Post on 23-Nov-2014
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Blood Transfusion
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What is Blood transfusion?
Introduction of whole blood or components into the venous circulation
Blood Transfusions can save LIVES !A mainstay in the treatment of patients
whose low blood count can compromised their lives
Carries risk in various degrees of transfusion reactions as well as transmission of blood-borne pathogens
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Purposes of Blood Transfusion
To restore blood volume after severe hemorrhage
To restore the capacity of the blood to carry oxygen
To provide plasma factors (antihemophilic factor , factor VIII) or platelet concentrates which prevent bleeding
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Blood groups
Human blood is classified into 4 groupsBlood type A,B , AB and O,The presence of a specific antigen in the
erythrocytes’ surface determines the blood type of the person
Antigens can cause antibody reactions when in contact with mismatched blood
Mismatched blood can cause a hemolytic reaction
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Rh Factor
Rh or Rhesus factor was discovered in 1940Rh antigens are also present in the surface
of erythrocytesPresent in about 85% of the populationCan cause hemolytic reactions in persons
with antibody to that antigenReferred to as Rh positive or Rh negative
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BLOOD COMPONENTSBlood Products for Transfusions
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Whole blood
Includes all the blood cells ( RBCs, WBCs,) and plasma
One unit of whole blood is 500 mlReplaces blood volume and blood products:
( RBCs, plasma, plasma protein, fresh platelets and other clotting factors
Primarily used for cardiac surgery or acute hemorrhage
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Packed Red blood cells
PRBCs are left after the plasma is separated out of whole blood
Used for routine blood replacement during surgery
Used to increase the oxygen- carrying capacity of blood in anemias and disorders with slow bleeding
1 unit raises hematocrit by approx 4 %
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Platelets
May come as a single unit from multiple donors or multiple units from a single donor
Used in patients with bleeding disorders from illness, medications, trauma or organ dysfunction or with platelet deficiency
Fresh platelets are most effective
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Plasma
Expands blood volume and provide clotting factors
No need to be typed and crossmatch
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Albumin
A protein manufactured by the liver Blood volume expander and provides plasma
proteins Maintains osmotic pressure that causes fluid to
remain within the bloodstream instead of leaking out into the tissues
Needs to be transfuse if albumin gets low Is not a component that must be cross-matched
but is considered as a blood product
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Clotting factors and cryoprecipitate
Obtained by slowly thawing a unit of FFP or fresh frozen plasma
“Cryo” is the recovered cold precipitate which is rich in certain clotting factors
Used for clients with clotting factor deficiencies ( factor VIII and XIII) and those with DIC syndrome
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Transfusion Reactions
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Transfusion Reactions
Blood from the donor and from the recipient are tested for compatibility
Referred to as typing and crossmatchingUsed to assess a client closely for
transfusion reactions2 types of transfusion reaction:
Hemolytic
Nonhemolytic
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I. Hemolytic Reaction
Incompatibility between client’s blood and donor’s Clinical signs: Chills, fever, headache, backache, dyspnea, cyanosis,
chest pain, tachycardia , hypotension Nursing intervention 1.Discontinue the transfusion immediately 2. Keep the vein open with normal saline or accdg to agency protocol 3. Send the remaining blood, a sample of the client’s blood , and a
urine sample to the laboratory 4. Notify the physician immediately 5. Monitor vital signs 6. Monitor intake and output
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II. Nonhemolytic reactions
Febrile reactionsAllergic reactionsFluid overloadSepsis
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Febrile reactions
Febrile reactions Sensitivity of the client’s blood to white blood cells,
platelets, or plasma proteins Clinical signs: chills, warm, flushed skin. headache;
anxiety, muscle pain Nursing intervention 1. Discontinue the transfusion immediately 2. Give antipyretics as ordered 3. Notify the physician
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Allergic reactions (mild)
Sensitivity to infused plasma proteins Clinical signs: flushing, itching, urticaria, bronchial
wheezing Nursing intervention 1. stop or slow the transfusion, depending on
agency protocol 2. notify the physician 3. administer medication (antihistamine) as
ordered
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Allergic reactions (severe)
Antibody-antigen reactions Clinical signs: dyspnea, chest pain, circulatory collapse ,
cardiac arrest Nursing intervention: 1. stop the infusion 2. Keep the vein open with PNSS 3. Notify the physician immediately 4. Monitor vital signs. Administer CPR if needed 5. Administer medications and/or oxygen as ordered
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Circulatory Overload
When blood is administered faster than the circulation can accommodate
Clinical signs: cough, dyspnea,crackles (rales),distended neck veins, tachycardia, hypertension
Nursing intervention: 1. Place the client upright ,with feet dependent 2. Administer diuretics and oxygen as ordered 3. Notify the physician 4. Stop or slow the transfusion
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Sepsis
Contaminated blood administered Clinical signs: High fever, chills, vomiting , diarrhea, hypotension Nursing intervention 1. Stop the infusion 2. Send the remaining blood to laboratory 3. Notify the physician 4. Obtain a blood specimen from the client for culture 5. Administer IV fluids, antibiotics
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Blood Administration
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Important considerations
Gather the pertinent data; know the purpose of the transfusion Confirm the physician’s order for the number and type of units
and the desired speed of infusion Obtain blood in plastic bag from the blood bank; place the blood
in a tray covered with a towel One unit of whole blood is 500 mL; a unit f PRBC is 200-250 mL Ensure that blood is typed and cross matched properly Blood administration is not delegated to a UAP; but UAP must
know the complications or adverse effects of blood transfusion and report it to the nurse
Note any premedication ordered by the physician; schedule the administration (usually 30 minutes prior to transfusion)
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Equipment
Unit of whole blood, packed RBCs, or other component Blood administration set with 170-200 u filters Supplemental blood filters , if needed IV pump if needed 250 ml normal saline for infusion IV pole Venipuncture start kit ( including a gauge 20 needle or
catheter); g 19 in some agencies Alcohol swabs Tape Sterile gloves
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Equipment
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Preparation
Verify client consent and obtain baseline data before the transfusion
Assess vital signs for baseline date Determine any known allergies or previous
reactions to blood Note specific signs related to the client’s pathology
and the reason for the transfusion Establish the intravenous line; check whether the
needle is appropriate to administer blood
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Preparing the IV infusion
Explain to the client what you are going to do, why it is necessary and how she can cooperate.
Provide for client privacy and prepare the client. Check the client’s identification; ensure the right patient Assist the client in a comfortable position; expose the IV site but
provide for client privacy Wash hands and observe appropriate infection control procedures Prepare the infusion equipment; ensure that blood filters inside the drip
chamber is suitable for the blood component Put on gloves; close all clamps on the Y-set Insert the piercing pin (spike) into the saline solution and hang on IV
pole about 36 inches above the venipuncture site Prime the tubing; start the saline solution
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Performance
Obtain the correct blood component for the client; check the physician’s order with the requisition
Check the requisition form and the blood bag label with a lab tech or according to agency policy
Check the client’s name, ID no, blood type and Rh group, blood donor number and expiration date of the blood
Observe the blood for abnormal color, clumping, gas bubbles and extraneous material
Compare the laboratory blood bag label with client’s data If any information does not match exactly, notify the charge
nurse and the blood bank
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Important considerations
Make sure that RBC are left at room temperature for no more than 30 minutes before starting the infusion
If the start of the transfusion is unexpectedly delayed return the blood into the blood bank
Do not store blood in the unit refrigerator DO NOT ADMINISTER BLOOD UNTIL DISCREPANCIES
ARE CORRECTED OR CLARIFIED
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Prepare for transfusion
Invert the blood bag gently several times to mix the cells with the plasma
Expose the port on the blood bag by pulling back the tabs Insert the remaining Y spike into the blood bag Suspend the blood bag Establish the blood transfusion; closed the upper clamp below the IV
saline solution; open the upper clamp below the blood bag; readjust the flow rate with the main clamp
Run the blood slowly for the first 15 minutes at 20 drops/ minute Observe the client closely for the first 15 minutes Note any adverse reactions and remind the client to call a nurse
immediately if any unusual symptoms are felt during the transfusion
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Document relevant dta
Record starting the blood, including vital signs, type of blood, blood unit, sequence number, site of venipuncture, size of the needle and drip rate.
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Care of the client
Monitor the client fifteen minutes after initiating the transfusion
Establish the required flow rate if there are no signs of reaction
Do not transfuse a unit of blood for longer than 4 hours Assess the client including V/S every 30 minutes or more
often, depending on the health status Terminate the infusion if no infusion is to follow Discard the administration set according to agency policy Fill in the time the transfusion was completed on the
requisition or monitoring sheet and the amount transfused Document relevant data
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Variation: Infusing other blood components
Platelets: pooled platelets usually contain 200 – 400 mL;
Do not refrigerate platelets and keep them agitated at all times
Fresh frozen plasma: 200 to 250 mL/unit; infuse within 24 hours of thawing , at 5- 10 ml /minute
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References:
Clinical Nursing Techniques :Kozier et alContemporary Medical-Surgical Nursing:
Daniels, et alBrunner and Sudarth Medical- Surgical
Nursing : Smeltzer and Bare
Thank you…
Vina Virgo-Velasco RN
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