The information given here supplements that given in Chapters 2 and 3. Users of these guidelines should read Chapters 2 and 3 before reading the information given below. This chapter covers background information (Section 4.1) and practical guidance (Section 4.2) relevant to venepuncture for blood donation.
4.1. Background information on venepuncture for blood donation
Blood banks use various processes to try to prevent infections that can be transmitted by infected blood donation. One important measure to prevent infection is to recruit donors from populations that are known to have low rates of infection for bloodborne diseases, such as voluntary, unpaid donors and people with no history of intravenous drug use. A second measure is to ask donors a series of additional screening questions (these will vary by region) to help identify those who may be at higher risk of infection. Phlebotomists must adhere strictly to the rules for including and excluding blood donors. A third measure is to test donated blood for infections common in the area before processing it for use for various therapeutic purposes.
The process for collecting blood from donors is similar to that used for blood sampling; however, a few additional measures are required for collection of donated blood. These measures are primarily to ensure patient safety, but also to minimize exogenous contamination of a donated blood unit or its derived components, particularly contamination from the skin flora of the donor's arm. Because of the volume or blood collected and the length of storage, pathogens can multiply during storage. Safe collection ensures that the blood products are safe for therapeutic use throughout their shelf life.
Skin flora is a common source of contaminants; it is therefore important to use an effective antiseptic on the donor's arm before blood donation. Transfusion with blood components that are contaminated with exogenous bacteria or other agents can cause fatal complications (30, 45). Studies on the topic have been inconclusive (46); however, based on available literature and expert opinion, the recommended option for skin antisepsis for blood donation is the one-step application of a combination of 2% chlorhexidine gluconate and 70% isopropyl alcohol for 30 seconds, followed by 30 seconds drying time (47–49).
Blood donations should be collected only by trained and qualified blood transfusion services personnel.
4.1.1. Minimum requirements for venepuncture for blood donation
The relevant guidance given in Chapter 2 on planning, location and infection prevention and control practices should be followed, as should the guidance in Chapter 3 on closed systems. Additional requirements for a collection system for blood donation are listed below.
Equipment:
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All equipment used for collection of blood donations should be regularly calibrated, maintained and serviced, as required. Such equipment includes blood pressure monitors, scales, donor couches or chairs, blood collection monitors or mixers, blood bag tube sealers, blood transportation boxes and blood bank refrigerators.
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Furniture and equipment in the area of blood donation and processing should be made of cleanable surfaces (e.g. vinyl rather than fabric). Containers used to transport supplies and specimens should also be cleanable by disinfectants such as sodium hypochlorite bleach solutions. Fabric or textile carriers should be machine washable.
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A closed collection system with a sterile blood collection bag containing anticoagulant, and with an integrally attached tube and needle should be used. Some bags include diversion pouches to sequester the first 20 ml of blood collected, to minimize contamination from skin flora and the skin core (50). If blood for haemoglobin testing is gathered with a capillary stick, a single-use sterile lancet should be used and then placed immediately in a safety box.
Location:
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Premises should be of sufficient size for efficient operations, with separate areas for clean and dirty processes, clean running water, and surfaces cleanable by disinfectants.
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Floors should not be carpeted.
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Waiting areas should be outside the collection area, to minimize the risk of respiratory pathogens for workers.
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All fixed and mobile blood donation sites should be safe, clean, hygienic and tidy, and should meet defined standards of environmental safety.
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The donation sites should be organized in a way that ensures the safety of blood donors, staff and donated blood units, and avoids errors in the blood donation process.
4.1.2. Before a blood donation
WHO has developed a set of basic requirements for blood transfusion services, which cover the steps to take before donation (51). Blood donation should be voluntary; it should not involve duress, coercion or remuneration. Also, potential blood donors should be selected carefully, according to the national criteria for donor selection.
Before a person donates blood (52):
the potential donor should be given pre-donation information, advice and counselling about the process of blood donation;
a relevant history of the donor should be taken, covering health and high-risk behaviour, and including
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history of mastectomy (blood should be taken from the arm opposite the site of surgery) (48, 53);
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current and recent medications or chronic infections;
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history of prolonged bleeding or a past diagnosis of bleeding disorders;
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history of previous donations, to ensure the waiting period is respected;
a preliminary physical check-up of the donor should be done, including weight, blood pressure, signs of infection or scarring at potential sites;
the donor should be offered fluids, to help reduce the risk of fainting after blood donation (
54);
the person should provide informed written consent, based on the national requirements.
4.2. Practical guidance on venepuncture for blood donation
4.2.1. Collecting blood
For collection of blood for donation, use the procedure detailed in Chapter 2 for blood sampling (e.g. for hand hygiene and glove use), as far as it is relevant, and follow the six steps given below.
Step1. Identify donor and label blood collection bag and test tubes
Step 2. Select the vein
Select a large, firm vein, preferably in the antecubital fossa, from an area free from skin lesions or scars.
Apply a tourniquet or blood pressure cuff inflated to 40-60 mm Hg, to make the vein more prominent.
Ask the donor to open and close the hand a few times.
Once the vein is selected, release the pressure device or tourniquet before the skin site is prepared.
Step 3. Disinfect the skin
If the site selected for venepuncture is visibly dirty, wash the area with soap and water, and then wipe it dry with single-use towels.
One-step procedure (recommended – takes about one minute):
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use a product combining 2% chlorhexidine gluconate in 70% isopropyl alcohol;
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cover the whole area and ensure that the skin area is in contact with the disinfectant for at least 30 seconds;
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allow the area to dry completely, or for a minimum of 30 seconds by the clock.
Two-step procedure (if chlorhexidine gluconate in 70% isopropyl alcohol is not available, use the following procedure – takes about two minutes):
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step 1 – use 70% isopropyl alcohol;
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cover the whole area and ensure that the skin area is in contact with the disinfectant for at least 30 seconds;
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allow the area to dry completely (about 30 seconds);
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step 2 – use tincture of iodine (more effective than povidine iodine) or chlorhexidine (2%);
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cover the whole area and ensure that the skin area is in contact with the disinfectant for at least 30 seconds;
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allow the area to dry completely (about 30 seconds).
Whichever procedure is used, DO NOT touch the venepuncture site once the skin has been disinfected.
Step 4. Perform the venepuncture
Perform venepuncture using a smooth, clean entry with the needle, as described in step 6 of Section 2.2.3. Take into account the points given below, which are specific to blood donation.
In general, use a 16-gauge needle (see
Table 3.1 in Chapter 3), which is usually attached to the blood collection bag. Use of a retractable needle or safety needle with a needle cover is preferred if available, but all should be cut off at the end of the procedure (as described in
step 6, below) rather than recapped.
Ask the donor to open and close the fist slowly every 10–12 seconds during collection.
Remove the tourniquet when the blood flow is established or after 2 minutes, whichever comes first.
Step 5. Monitor the donor and the donated unit
Closely monitor the donor and the injection site throughout the donation process – look for:
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sweating, palor or complaints of feeling faint that may precede fainting;
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development of a haematoma at the injection site;
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changes in blood flow that may indicate the needle has moved in the vein, and needs to be repositioned.
About every 30 seconds during the donation, mix the collected blood gently with the anticoagulant, either manually or by continuous mechanical mixing.
Step 6. Remove the needle and collect samples
4.2.2. After a blood donation
Donor care
After the blood has been collected:
ask the donor to remain in the chair and relax for a few minutes;
inspect the venepuncture site; if it is not bleeding, apply a bandage to the site; if it is bleeding, apply further pressure;
ask the donor to sit up slowly and ask how the person is feeling;
before the donor leaves the donation room, ensure that the person can stand up without dizziness and without a drop in blood pressure;
offer the donor some refreshments.
Blood unit and samples
Transfer the blood unit to a proper storage container according to the blood centre requirements and the product (
55–
58).
Ensure that collected blood samples are stored and delivered to the laboratory with completed documentation, at the recommended temperature, and in a leak-proof, closed container (
55,
57,
58).
4.2.3. Adverse events in blood donation
Be aware of possible adverse events, and the actions to take if these occur ().
Adverse events in blood donation.
