Blood Administration

Question 1

What is a blood type and screen?

Answer 1

• Blood typing is determining the blood type and Rh factor of a sample of blood.
• A screen is looking for the most commonly found unexpected antibodies.

The results of this test are good for 72 hours.

Question 2

Why would a client need a blood transfusion of packed red blood cells (PRBCs)?

Answer 2

For active bleeding or the client has a very low hemoglobin and hematocrit level.

Question 3

Why would a client get a blood transfusion of platelets?

Answer 3

To treat thrombocytopenia or platelet disorders.

Question 4

Why would a client get an infusion of fresh-frozen plasma?

Answer 4

To replace clotting factors due to a clotting factor disorder.

Question 5

Which clients would get an infusion of granulocytes?

Answer 5

Granulocytes are to boost the immune system for:

• a client with sepsis (systemic infection)
• neutropenic client that is unresponsive to antibiotics - usually for clients getting chemo

Question 6

What are the 4 blood types?

Answer 6

1. Type A
2. Type B
3. Type AB
4. Type O

Question 7

Complete the sentence:

Type O is the universal ________.

Answer 7

donor

Anyone can receive type O blood (as long as the Rh factor is appropriate).

Remember the O in dOnor.

Question 8

Complete the sentence:

Type AB is the universal _________.

Answer 8

recipient

This client can receive blood from any blood type.

Question 9

Type A can get blood from which other blood types?

Answer 9

A or O

Question 10

Type B can get blood from which other blood types?

Answer 10

B or O

Question 11

Type AB can get blood from which other blood types?

Answer 11

A, B, AB or O

Question 12

Type O can get blood from which other blood type?

Answer 12

Type O

Question 13

What is Rh, Rh positive and Rh negative?

Answer 13

Rh is a protein on red blood cells:
* if you have it, you’re Rh positive
* if you don’t have it, you’re Rh negative

Question 14

Can an Rh negative client receive Rh positive blood?

(Immediate Complication)

Answer 14

No. The client can die.

Rh positive blood will make antibodies against the Rh negative client and destroy the red blood cells.

Question 15

Can a Rh positive client receive Rh negative blood?

Answer 15

Yes.

Question 16

What are the steps to giving a blood product?

Answer 16

1. verify order from the HCP
2. start IV line with normal saline 0.9%
3. get the blood from the blood bank
4. get the tubing ready with the blood product and normal saline (but don’t hook it up to the patient yet)
5. verify the client and blood product/blood type with another RN
6. get a set of baseline vital signs
7. hook up the tubing and start the blood transfusion
8. stay with the client to assess for any reactions
9. take another set of vital signs in 15 minutes (or hospital policy requirements)
10. document

Question 17

What type of IV fluid is compatible with blood?

Answer 17

Normal saline, 0.9% - that’s it, nothing else.

Question 18

What gauge needle is given with blood?

Answer 18

Blood administration needs a larger gauge lumen such as 18 or 19.

This is to prevent the red blood cells from breaking as they go through the IV catheter.

Question 19

Label the parts of blood tubing:

• blood bag
• blood information (Rh, ABO group, expiration date, ID number)
• drip chamber
• filter
• normal saline bag
• roller clamp

Answer 19

Question 20

Why is there Y tubing and a filter for blood tubing?

Answer 20

• The Y tube is to mix the blood with normal saline
• The filter is to filter out blood clots, clumps of platelets and white blood cells

Question 21

To get blood into the filter chamber should you squeeze it?

Answer 21

Never, you can damage the filter. Let it fill up from gravity.

Question 22

How long should blood be started after receiving it from the blood bank?

Answer 22

Start the blood product within 30 minutes of receiving it from the blood bank.

Question 23

Over how long should 1 unit of blood be given?

Answer 23

Within 4 hours.

Question 24

How often are vital signs taken when blood is being administered?

Answer 24

• Right before the blood is started
• 15 minutes after it’s started (unless the client shows symptoms - get vital signs earlier)
• At least every 30 minutes to 1 hour until it’s finished
• A final set of vital signs after the infusion is completed

Question 25

How **long** should the nurse stay with the client once the blood transfusion is started?

Answer 25

For the **first 15 minutes**, to monitor for transfusion reactions.

Question 26

Who **verifies** the client and blood product right before the blood is started?

Answer 26

**2 Registered Nurses** will confirm: * correct client * blood type and Rh factor of the client * correct blood product and blood type

Question 27

What is a **hemolytic blood transfusion reaction?** | (Immediate Complication)

Answer 27

When there is an **incompatibility with the blood product** that causes the **red blood cells to get destroyed.**

Question 28

What is an **allergic blood transfusion reaction?** | (Immediate Complication)

Answer 28

An allergic reaction is when there is an **incompatibility with the blood product that causes an allergic response** such as mild itching to severe anaphylaxis.

Question 29

What is a **febrile/bacterial/septic** blood transfusion reaction? | (Immediate Complication)

Answer 29

When there is **bacteria in the blood that causes a systemic infection.**

Question 30

How is septicemia **treated** when acquired from a blood transfusion? | (Immediate Complication)

Answer 30

* get blood cultures of the blood and blood bag * give O₂ * IV fluids * antibiotics * vasopressors: to increase the blood pressure from septic shock * steroids: to decrease inflammation

Question 31

What are the **signs and symptoms** of a mild blood transfusion reaction?

Answer 31

* fever * chills * urticaria (hives) * itching (pruritis)

Question 32

What **medications** are commonly given before a blood transfusion starts for a client that has had a mild allergic reaction in the past?

Answer 32

* **acetaminophen** for fever * **diphenhydramine** for itching ## Footnote Give meds 30 minutes before starting blood transfusion.

Question 33

What are **life-threatening signs and symptoms** of a blood transfusion reaction? | (Immediate Complication)

Answer 33

* respiratory distress, dyspnea, dizziness, shortness of breath * chills, diaphoresis * back or chest pain ## Footnote Antibodies are attacking the red blood cells causing decreased oxygen.

Question 34

What are the **steps** if there's a reaction to a blood transfusion? | (Immediate Complication)

Answer 34

1. **FIRST: stop the blood transfusion** 2. change out the tubing, but keep the IV line in 3. start a new bag of normal saline, 0.9% 4. tell the HCP and blood bank 5. return the blood and tubing to the blood bank 6. stay with the client 7. may have to give epinephrine for severe symptoms such as difficulty breathing

Question 35

What causes **circulatory overload** from a blood transfusion?

Answer 35

* The blood is being administered **too quickly** * The client has renal, heart or liver failure and **cannot tolerate the extra fluids**

Question 36

How is circulatory overload **prevented** when giving a blood transfusion?

Answer 36

* Give the blood product at a **slower rate** * Assess for signs of **fluid volume overload**

Question 37

How can a blood transfusion **cause** hypocalcemia?

Answer 37

Hypocalcemia is caused by a preservative in the blood binding with **calcium and being excreted.**

Question 38

How can a blood transfusion **cause** hyperkalemia?

Answer 38

Hyperkalemia is caused by **old blood causing potassium to be released from cells.**