Infusion of cryopreserved stem cells

Equipment

1. Dewar containing stem cells in liquid N2.

4. Protective gloves.

5. Patient's notes.

6. Trolley with: syringes, needles, ampoules of 0.9% saline, blood giving sets, sterile dressing towels, chlorhexidine spray, bags of 500mL N/Saline, sterile gloves.

Ensure the patient has had procedure and any possible side effects explained.

Method

1. Write up the stem cell infusion on the blood product infusion chart.

2. 30 mins before re-infusion, ensure water bath is filled and heated to 37°C-40°C and give (chlorpheniramine) 10mg IV and paracetamol 1g PO.

3. When ready to return the stem cells take the dewar and equipment 312 trolley to the patient's bedside.

4. Check the patient's vital signs.

5. Set up a standard blood giving set with microaggregate filter. Never use additional filters. Prime with 500mL 0.9% saline, connect to the patient and ensure good flow before starting to thaw any cells.

6. Check the water bath is 37°C-40°C and using the protective gloves and large tongs remove a bag of cells from liquid nitrogen dewar and place on the trolley. Carefully remove from the outer sleeve and place in water bath and allow one minute. DMSO cryopreservative is very toxic to cells once thawed so it is important to go straight from rapid thaw to infusion.

7. Remove bag of cells from water bath using the tongs, spray with chlorhexidine and allow to dry. Check patient identification number and DOB with the patient and if correct then connect to the giving set.

8. Cells should be returned as quickly as possible. Each bag contains approximately 100-150mL. Providing the flow is good, start thawing the next bag. Only thaw the next bag if you are able to finish the previous bag within the next minute. Check the patient's details on every bag.

9. Check the patient's observations at 15 minute intervals.

10. If the patient complains of abdominal pain, nausea or feeling faint, slow down the IVI for a short time. If symptoms persist or patient develops chest tightness or wheezing—stop the infusion. O2 ± nebulised salbutamol may be required. Anaphylaxis rarely occurs.

11.At the end of re-infusion ensure no more bags of stem cells in the dewar and clear away all equipment.

12.Write the infusion details in the patient's notes in red ink.

Special considerations

► If the bag splits/leaks do not re-infuse—contents will not be sterile. Very rarely, a bag could start to expand rapidly upon thawing if all air not removed from the bag before freezing. A sterile needle may be used to pierce the bag if release of pressure appears essential.

►► Acute anaphylaxis is very rare but epinephrine (adrenaline) (1mL of 1:1000 ) should be available in the patient's room for SC or IM administration.

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