Blood Administration

Question 1

explain consent and when consent doesn’t need to be given

Answer 1

When the person understands and agrees
required by standards and regulations
• no consent needed if the transfusion is required to preserve life or continuing health
• Patient is unable to consent and no substitute decision maker is available
• no evidence of prior wishes to refuse transfusion known for personal or religious reasons

Question 2

all blood orders must include?

Answer 2

first and last name and at least 1 urn
type of blood product
number of units or amount
rate of infusion
special requirements
premedication, if required
Group type and crossmatch

Question 3

what is the best time for blood transfusions if they are non-urgent?

Answer 3

the early shift

Question 4

before picking up the blood what needs to happen?

Answer 4

ensure IV patency
verify consent
administer any premeds
arrange for pickup and delivery

Question 5

How should blood be checked?

Answer 5

be at the bedside
2 qualifyed individuals need to check
check for clots, strange colour, leaks
Check compatible blood group
Verify order and consent
must be started immediately after being checked
label must remain attached to blood unit throughout transfusion
place documentation in patients chart

Question 6

What are the steps for checking blood?

Answer 6

1. check armband
2. check that patients name and urn match on armband and blood bag
3. check blood unit number and donor blood group matches

Question 7

before starting the blood what needs to happen?

Answer 7

get baseline vital signs

Question 8

after starting the blood what needs to happen?

Answer 8

for first 15 mins
- start at slow rate and monitor closely
after the first 15 minutes
- reassess vital signs and increase blood flow if no reaction observed

Question 9

what do we need to do when completing the trasfusion?

Answer 9

flush the line
disconnect the tubing
bag must be stopped after 4 hours from removal from storage
dispose of in biohazard container or return to blood collection if required

Question 10

what are the 3 different components of blood products?

Answer 10

red blood cells
plasma
platlets

Question 11

what are the major uses of red blood cells?

Answer 11

bleeding
anaemic non-bleeding
Low HB

Question 12

How are red blood cells stored and for how long can they be stored?

Answer 12

2-6 degrees C in approved fridge only

Up to 42 days

Question 13

what are the major uses of plasma and how many different products can plasma make?

Answer 13

16 different products
liver disease coagulopathy
massive transfusions

Question 14

What are some of the different plasma products?

Answer 14

clinical plasma
intravenous immunoglobin
hepatitis B immunisation
hepatitis A immunisation
cryoprecipitate
albumin
tetanus immunisation
Zoster immunisation

Question 15

How do you store plasma, and for how long until it expires?

Answer 15

frozen - stored for 1 year
once thawed stored at 1-6 degrees C
expires after 24 hours or 5 days

Question 16

What are some reactions to transfusions?

Answer 16

usually occur within 24 hours
• Fever
• Shaking chills or rigour without fever
• hives or rash, itchiness, swelling
• dyspnea, shortness of breath or wheezing
• hypotension or hypertension
• red urine, diffuse bleeding or oozing
• lumbar/lower back pain, anxiety, pain at the IV site
• nausea and vomiting
• headache

Question 17

what management should you do if there is a reaction?

Answer 17

1. stop transfusion immediately
2. maintain IV access but do not flush the blood tubing
3. check vital signs
4. verify ID matches fluid label
5. notify doctor but remain with patient
6. notify nursing team leader
7. notify blood bank as per hospital policy
8. treat symptoms as ordered by doctor

Question 18

when restarting a transfusion what needs to happen?

the person needed the blood in the first place

Answer 18

only restart if very minor reaction
consult for order to restart
medicate patient as ordered
proceed with more frequent observations

Question 19

what happens in a reaction investigation?

Answer 19

blood bag and tubing sent to be investigated

Question 20

What are some complications?

Answer 20

Acute intravascular hemolysis

Disseminated Intravascular Coagulation

Question 21

What happens in acute intravascular haemolysis?

Answer 21

Symptoms may include chills, rigors, dyspnoea, chest and/or flank pain, discomfort at infusion site, sense of dread, abnormal bleeding and may progress rapidly to shock.

Question 22

What happens in Disseminated Intravascular Coagulation and what are some symptoms?

Answer 22

• The blood’s platelets and clotting factors to become depleted, excessive bleeding (haemorrhage) occurs throughout the body.
• The severity of bleeding can range from small red dots and bruises under the skin to heavy bleeding.
• Symptoms of organ damage caused by excessive blood clotting may include:
shortness of breath from lung damage, low urine output from kidney damage, or stroke from damage to the brain.

Question 23

What gauge IV access needs to be used?

Answer 23

16-18 gauge for rapid transfusion for adults

for routine 20-22 gauge for adults

Question 24

What are the major uses of Platelets?

Answer 24

to control or prevent bleeding in patients with
• low platelet counts
• congenital platelet dysfunction
• platelets not functioning due to medication effects

Question 25

How are platelets stored?

Answer 25

20-24 degrees C or on an agitator to prevent clumping

expire in 5 days

Question 26

what proportion of blood volume do the following constituents provide?

• plasma
• red blood cells
• white blood cells and platelets

Answer 26

plasma - 55
RBC - 45
white blood cells and platelets - 10

Question 27

How long can reaction symptoms occur after blood has finished?

Answer 27

6 hours

Question 28

What is clinical plasma (ffP)used for?

Answer 28

major bleeding

Question 29

What is cryoprecipate used for?

Answer 29

clotting

Question 30

What is intravenous immunoglobulin (INtragam) used for?

Answer 30

replaces antibodies

used in the treatment of some immune, blood and neurological disorders.

Question 31

What is albumin used for?

Answer 31

For treatment of shock due to blood loss, during heart-lung bypass surgery and plasma exchange