Administration of Blood ProductsEdith O Perez RN,BSN,MSN,FNPc

Type of Blood Components

Packed red blood cells (RBCs)Evaluation of effective response determined by resolution

of anemia and increase in erythrocyte count250-350 ml within 4hWhole Blood 300-550 ml /hr within 4h Replace red cell mass and plasma volumen Expected to rise Hgh 1g/100ml and Hct by 3 %

PlateletsEvaluation of effective response determined by

improvement in platelet count, normally assessed 1 hour and 18 to 24 hours after transfusion

Maximum infusion time is 15-30 minutes. 

. Type of Blood Components

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CryoprecipitatesEvaluation of effective response determined by improvement in clotting

factors, particularly factor VIII and fibrinogen

White blood cells (WBCs)Evaluation of effective response assessed by monitoring white blood

cell and differential counts

Fresh frozen plasmaReplace plasma without RBC, resolution of hypovolemia, pt with

bleeding problems, Management of bleeding or to prevent bleeding prior to an urgent invasive procedure in patients requiring replacement of multiple coagulation factors

200-250ml Must go through blood giving set (has a filter). Infusion time is15- 30 minutes per bag. All units must be given within 4 hours of defrosting. 

Types of Blood Donations

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AutologousDonation of client’s own blood before scheduled

procedure 72 h before the procedureBlood salvage

Autologous donation that involves suctioning blood from blood cavities, joint spaces, or other closed body sites

Designated donorDonation of blood from recipient, who selects his or

her own compatible donors

Compatibility

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Recipient blood samples drawn, labeled at bedside, dated, timed; client states name for verification, compared with identification band

Recipient’s ABO type and Rh type identifiedAntibody screen done to determine presence of

antibodies other than anti-A and anti-BCrossmatching completed, found to be compatible if

no RBC agglutination occursUniversal RBC donor, O negative; universal

recipient, AB positiveClients with RH-positive blood can receive RBC

transfusion from an Rh-negative donor if necessary; however, an RH-negative client should not receive Rh-positive blood

Infusion Pumps

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These may be used to administer blood products if designed to function with opaque solutions

Always consult manufacturer guidelines for controller or pump

Special manual pressure cuffs may be used to increase flow rate, but pressure should not be higher than 300 mm Hg

Standard sphygmomanometer cuffs not to be used to increase flow rate

Blood Warmers

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May be used to prevent hypothermia and adverse reactions when several units of blood administered

Only use devices tested for this purposeDo not warm blood products in microwave or hot water

Precautions and Nursing Responsibilities

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– Blood must be administered as soon as possible after being received from blood bank, within 15 minutes

– Check blood bag for date of expiration; inspect bag for leaks, abnormal color, clots, bubbles

– Blood administration sets should be changed every 2-4 hours or according to agency policy

– Blood should not be infused rapidly unless platelets, which may be infused rapidly, with caution

– No medications should be added to blood bag or piggybacked into blood transfusion

– Only normal saline should be infused or added to blood components– Measure vital signs, lung sounds before and after 15 minutes of

transfusion, then every hour until completed– Only two RNs may check blood bag against client’s blood

identification band

Complications

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• Transfusion reactionsTypes of transfusion reactions include:Febrile non hemolyticacute hemolyticdelay hemolytic allergic febrile or bacterial reactions (septicemia), transfusion-associated graft-versus-host

disease (GVHD).

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Acute Hemolytic

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Occur within 15 minutes of transfusion initiation Nauseas, vomiting, lower back pain, hypotension, decreased

urinary output, hematuria, increased sensation heat, increased temperature apprehension,bronchoespasm,DIC

Interventions include:Stopping the transfusionChange tubing Keeping vein open with 0.9% normal salineNotifying health care provider and blood bank Monitoring client closely, preparing to administer emergency

medications (e.g., antihistamines, vasopressors, corticosteroids)Sending urine specimen to laboratory Returning all blood tubing and bags to blood bank

Complications

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Delay transfusion reaction: 2 -14 days Monitor for signs of delayed

reactions (which may occur up to 1 year following transfusion)

these include fever, mild jaundice, decreased hematocrit level

Febrile non Hemolytic

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Fever > 1C above the baseline Flushing, chillsHeadache Muscle pain Stop the transfusion Administer antipyretics Monitor temperature every 4 h

Allergic Reaction

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Local erythematicHivesUrticariaItchingPruritusSevere allergic reaction: Coughing,

respiratory distress, wheezing, hypotension, LOC, possible cardiac arrest

Stop the Blood transfusionNotify MDAnthistaminic

Unconscious

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Monitor for signs in unconscious client; these include weak pulse, fever, tachycardia or bradycardia, hypotension, visible hemoglobinuria

Circulatory overload

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Monitor for signs; these include

cough, dyspnea, chest pain, wheezing, hypertension, tachycardia

Interventions include slowing rate of infusion, placing client upright with feet in dependent position, notifying health care provider, administering oxygen, diuretics, and morphine sulfate as prescribed, monitoring for dysrhythmias

Septicemia

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Monitor for signs; these include rapid onset of chills and high fever,

vomiting, diarrhea, hypotension, shock

Interventions include notifying health care provider

obtaining blood cultures and cultures from blood bag

administering oxygenIV fluids, antibiotics, vasopressors,

and corticosteroids as prescribed

Iron overload

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Assess for altered hematological values

Vomiting and diarrheaHypotensionInterventions include administering

deferoxamine (Desferal) as prescribed to remove iron in the kidney

Educating client that urine will turn red as iron is excreted

Complications Disease transmission

Hepatitis C is commonly transmitted disease

Other transmitted diseases may include hepatitis B, HIV, Epstein-Barr virus, cytomegalovirus, malaria

HypocalcemiaMonitor for hyperactive reflexes,

paresthesia, cramps, positive Trousseau’s and Chvostek’s signs

Slow transfusion rate, notify health care provider if signs occur

Hyperkalemia

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The older the blood, the greater the risk for hyperkalemia, because hemolysis causes potassium release

Monitor for muscle weakness, paresthesias, abdominal cramps, diarrhea, dysrhythmias

Slow transfusion rate, notify health care provider if signs occur

Question

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The nurse determines that a client is having a transfusion reaction. After the nurse stops the transfusion, which action should the nurse take next?

1.Remove the intravenous (IV) line.2.Run a solution of 5% dextrose in water.3.Run normal saline at a keep-vein-open rate.4.Obtain a culture of the tip of the catheter

device removed from the client.