Blood products Flashcards
Packed red blood cells (PRBC)
- used to replace erythrocytes
- usually supplied in 250 mL unit bags but ca be 250-350 or 350-400 mL bags
- each UNIT increases the hemoglobin by 1g/dL and hematocrit by 2-3%
*The change takes 4-6 hrs to appear in labs
Evaluation: based on resolutions of anemia symptoms and an increase in erythrocytes count
Whole Blood
- rarely used, treatment with blood component usually prescribed
-used to resolve hypovolemic shock from hemorrhage - contains RBC’s, plasma, and plasma proteins
- each unit contains 500 mL
Evaluation: resolution of symptoms of hypovolemia
Platelets
- used to treat thrombocytopenia and platelet dysfunctions
- crossmatching NOT required
- volume is anywhere from 50-70 mL/unit to 200-400 mL/unit
- Administered immediately once received and given rapidly, usually over 15-30 minutes
- Evaluation: increased platelet count. Counts elevated 1 hr & 18-24 hours after
Fresh Frozen Plasma
- provide clotting factors or volume expansions.
- contains NO platelets
- infused within 6 hours of thawing, while clotting factors are still viable
- Rh compatibility and ABO compatibility REQUIRED
- Unit normally contains 250 mL
Evaluation: monitor coag studies: PT, PTT and resolution of hypovolemia
Compatibility
- Clt blood samples drawn and labeled at bedside. Clt is asked to state name and it’s compared to name on ID bracelet.
- ABO type and Rh type identified.
- Antibody screen is done to check for presence of antibodies other than anti-A and anti-B
- Crossmatch testing is done (DONOR RBC’s combined with clt’s serum and Coomb’s serum. *Compatible if NO RBC agglutination occurs)
- In emergency, O-neg RBC’s and AB plasma can be safely administered w/o testing.
Precautions and Nursing Responsibilities
- A large volume of refrigerated blood infused rapidly through a central catheter into the ventricle of the heart can cause cardiac dysrhythmias.
- No solution other than normal saline should be added to blood components.
- Medications are never added to blood transfusions.
- To avoid the risk of septicemia, infusions (1unit) should not exceed 4 hours.
- The blood administration set should be changed every 4 hours or according to institution policy to reduce the risk of septicemia.
- Always check the blood bag for the date of expiration; components expire at midnight on the day marked on the bag unless otherwise specified.
- Inspect the blood bag for leaks, abnormal color, clots, excessive air, and bubbles.
- Blood must be administered within 30 minutes from its being received at the blood bank, as this is the maximal allowable time out of monitored storage.
- NEVER refrigerate blood in refrigerators other than those used in blood banks; if the blood is not administered within 30 minutes, return it to blood bank.
- The recommended rate of infusion varies with the blood component being transfused and depends on client’s condition; generally, blood is infused as quickly as the client’s conditions allows.
- Components containing few RBCs and platelets may be infused rapidly, but caution should be taken to avoid circulatory overload.
- Vital signs and lung sounds should be taken before the transfusion and again after the first 15 minutes and every hour until 1 hour after the transfusion has been discontinued.
- If a major ABO incompatibility exists or a severe allergic reaction occurs, it is usually evident within the first 50 mL of the transfusion.
- Document the client’s tolerance to the administration of the blood product.
- Monitor appropriate laboratory value and document effectiveness of treatment related to the specific type of blood product.
Transfusion Reactions- immediate
o Chills and diaphoresis o Muscle aches, back pain, or chest pain o Rashes, hives, itching, and swelling o Rapid, thread pulse o Dyspnea, cough, wheezing, or rales o Pallor and cyanosis o Apprehension o Tingling and numbness o Headache o Nausea, vomiting, abdominal cramping and diarrhea
Transfusion reactions- in unconscious patient
o Weak pulse o Fever o Tachycardia or bradycardia o Hypotension o Visible hemoglobinuria o Oliguria or anuria
Transfusion reactions- delayed
o Reactions can occur days to years after a transfusion
o Signs include fever, mild jaundice, and decreased hematocrit
What does the nurse do if there is a transfusion reaction?
o Stop the transfusion immediately
o Keep the IV line open with 0.9% normal saline
o Notify the physician immediately
o Remain with the client, observing signs and symptoms and monitoring vital signs as often as every 5 minutes
o Prepare to administer emergency medications such as antihistamines, vasopressors, fluids and steroids as prescribed
o Obtain a urine specimen for laboratory studies
o Return blood bag, tubing, attached labels, and transfusion record to the blood bank
Circulatory overload- what is is?
Caused by infusion of blood at a rate too rapid for the client to tolerate.
Circulatory overload- signs and symptoms
o Cough o Dyspnea, chest pain, rales, and pulmonary edema. o Headache o Hypertension o Tachycardia and rapid bounding pulse o Distended neck veins
Circulatory overload- what does the nurse do?
o Slow the rate of infusion
o Place the client in upright position, with the feet in a dependent position.
o Notify the physician
o Administer oxygen, diuretics, and morphine sulfate as prescribed
o Monitor for dysrhythmias
o Phlebotomy may also be a method of prescribed treatment
Septicemia- what is it?
occurs with the transfusion of blood contaminated with microorganisms
Septicemia- signs and symptoms
o Rapid onset of chills and a high fever o Vomiting o Diarrhea o Hypotension o Shock
