Should perfusionists in the operating room be allowed to administer units of blood?

A transfusion medicine physician in Southern California reports that her hospital wants to change their Blood Administration Policy to allow perfusionists in the operating room to 'hang' units of blood. Apparently, the hospital's current Blood Administration Policy requires that "licensed" personnel hang blood products. This is problematic, since (according to the inquiring physician) perfusionists are "credentialed" but not "licensed". The inquiring physician is of the opinion that none of the following documents requires that a blood product must be hung only by a licensed individual: the AABB Standards, the Technical Manual, the CAP Transfusion Medicine Checklist. She wants to know if other hospitals allow perfusionists to hang blood products.

The following responses were received.

ADDENDA Sept. 9, 2003

1. A blood banker from Michigan states: "Yes, we allow perfusionists to hang blood, provided they have been trained and have passed a competency assessment examination. Here is the pertinent section from our Blood Transfusion Policies and Standard Practices book."

STEPS THAT MUST BE TAKEN IMMEDIATELY PRIOR TO BLOOD TRANSFUSION

• Verify physician's orders for transfusion and premedication
• Verify patient/component identification at the bedside.

Before transfusion, the identification of the unit, using the label on the bag and the Transfusion Record Form, must be checked by two people at the patient's bedside against the identification of the intended blood recipient using the patient wristband. This step must never be bypassed. This is to be performed by qualified individuals such as a physician and registered nurse, two registered nurses, or by a registered nurse and a licensed practical nurse. Non-physician transfusionists and anyone who assists in double-checking the units (i.e. physician assistants, perfusion technicians, anesthesia allied health technicians, and emergency department technicians) must also complete the "Blood Transfusion Policies" course and examination. These two individuals must sign the Transfusion Record Form before blood transfusion is initiated.

2. A blood banker in Missouri reports that at his institution they perform 600 heart surgeries per year. Their perfusioninsts are responsible for all the cell-saver/washing, are allowed to hang the blood, and have done so for years. The responding Missourian reports that his institution is accredited by CAP, AABB, and JCAHO and is compliant with the state requirements.

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