Blood Administration Flashcards
What is a blood transfusion?
Replacement of blood or blood components when oxygen delivery to the tissue is compromised
What does blood management involve?
- Appropriate provisions for the use of blood and blood products
- Strategies to reduce or avoid the need for a blood transfusion
What are the benefits of blood management?
- Improves patient outcomes
- Lessens exposure to infection
- Facilitates faster recovery
- Decreases post operative infection rates
What are blood and blood products used for?
- Improve or restore oxygen carrying capacity and tissue oxygenation
- Restore blood volume lost d/t trauma, hemorrhage, surgery and burns etc
- Correct red blood cell deficiency
- Maintain or improve blood’s clotting ability
Identify the risks associated with the administration of blood and blood products
Transfusion reaction
• Most common occurrence of transfusion reactions due to
o Administrative errors
o Misidentification
• It is critical you correctly identify the recipient and transfusion product
Explain the principles guiding the procedure for establishing blood type and crossmatch
Blood type
• There are 4 blood groups based on presence of A and B antigens on red blood cells
• Blood group O – has no antigens and is the universal donor
• AB – has both A and B antigens and is the universal recipient
RH or Rhesus factor
• Antigen D is an inherited antigen on the surface of RBCs
• People with antigen D are Rh+
• People without antigen D are Rh-
• Exposure to antigen D is necessary for production of Rh antibodies
Blood compatibility (reason why crossmatch is necessary)
• Recipient red blood cell antigen must be compatible with the donor red cell antigen, otherwise the recipient surface antigen will react with the agglutinin (also known as antibody) in the serum of the donor
• Antibodies destroy or neutralize antigens by clumping (agglutination)
Explain the difference between homologous and autologous blood administration
Homologous
• Blood transfusion involving someone collecting and infusing the blood of a compatible donor
Autologous
• Collection and reinfusion of the patients own blood or blood components
Describe the various reactions associated with the administration of blood and blood products
• Acute hemolytic - antibodies in the recipient’s serum react with antigens on the donor’s RBCs. This results in agglutination of cells, which can obstruct capillaries and block blood flow.
signs: chills, fever, low back pain, flushing, tachycardia, tachypnea, hypotension, vascular collapse, jaundice, dark urine, bleeding, renal failure, shock, cardiac arrest, death.
interventions: give diuretics, stop transfusion
• Febrile, non hemolytic (most common) - due to leukocyte incompatibility. Can give tylenol or benadryl 30 mins prior to transfusion.
signs: chills, fever, h/a, flushing, anxiety, vomiting, muscle pain.
• Mild allergic - results from recipient’s sensitivity to plasma proteins of the donor’s blood. Antihistamines may be used.
signs: flushing, itching, urticaria.
interventions: if symptoms are mild, transfusion may be restarted slowly.
• Anaphylactic - epinephrine or corticosteroids may be used and stop transfusion immediately.
signs: anxiety, urticaria, dyspnea, wheezing, cyanosis, bronchospasm, hypotension, shock, cardiac arrest.
• Circulatory overload - an individual with cardiac or renal insufficiency is at greater risk. complaints of SOB and presence of adventitious breath sounds may indicate fluid overload. Perform baseline auscultation of the lungs.
signs: cough, dyspnea, pulmonary congestion, h/a, hypertension, tachycardia, distended neck veins.
• Sepsis - transfusion of bacterially infected blood
signs: chills, high fever, vomiting, diarrhea, hypotension, shock.
interventions: antibiotics, IV fluids, vasopressors.
- Transfusion related acute lung injury (TRALI)
reaction between antileukocyte antibodies and leukocytes.
signs: fever, hypotension, tachypnea, dyspnea, low O2 sat, frothy sputum.
interventions: provide oxygen and administer corticosteroids, CPR.
Explain why a transfusion reaction occurs
Transfusion reaction
• Systemic response to the administration of a blood product that is either incompatible with that of the recipient, contains allergens to which the recipient is sensitive or is contaminated with bacteria
What are the signs and symptoms of a transfusion reaction?
- Rash, Pruritis
- Headache, flushing, back pain, chest pain
- Fever (oral T more than 38 and more than 1 degree rise above baseline)
- Rigors, restlessness, anxiety, facial or tongue swelling, dizziness, nausea/vomiting
- Heat/pain at IV site, hypertension, hypotension, tachycardia
- Dyspnea, wheezing, hypoxia and oliguria
Identify the immediate nursing actions for the individual experiencing a blood transfusion reaction
Stop transfusion and disconnect at site
Run NS via new tubing
Verify patients ID band to blood product tag
Check VS and symptoms
Notify physician and transfusion services
Complete transfusion reaction form and any follow up investigation of the reaction
Identify assessments critical to the safe and effective administration of blood
Written consent is required to administer non-fractionated blood products (2 nurses needed to check)
RN, RPN, Physician & LPN may check fractionated blood products without a second person.
No Medication may be added to the blood or infused through the same tubing
What are the components of whole blood?
- Concentrated Red Cells
- White cells
- Plasma (proteins, globulins, albumin)
- Platelets
non fractionated blood products
- Red Blood Cells
- Fresh Frozen Plasma
- Platelets
- Cryoprecipitate
- Autologous Whole Blood
fractionated blood products
- Immune Globulin
- Albumin
- Factor Concentrates
What is albumin?
- A protein in plasma and is a plasma volume expander by increasing oncotic pressure
- Pasteurized and should be clean of disease
- 25% albumin is hyperoncotic
- 100 ml of 25% albumin will draw approx 300 ml fluid from extra vascular tissue into circulation
What is pentaspan?
- Synthetic cornstarch derivative in saline solution
- Plasma volume expander
- No risk of disease transmission
- 1.5 x greater volume expander than albumin with longer duration of expansion
- Safety in paediatrics not established
massive blood transfusions
- PRBCs are deficient in clotting factors and platelets
- Calcium binds with preservatives in PRBCs
- For these reasons, FFP, platelets, calcium and cryoprecipitate are given to patients receiving massive blood transfusions
- Rule of thumb – for every three units of PRBCs the patient is given 1 FFP and 1 bag of platelets
