blood transfusion Flashcards
why would you use washed RBC or leukocyte-reduced?
- history of allergic transfusion reactions
- hematopoietic stem cell transplant patients
what are washed RBC or leukocyte-reduced?
WBC, plasma, and immunoglobulin A have been reduced
this reduces the risk for an infection
what are the types of autologous transfusions?
- preoperative
- perioperative salvage
- postoperative salvage
benefits of autologous transfusions?
eliminates compatibility problems and reduces risk for transmitting bloodborne diseases
why isn’t whole blood given?
rarely given
- increase volume & increase chance for reaction
transfusion reaction types
- hemolytic
- febrile
- allergic (mild)
- allergic (severe)
- bacterial (sepsis)
- circulatory overload
transfusion reaction: circulatory overload
s/s & interventions
blood admin faster than circulation can accommodate
- cough, crackles (rales), distended neck veins
- sit up w/feet dependent
- slow/stop infusion
- admin diuretics/O2 as orderd
- notify MD
transfusion reaction:
bacterial (sepsis)
s/s & interventions
contaminated blood admin (r/f septic shock)
- high fever, vomiting, chills, hypotension
- stop transf
- notify MD
- admin IV fluid, antibiotics
- KVO w/NS (new tubing)
- send blood to lab
- pt blood cultures
transfusion reaction:
allergic reaction (severe)
s/s & interventions
antibody-antigen reaction (r/f shock & airway)
- dyspnea, facial swelling
- stop trans
- NS at KVO (new tubing)
notify MD - monitor VS
- CPR as needed
- admin meds/O2 as ordered
transfusion reaction:
allergic reaction (mild)
s/s & interventions
SENSITIVITY to transfused plasma protein
- itching, urticaria, flushing, wheezing
- slow or stop infusion
- notify MD
- antihistamines/benadryl
- NS KVO
transfusion reaction:
febrile reaction
s/s & interventions
sensitivity to WBCs, platelets, or plasma protein
- fever, flushed skin, muscle pain
- stop infusion
- antipyretics (fever)
- notify MD
- KVO w/NS
transfusion reaction:
hemolytic reaction
s/s & interventions
incompatibility between clients blood & donor’s blood, common first 15min, (delay=milder), can lead to shock
- cyanosis, chest pain, tachycardia, hypotension, backache
- strop trans, new tubing
- notify MD
- KVO w/NS, 10ml hr
- send blood pack & pt sample to lab
- monitor VS, I&O
gerontological considerations for IV access
- veins prone to scarring
- loss of tugor
- vasoconstriction
- easy rupture/bruising
gerontological considerations for systemic reactions
- prevent fluid volume overload
- consider hx CHF, renal insuff.
- monitor fluid & electro balance, edema, resp insuff
goals/evals from trans
- RBC count
- h+h
- platelet count
- clotting factors
- relief from clinical manifestations
transf responsibilities
- correct tubing
- only use NS
- stay w/ patient 15-30min, severe reaction
- infuse at rate for type (avoids fluid overload)
- monitor VS before, 15min, once an hr
transfusion rate: normal vs CHF
normal = 100mL/hr
CHF = 50mL/hr
equipment prep for trans
16-20g catheter (19-20g for older adult)
Y-type tubing
- optional eq: elect pump, pressure cuff, blood warmer
pretrans responsibilities
- verify prescription x2 RN
- use 2 ID for pt, verify x2 RN
- exp date/time x2 RN
- ensure test donor & recipient blood compatible
- examine blood bag label, attached tag, requisition slip for ABO/Rh compat w/client
- inspect blood color, gas bubbles, cloudy
- admin within 30min after blood bank
- given less than 4 hrs
therapeutic apheresis
donation of only parts of the blood, machine separates parts then returns the other
- platelets
- WBC
- blood stem cells
transfusion methods (collection) and explain
- homologous - one person to another
- designated (directed) blood, 2-3 days person volunteers
- autologous - donate to self
granulocyte (WBC) transfusion
rarely, neutropenic clients
massive transfusion protocol
rapid trans. mimics whole blood, low H+H, massive hemorrhage
1:1:1 ratio
- PRBC, platelets, plasma
fresh frozen plasma trans (FFP)
- replace blood volume & clotting factors
- 200 mL
- immediately after thawing
- 30-60min infusion
- Yset or straight filter tubing
- needs ABO compat, has antibodies
platelets
- low platelet count <10,000, active bleed, scheduled invasive procedure
- single donor 200mL, pooled donors 300mL
- immediately give w/smaller filter& shorter tubing
*filter removes WBC, decrease risk for febrile reaction with multiple trans
*reg tubing cause blood to adhere to lumen & not go to pt
packed red blood cells (PRBC)
- most common
- replaces cells lost from trauma or surgery
- RBC deficient pt
- 250mL bag
- RBC & rh antigen specific
blood safety
- ABO
- Rh factor/factor D
- testing
- cross matching
disease testing
- nucleic acid technology (NAT) (viruses)
- hep C
- HIV
- west nile virus
AB blood type is….
universal reciever
O blood type…
universal donor
rh + vs -
Rh + can receive Rh -
Rh - NOT receive Rh +
what should the pt report during transf. (teach)
unusual sensations: chills, SOB, hives, itch, or back pain
