FLIP CHART for use in the PHYSICAL PLASMA START-UP 123 Kindness Street, Anywhere, USA 90090
EXAM
BLOOD
DONATION
2
READ ME OUT LOUD
I have read the consent form provided to me in the Donor Education Pamphlet. I understand that donating plasma is voluntary and that I can withdraw my consent and stop donating at anytime.
WHAT TO EXPECT Step 1.
The Nurse will review the self-administered health questionnaires & body map you completed before the exam started.
Step 4.
Nurse will perform a handson physical exam
Step 5. First Plasma Donation & Testing
Step 2. Nurse will review your current medications to ensure donating will not negatively impact you or a patient that might receive your plasma in the future.
Step 3. Nurse will review the risks of donation and ask you sign an Informed Consent.
Thank You for Your Donation
DONOR RESPONSIBILITY
Drink enough water
Eat a Healthy Meal Before Donation
Rest and relax before blood donor
Avoid fatty food
Avoid caffeine & alcohol
Avoid Smoking
Creutzfeldt-Jacob Disease (CJD) or (vCDJ) This is rare degenerative disease that effects the brain.
Causes: Consumption of infected raw meat Tissue transplant from infected donor Transmitted through blood / plasma
CJD or vCJD
THERE IS NO TEST FOR CJD DO NOT DONATE IF YOU ARE AT RISK
Routine
The following tests may be performed on your blood.
Testing Human Immunodeficiency Virus (HIV ½) Hepatitis B (HBSag) Hepatitis C (HCV) NAT (HIV, HBS, HCV) Syphilis (RPR)
West Nile Virus (WNV) Zika Virus Atypical Antibodies Serum Protein (SPE)
WHAT HAPPENS IF I TEST POSITIVE?
01
Deferred from Donating
02
Notification by Mail
You, your sexual partners & household contacts may be temporarily or permanently deferred from donating.
You will receive a notification requesting you to return to the center to confidentially discuss your results. We cannot discuss via phone.
Health Department Notification Your information will be sent to the local Health Department.
NDDR Notification Your information will be entered into the National Donor Deferral Registry.
03
04
TESTING RISKS: There is a small chance you could have a false positive or false negative test result. Do NOT donate if you have any of the risk factors listed in the Donor Education Pamphlet. Do NOT Donate to receive free testing. Our testing is for Screening purposes only.
If you identify yourself with ANY of the high-risk groups, please do NOT donate.
If you have ANY signs or symptoms of HIV / AIDS, do NOT donate.
Your Plasma Will be Used to Help Others. Please Report Any Conditions That You Feel May Affect the Quality of Your Plasma, including Activities, Illnesses & Medications.
Donation RISKS
Drop in Protein
O
This is a sample text. Insert your desired text here.
Drop in Hemoglobin
A
Sometimes red cells cannot be returned to you due to poor veins, or equipment failure. You will be deferred 8-weeks to recover.
Feeling Iky
AB
You could experience light headedness, dizziness, fainting, nausea, vomiting or rapid pulse which could be caused by the change in blood volume.
Bruise or Hematoma
B
It is not uncommon to experience a small bruise, but there is a potential for blood to leak around the vein and create a bruise that could last a few days to a few weeks.
Infection at Site
B
Even though we use antiseptics to clean your skin, there is a chance of infection.
Donation RISKS
Injury
O
There is a possibility to experience an injury as a result of a reaction.
Equipment Failure
A
The apheresis machines are equipped with air detectors, however, there is a possibility that air might be infused during a red cell return.
Anticoagulant
AB
Your blood is mixed with anticoagulant to prevent it from clotting. Sometimes AC can cause a tingling sensation around the lips or fingers, as well as muscle tightness.
Fluid Loss
B
When you donate plasma you will experience a fluid loss.
Allergic Reaction
B
Although rare, allergic reactions may occur: flushing, itching, hives, cramps, difficulty breathing, chest pain or bronchospasm which may be life threatening.
POST Donation Instructions
• • • •
Leave bandage on for at least two hours Do not touch or mess with the venipuncture site. Call the center if you have any bleeding, swelling or rash at the venipuncture site. Call the center if you experience a reaction after leaving.
QUIZ List Three (3) Risk Factors for HIV / AIDS
List Some Signs and Symptoms of HIV /AIDS
List Some Possible Side Effects of Donating
What Should You Avoid After Donating?
INFORMED CONSENT
The plasma donation procedure is completely voluntarily. You may stop donating at any time.
THE PHYSICAL EXAM
01
General Health & Nutrition
02
Endocrine
Skeletal, Gait, Skin & Neuromuscular
Head & Neck, Lymph Nodes, Thyroid Gland
Cardiovascular & Pulmonary Heart & Lungs
Gastrointestinal
Abdominal palpitation,
03
04
16
BODY MAP: If you receive a piercing or tattoo, you must report it before the next donation.
QUESTIONS
If you have questions or concerns, today or in the future, please ask to speak with our medical staff. ALL discussions and information are kept strictly confidential.
WHEN YOU LEAVE
If you feel your plasma should not be used after leaving the center, you may call and speak to the manager or medical staff about removing your plasma from inventory.
PLASMA CENTER
PLASMA START-UP Tel. 555-5555