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Home Healthcare Nurse:
Clinical Concerns

Transport and Storage of Infusion Supplies and Blood Products

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Home care nurses face many challenges in transporting and storing medications and blood products in their vehicles and in patients’ homes. Unlike climate-controlled institutions, products subject to the cold of winter and the heat of summer can easily be damaged, which can be harmful to the patient. Additionally, several regulations and protocols demand that products be cared for in a certain manner, stored in the proper container, and labeled appropriately.

The following information presents the current practices in storing and transporting these products safely. It can be used as a guide for policy and procedure development and a review for clinicians in assuring safe handling of these products from office to home to lab.

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Blood Storage for Home Transfusions

Maintaining the appropriate blood or blood product temperature is essential in controlling bacterial growth and preventing hemolysis when the blood is to be administered in the home. When blood and blood products (blood) that are to be administered in the home are transported, storage and transportation time should be kept to a minimum, and the blood should be transported directly from the blood center to the patient’s home. The blood should be placed in a sealed plastic bag and then placed in an impervious, clean, thermally insulated cooler or other device for transport.

The blood should be stored with wet ice or a coolant that maintains a temperature of 1° to 10° C or 33° to 50° F. Fresh-frozen plasma should be stored at 1° to 6° C or 33.0° to 42.8° F. Blood must be protected against direct exposure to ice packs or other coolant sources. Platelets and thawed fresh-frozen plasma should be stored at room temperature, which should not exceed 37° C, in an impervious, clean, thermally insulated cooler without coolants and without exposure to temperature extremes. Temperature-sensitive monitor tags or monitors may be placed on the blood bag to ensure the blood is maintained at the proper temperature during transport and before administration (Fridey, Kasparin, & Issitt, 1994).

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Blood Storage in the Patient’s Home

In the patient’s home, if more than 1 unit of blood will be transfused, the unused component(s) should remain in the insulated cooler until transfused into the patient. The blood or blood products should not be stored in the patient’s refrigerator or freezer because temperatures may vary. If the ice melts or the temperature-sensitive monitors do not display a temperature reading that is within acceptable temperature limits, the blood center should be contacted for further instructions.

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Transporting Blood Specimens

After blood specimens are obtained in the patient’s home, they should be placed in an impervious container for storage or transport. If a non-red container, such as a plastic sandwich container, is used to store blood specimens during transport, it should have a biohazard label affixed to the top. Some home care organizations teach their patients to dispose of their sharps in other impervious household containers.

If the home care organization’s policy is to pick up non-red sharps containers for disposal, the container must be placed inside a red bag or labeled with a biohazard label for transport and storage. Bags of cross-matched blood, blood components, or other blood products that are labeled as to their contents and have been released for transfusion are not required to be labeled biohazardous (OSHA, 1991).

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Storage and Transport of Parenteral Medications

Once parenteral products have been prepared, they should be held in a refrigerator until being placed in a clean, insulated cooler for delivery. Food or laboratory specimens should not be stored in the same refrigerator as medication.

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Medication Storage During Transport

Medications that have been compounded by the pharmacy, such as IV antibiotics, compounded analgesic suppositories, IV admixtures, and total parenteral nutrition (TPN) formulas, should be kept refrigerated during transport to the patient’s home and before administration. While transporting compounded medications that will be administered in the home, medications that require refrigeration should be placed in a sealed plastic bag and then placed in an impervious, clean, thermally insulated cooler.

During transport, the medication or TPN solution should be stored with reusable ice blocks that maintain a temperature of 2° to 8° C or 35° to 46° F (USP, 1996). Other drugs that are being delivered to the patient’s home that are not compounded, such as heparin or saline flushes, should be placed in an appropriate container to prevent product contamination during transport.

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Medication Storage in the Patient’s Home

The length of time that compounded medication or TPN solution may be refrigerated is based on the stability of the admixed components. When the medication or TPN is refrigerated in the home, it should be stored in separate areas of the refrigerator than where food is stored, if possible.

The compounded medication and or TPN solution needs to remain refrigerated until it is taken out to warm to room temperature just before administration. TPN solutions should be removed from the refrigerator approximately 1 hour before infusion. Medication that is stored frozen should be thawed in the refrigerator and not left out atop the patient’s kitchen counter for several hours at room temperature. If the medication must be refrigerated and the patient does not have a refrigerator, the agency may provide a refrigerator on a temporary basis, or the patient must gain access to a refrigerator (e.g., from a neighbor or friend).

The temperature in the patient’s refrigerator does not have to be monitored or checked with a thermometer; however, the refrigerator should maintain the medications cold. Medications and TPN solutions must not be used beyond their expiration date. New medications that are delivered to the patient should be rotated in the refrigerator to ensure that the patient uses the older medications first.

Reprinted, with permission, from Rhinehart, E., & Friedman, M. M. (1999). Infection Control in Home Care. Gaithersburg, MD: Aspen. To order call (800) 638-8437 or visit http://www.aspenpublishers.com.

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Transport and Sotage Tips

▪ Minimize blood storage and transportation time.

▪ Transport blood directly from the blood center to the patient’s home.

▪ After blood specimens are obtained, place in an impervious container for storage or transport.

▪ The length of time that compounded medication or TPN solution must be refrigerated is based on the stability of the admixed components.

▪ Medications such as IV antibiotics, compounded analgesic suppositories, IV admixtures, and TPN formulas should be kept refrigerated during transport to the patient’s home and before administration.

▪ While transporting compounded medications that will be administered in the home, medications that require refrigeration should be placed in a sealed plastic bag and then placed in an impervious, clean, thermally insulated cooler.

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REFERENCES

1. Fridey, J., Kasparin, C. & Issitt, L. (Eds). (1994). Out-of-hospital transfusion therapy. Bethesda, MD: American Association of Blood Banks.

2. Occupational Safety and Health Administration (OSHA). (1991). Occupational exposure to bloodborne pathogens: Final rule, 29 CFR 1910.1030. Federal Register, 56, 64003–64282.

3. U. S. Pharmacopeia (USP). (1996). The U.S. pharmacopeia (23rd rev.). Rockville, MD: U.S. Pharmacopeia Convention.

© 2001 Lippincott Williams & Wilkins, Inc.

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