blood component therapy Flashcards
PRBC
what is at bottom of vial after centrifuge -> no plasma, wbc, plt
for severe anemia
type and cross match
indirect coombs
RH - cannot get Rh +
o- is universal donor
AB+ is universal acceptor
donor has to have same antigens as recipient
preT responsibilities
assess labs (H+H)
verify order, type and cross (q46hr), identify pt, consent form, premedicate prn (acetaminophen, beny)
anticipate 250-350mL
IV set up: venous access 20g but 18 ideal (larger bc small leads to hemolysis), Y tubing (blood, NC only!), filter, be ready before blood is on floor, only have 30 min, close NS clamp when blood going
final pt identity check at bedside with second nurse
recommendations of hemodynamically stable (BP and HR ok) pt without active bleeding
hgb <6: unless exceptional circumstances
hgb 6-7: transF likely
hgb 7-8: for orthopedic sx or heart sx, and in those with stable CV disease, after eval of clinical status
hgb 8-10: generally not indicated but considered for some - s anemia, bleeding, acute coronary s with ichemia, hemoc pt with severe thrombocytopenia at risk of bleed)
hgb >10: exceptional circumstances only
transF responsibilities
return blood asap if not used
explain procedure to pt, need to report any unusual sensations (chills, sob, itch, back pain), cold at site ok
take baseline VS
infuse slow (1-2mL/min or 60-120mL/hr) for first 15 min
constant obs by rn first 15-30 min, cannot delegate
VS after 15 min, no rxn, increase rate to infuse to finish in ~2hr (unless r/o FVO - use 4hr max), VS q1hr, then at end
post infusion orders: lasix (FVO), another unit, other meds (antihistamines/pyretics)
end of infusion: roller clamp blood and open NC to flush line
plt
NOT clotting factor, still enhance clotting
perpared from fresh whole blood, 30-60mL
multiple unites from 1 donor, room temp, good 1-5 days
agitate bag periodically (so they dont clump), admin fast as tolerable
no ABO compatibility needed
I: bleeding caused by thrombocytopenia, plt <20,00, cancer (chemo)
FFP
have clotting factors (proT)
liquid portion, 250mL, yellow, no platelets
need ABO compat
store 1yr, use within 24 hr thawed
I: bleed bc deficiency in CF, fluid volume expander (low BP) - less often
albumin
colloid -> pulling power
malN, liver disease
blood product derivative, plasma volume expander, keep fluid in intravascular space (edema if water in interstitial)
preppred from plasma
no compatibility needed
5%-25% osmotically equivalent to pt plasma (can be v hypertonic)
transF rxns general
stop!
maintain new IV line with NS -> at same site, dont just use NS in y tubing bc blood still in there) prime new bag and tubing with NS, then switch tubing
assess, notify blood bank and HCP, recheck ID tags and #s, monitor vs and urine output (hemolytic only, kidneys shut down)
treat S per order - usually fever
save bag and tubing for bank
complete transF rxn report form
collect specimens to eval for hemolysis
document reaction
acute hemolytic
incompatible blood
febrile non hemolytic
fever during infusion
mild allergic
sensitization to donor wbc, plt, plasma; more common with hx of allergies
anaphylactic and severe allergic
sensitization to donor plasma proteins (antibodies)
bacterial/sepsis
bacteria in blood
circulatory overload
TACO
too much volume administration
