U.O. Immunoematologia e Trasfusionale, Policlinico S.Orsola-Malpighi, Bologna, Italy.
Blood Transfus. 2009 Oct;7(4):313-8. doi: 10.2450/2009.0001-09.
Blood safety must be maintained throughout the whole transfusion chain to prevent the transfusion of incorrect blood components. The estimated risk of an incorrect transfusion is in the order of 1 per 10,000 units of blood. Although several kinds of errors contribute to "wrong blood" events, 70% of errors occur in clinical areas with the most common being due to failure of the pre-transfusion bedside checking procedure.
Several methods are available to reduce such errors. The I-TRAC Plus system by Immucor consists of an identification bracelet which is a bar-coded wristband and a handheld portable computer that identifies patients and blood bags by a scanner and prints the information through a portable printer. The labels attached on the blood order forms and on the sample tubes are read and recorded in the blood bank's informatics system (EmoNet INSIEL). Labels showing the bar-code of the assigned number, which includes the ID number of the patient, the ID number of the unit and a code identifying the kind of product and use (allogeneic or autologous), are generated and applied to the blood components. The transfusions are administered after checking the unit and the patient's wristband using the scanner of a portable PC.
In 5 years a total of 71,400 units of blood components were transfused to 15,430 patients using the I-TRAC Plus system. The system prevented 12 cases of mis-identification of patients (5 in 2003, 0 in 2004, 1 in 2005, 1 in 2006 and 5 in 2007).
In 2003 we introduced the use of a bar-code matching system between a patient's wristband and the blood bag to avoid mistakes at the bedside. In 5 years the system provided benefits by avoiding errors in the identification of patients, thus preventing "wrong blood" transfusions.
为了防止输注错误的血液成分，必须在整个输血链中保持血液安全。估计错误输血的风险为每 10000 单位血液 1 例。尽管有几种错误导致“错误的血液”事件，但 70%的错误发生在临床区域，最常见的错误是由于术前床边检查程序失败。
有几种方法可以减少此类错误。Immucor 的 I-TRAC Plus 系统由识别腕带组成，腕带是一个条形码腕带，还有一个手持便携式计算机，通过扫描仪识别患者和血袋，并通过便携式打印机打印信息。附加在血液订单和样本管上的标签在血库信息系统（EmoNet INSIEL）中读取和记录。标签显示分配号码的条形码，其中包括患者 ID 号、单位 ID 号以及识别产品种类和用途（异体或自体）的代码，然后将条形码标签应用于血液成分。使用便携式 PC 的扫描仪检查单位和患者腕带后，即可进行输血。
使用 I-TRAC Plus 系统在 5 年内共向 15430 名患者输注了 71400 单位的血液成分。该系统预防了 12 例患者身份识别错误（2003 年 5 例，2004 年 0 例，2005 年 1 例，2006 年 1 例，2007 年 5 例）。
2003 年，我们引入了患者腕带和血袋之间的条形码匹配系统，以避免床边的错误。在 5 年内，该系统通过避免患者身份识别错误，避免了“错误的血液”输注，从而带来了好处。
