4.5 Transfusion Flashcards
Transfusions
- Whole blood is usually not used anymore. It can help many people if blood is split into components.
- We use packed RBC’s which is RBC’s with only a little bit of plasma (to treat anemia)
- Platelets in packed blood are not functional and WBCs can cause a reaction
- Platelets are typically given if count goes down to 5000-10000. Only given if really needed
- Plasma (fresh frozen plasma) has coagulation factors and complement. Its used for coagulation factor deficiencies
- Gamma Globulin may be given for people who is immunodeficient.
Types of Blood Donation
Directed - Given for a specific individual
Standard - Classic blood donation at events or blood banks.
Autologous - Used for scheduled surgical procedures 4-6 weeks prior. Decreased risk for viral infections but bacterial infections is average.
Intraoperative Blood Salvage - Blood from surgery is sucked into a cell-saver machine, washed with saline solution, then returned to patient with IV infusion. This type of blood cannot be stored because bacteria in the blood cannot be fully removed
Hemodilution - 1-2 units of blood is removed from the patient and replaced with colloid/crystalloid solution. Blood is reinfused after surgery. Patients lose less erythrocytes during surgery with this method.
Transfusion of Packed RBC’s
Pre-Op
- Confirm prescription
- Crossmatch patients blood to find blood type
- Verify Informed Consent
- Explain procedure and possible transfusion reactions
- Take baseline vitals, auscultate lungs, assess JVD
- 20 Gauge needle or larger is inserted into vein, special tubing that filters blood is used to remove fibrin clots. Do not vent blood container.
Procedure
- After IV line is started, obtain the RBC’s from the blood bank
- 2 people need to check blood compatibility and correct patient ID
- Check blood for gas bubbles (bacterial growth) or cloudiness (hemolysis)
- Transfusion must start 30 minutes after removal from blood bank
FIRST 15 MINUTES - SLOW TRANSFUSION LESS THAN 5 mL/min (observe adverse effects)
After, if there is no adverse effects, you may infuse faster (if patient is not at risk for circulatory overload)
- Re-check vitals and reactions throughout infusion
- Administration time should not exceed 4 hours due to risk of bacterial proliferation
- Change blood tubing every 2 units to decrease risk of bacterial contamination
Post-Procedure
- Obtain vitals
- Dispose materials
- Document
- Monitor patient
Notes
- NEVER ADD MEDICATION TO BLOOD
- Add normal saline if blood is too thick to run
Transfusion Complications
Circulatory Overload
- Difficulty breathing
Transfusion related Acute Lung Injury
- Pulmonary edema
- Hypoxemia
- Respiratory Distress
- Occurs within hours of large transfusion
Risks go up for older patients, patients with pre-existing cardiac disease, and higher transfusions
Transfusion Reactions
Febrile Non-Hemolytic Reaction - Fever that causes inflammation
Acute Hemolytic Reaction - Very bad. Caused by administering wrong blood type. (Fever, chills, headache, back pain, or generalized pain)
Delayed hemolytic reaction - Fever, flank back pain, hematuria, tachycardia
Allergic Reaction - Flushed face, rash, hives, hypotension, anxiety
Circulatory Overload - Difficulty breathing
Bacterial Contamination - Fever, hypothermic, severe chills, abdominal pain, nausea
Acute Lung Injury - Pulmonary edema, hypoxemia, respiratory distress within a few hours
Disease Acquisition - They may acquire diseases later from the blood
Long-Term Transfusion therapy - Can cause iron overload, infection, cytomegalovirus
Nursing Management of Reactions
- STOP THE TRANSFUSION (turn off both roller clamps)
- Get a new bag of saline and flush the line
- Assess patient
- Notify provider for treatment
- Notify blood bank
- Continue to monitor
- Return blood to blood bank
- Obtain blood samples for hemolysis and urine samples for hematuria
Transfusion Alternatives
- Growth factor
- Erythropoietin
- Granulocyte colony-stimulating factor
- Granulocyte macrophage colony stimulating factor
- Thrombopoietin
