Coagulation factors

Once administered the products stay in the blood for a relatively short time (half life) thus they are given frequently when bleeds occur or when a child is having surgery or acute bleeding (Rationales 1 and 2).

Preparation - child and family

Inform child and family of the following (Rationale 3):

• that a coagulation factor is necessary
• the reason for the infusion
• what it entails
• the likely duration of the procedure

Ensure the following pre-transfusion observations of the child are recorded (Rationales 4, 5 and 6):

• temperature
• respiration rate
• heart rate
• blood pressure

Ensure venous access has been established (Rationale 7).

This should be according to intravenous transfusion guidelines.

Preparation - prescription

Coagulation factors must not be administered unless prescribed on the child’s prescription chart (Rationale 8).

Ensure the coagulation factor is prescribed according to the Drug Policy (Rationales 8, 9 and 10).

This should be in international units or micrograms.

Ensure you have a prescription or instructions for what should happen after the transfusion (Rationales 11 and 12).

If administering an intravenous pre-medication of an anti-histamine and steroid do so prior to commencing infusion (Rationale 13).

Preparation - injection/infusion

Planned administration

The coagulation factors should be available in the drug refrigerator on the ward (Rationale 14).

Emergency administration

The coagulation factors can be collected from the refrigerator in the Haemophilia Centre.

The person collecting the coagulation factors from the Haemophilia Centre must record their removal in the treatment book (Rationale 15).

Check the child’s details are the same in the treatment book & their health care records ie (Rationale 16):

• hospital number
• first name and family name
• date of birth

Gather the equipment required to administer an intravenous infusion or injection (as appropriate) (Rationale 17).

Coagulation factors must not be filtered (Rationale 18).

Prepare injection/infusion using standard (universal) precautions & an aseptic non-touch technique (ANTT) (Rationale 19).

Infuse/inject product - general

Check the child’s name band and prescription according to the Drug Policy (Rationale 16).

Inject/infuse product according to prescription according to the relevant intravenous therapy guidelines using an aseptic non-touch technique (Rationales 9 and 19).

Infuse/inject product - observations and recordings

Record the following in the child’s health care records:

• Date and time of starting administration (Rationale 20).
• Sign that you are responsible for its administration (Rationale 21).

Establish the frequency and type of observations that the child may require during the transfusion according to their clinical condition (Rationale 22).

Observe child for minor reactions to coagulation factor eg (Rationale 23):

• sweating
• mottled appearance
• dizziness
• rash
• redness on chest or flushing
• fever
• tachycardia
• nausea
• chills

Observe child for major reactions to coagulation factor eg (Rationale 23):

• rigor
• laboured breathing/wheezing
• chest pain
• back or loin pain/darkened urine
• loss of consciousness
• sudden collapse

Infuse/inject product - reaction management

If the reaction is unexpected:

• Stop transfusion (Rationale 24).
• Infuse 0.9% sodium chloride (Rationale 25).
• Obtain medical assistance (Rationale 26).
• Record incident in child’s health care records (Rationale 20).
• Complete an incident report form. 
• Continue administration when possible.

If child had potential for a reaction:

• Stop transfusion.
• Infuse 0.9% sodium chloride (Rationale 25). 
• Give prescribed steroid and anti-histamine (Rationale 24).
• Continue administration when child has recovered.
• Inform doctor.
• Record in child’s health care records (Rationale 20).
• Complete an incident report form. 

If a severe reaction occurs:

• Stop transfusion immediately (Rationale 27).
• Infuse 0.9% sodium chloride (Rationale 25).
• Seek urgent medical assistance. 
• Give steroid and anti-histamine if prescribed (Rationale 24).
• Do not recommence administration.
• Record incident in child’s records.
• Complete an incident report form.

Completing infusion

If the prescription is complete: 

• Dispose of all used equipment according to the Waste Policy.  Do not put into sewage/water system (Rationales 8 and 28).
• Wash and dry hands (Rationale 19)
• If large volumes of coagulation factors are required, inform the Haemophilia Centre (Rationale 29).

Appendix 1 - Coagulation factors

Rationale

Rationale 1: Children with inherited or acquired bleeding disorders are treated with coagulation factors to correct their underlying bleeding disorder.
Rationale 2: In children with severe bleeding disorders these are given prophylactically, usually three times per week, to prevent bleeding occurring.
Rationale 3: To obtain "consent".
Rationale 4: To establish the baseline parameters for a child.
Rationale 5: To rule out pre-existing diseases processes if a reaction is suspected.
Rationale 6: These could alter in a reaction.
Rationale 7: To enable infusion to commence.
Rationale 8: To maintain Hospital Policy.
Rationale 9: To prevent infusion errors.
Rationale 10: To reduce wastage.
Rationale 11: Doses may need to be repeated.
Rationale 12: To ensure planning takes place.
Rationale 13: To prevent a reaction to the blood product in children who have suffered reactions in the past.
Rationale 14: Coagulation factors must be stored at 4-8°C.
Rationale 15: To ensure product tracing can take place.
Rationale 16: To ensure the correct product is given to the correct child.
Rationale 17: Coagulation factors are administered by intravenous injection except for Fibrinogen which needs to be infused over 20-30 minutes.
Rationale 18: Coagulation factors will be removed by filters leading to the administration of a suboptimal dose and result in bleeding.
Rationale 19: To minimise the risk of infection.
Rationale 20: To ensure accuracy of records.
Rationale 21: To determine accountability for the transfusion.
Rationale 22: To monitor for potential complications.
Rationale 23: To ensure safety of child.
Rationale 24: To stop reaction.
Rationale 25: To maintain patency of IV access device.
Rationale 26: To obtain prescription for steroid and anti-histamine.
Rationale 27: To minimise impact from reaction.
Rationale 28: To reduce risk of infection by safe disposal.
Rationale 29: To assist ordering and stock delivery to ward areas.

Further reading

Reference 1:
UKHCDO (1997) Guidelines on the therapeutic products to treat haemophilia and other hereditary coagulation disorders. Haemophilia 3: 63-77.

Reference 2:
Bolton-Maggs PH, Colvin BT, Satchi BT, Lee CA, Lucas GS (1994) Thrombogenic potential of factor XI concentrate. Lancet 344 (8924): 748-9.

Reference 3:
Khair K, Richardson J, Susman-Shaw A for Haemophilia Nurse Association (1995) Standards of care for haemophilia nursing. London, Royal College of Nursing

Reference 4:
Bedford M, Elliott D, Khair K, Mackett N for Haemophilia Nurse Association (2002) A competency framework for nurses caring for people with haemophilia and related bleeding disorders. London, Royal College of Nursing

Reference 5:
Department of Health (1993) Provision of haemophilia treatment and care. Health Service Guidelines (HSG) 30: pages not given.

Document control information

Lead author(s)
Kate Khair, Nurse Consultant, Haemophilia