faint.
Ensure that the donor remains lying down for 5 minutes either on the bed used for venpuncture or on a designated rest bed. Allow the donor to sit up slowly after 5 minutes and give a cup of hot fluids.
Before the donor leaves the donor room, inspect the site of venepuncture for any bruises or naematoma. Thank the donor for his contribution and motivate him/her to donate again.
Adverse donor reactions
Adverse reactions due to donation of blood are rare but sometimes the donor may develop reactions during or after donation of blood. Each transfusion centre must have medical and paramedical staff trained to handle and manage these reactions.
As the staff working in a blood collection centre may not routinely come across a serious donor reaction they may not be skilled to handle such reactions. It is necessary to send the staff by rotation for a refresher course to learn resuscitation measures every 6 months. This can be done in collaboration with the anesthesia department of the hospital.
Donor reactions can be classified as
- Mild
Vasovagal symptoms
- Moderate
Exaggerated mild symptoms with loss of consciousness.
- Severe
Any of the above, accompanied by convulsions.
Sudden cardiac arrest.
Mild reaction
- Syncope or fainting is a commonly encountered reaction. It may be associated with a rapid pulse rate, pallor, sweating and increased respiration. When this occurs the following steps should be taken
- Discontinue donation.
- Place donor in a head low position.
- Keep the donor cool.
- Offer a drink/light food on recovery.
- Monitor the pulse, blood pressure and respiration.
- Provide an emesis basin or kidney tray in case the donor vomits.
- Reassure donor and allow a sufficient period of rest before he leaves the room.
- Vasovagal attack may be associated with loss of consciousness and has to be managed as above.
- Muscular spasm or tetany
Muscular spasm may sometimes be observed. The donor is asked to breathe in a paper bag which alleviates the symptoms.
- Haematoma
A haematoma may form at the site of venepuncture. This can be prevented by a good venepuncture technique and application for pressure after donation. If it forms during the collection, stop the donation, raise the arm and apply pressure. When it stops oozing, apply a pressure bandage.
If haematoma is noticed later, apply ice immediately to the area for 10-15 minutes to avoid swelling and discoloration, Inform the donor that discoloration of skin will disappear in 5-6 days.
- Nausea & Vomiting
This reaction may occur due to vagal stimulation. Make the donor comfortable and turn the head to one side to avoid aspiration. Give water to clean the mouth.
- Convulsions
Convulsions are rarely observed as adverse donor reaction. To manage such reaction
- Turn donor to a lateral position to maintain free airway.
- Monitor pulse and B.P.
- Maintain adequate airway.
- If required, give anticonvulsant agents.
- The donor should be escorted home and advised not to donate blood again.
- Sudden cardiac arrest
Sudden cardiac arrest is a very rare reaction which may be seen in a donor particularly plasmapheresis donors. It is, therefore, very important for all the staff members working in the donor room to be trained in handling various types of donor reactions.
All donor reactions and their management should be recorded in the donor’s record
