Blood Transfusion Flashcards
<p>Purpose of blood transfusion?</p>
<p>1. To increase circulating blood volume after surgery, trauma, or hemorrhage
2. To increase the number of RBCs and to maintain hemoglobin levels in client's with severe anemia
3. To provide selected cellular components as replacement therapy; clotting factors, platelets, and albumin</p>
<p>Autologous transfusion advantage</p>
<p>(1) Increases patient safety with the elimination of incompatibility reaction
(2) Conserves blood supply, especially if the patient has a rare blood type
</p>
<p>Red Blood Cells indications</p>
<p>-Symptomatic anemia
-Exchange transfusion
</p>
<p>Red Blood Cells contraindications</p>
<p>When anemia is not severe and can be corrected with specific medications, e.g., iron, B12, folic acid, EPO, etc...</p>
<p>Platelets indication</p>
<p>-Treatment of patients with bleeding due to thrombocytopenia or abnormal platelet function
-May be given prophylactically to patients with rapidly falling or low platelet counts (usually less than 10 x 109/L [10,000/L]) secondary to cancer or chemotherapy
</p>
<p>Platelet contraindication</p>
<p>-Platelets should not be used if bleeding is unrelated to thrombocytopenia or abnormal platelet function
-Should not be used in patients with destruction of endogenous and exogenous platelets, such as in Thrombotic Thrombocytopenic Purpura (TTP) or Idiopathic Thrombocytopenic Purpura (ITP), unless the patient has a life-threatening hemorrhage.
</p>
<p>Frozen plasma indicaton</p>
<p>-Replacement of clotting factors following massive transfusion
-Exchange transfusion in neonates
-Reverse the effects of Warfarin
</p>
<p>Frozen plasma contraindication</p>
<p>-When a coagulopathy can be corrected more effectively with specific therapy, such as vitamin K, cryoprecipitated, or Factor VIII concentrates
-When blood volume can be safely and adequately replaced with other volume expanders such as 0.9% Sodium Chloride Injection (USP); Lactated Ringer’s Injection (USP); Albumin; or Pentaspan
</p>
<p>Cryoprecipitate indication</p>
<p>-Source of fibrinogen or factor XIII and cryo is a source of coagulation factors</p>
Pre transfusion RBCS
- Type & Screen (ABO & Rh Group, Antibody Screen)
- Crossmatch (Compatibility test)
- Specimens for T&S are good for 3 or 72 hours
Pre transfusions Plasma, platelets, Cryo
- Type & Screen
- ABO & Rh on file (done twice in TraceLine or same admission)
Nursing responsibilities during transfusion
- Knowledge of the hospital policies
- Before calling for the blood
- Ensure appropriate IV access
- Check the patient’s temperature and take baseline vital signs
- Do not start a transfusion if the patient has to leave the floor
Pre transfusion monitoring
- All fresh blood products must be infused using a standard blood filter (170-260µ)
- Start infusion slowly (~50 ml/hr or 8 gtts/min) for first 15 minutes; or 2 ml/min or 20 gtt/min for the first 15 minutes or…
- Perform Vital Signs 15 mins, & every 30 mins then q1h after transfusion or per agency policy.
- Increase rate after 15 minutes if no S&S of reaction
- The administration set must be changed after 4 hours (at each unit of blood)
- One unit of blood should be infused within 4 hours
Signs and symptoms of a reaction?
- fever equal or greater than 38.5C and increase of 1 C from baseline
- chills or rigors
- uticaria, hives
- dysnpea
Other s and s
- hyper/hypotension =/- 30mmHg
- chest pain/back pain
- tachycardia
- shock
- facial tongue swelling
- pain or heat at IV site
Nonimmunologic reactions
- fluid volume overload
- transmission of disease
- transfusion hemosiderosis
- massive blood transfusion
Nursing actions after reaction
- stop the infusion, reassure pt/family
- keep line open with NS with a new primed tubing
- assess vs and quick evaluation opt clinical status
- notfify MD and transfusion service
- Complete Transfusion Service requisition section on transfusion reactions
- Draw “ 4 ml EDTA tube” & send to Transfusion Service with blood bag & administration set in ziploc
- Draw and send blood cultures on patient if bacterial contamination is suspected
Documentation after a reaction
- clinical manifestations
- interventions
- time transfusion occur
- time transfusion stopped
- amount of blood transfusion
Nurse’s notes
- start/end time
- product type
- pt’s tolerance of the transfusion
- problems encountered such as reactions
- vital signs
What do the two RNs verify during the verification when a unit of PRBCs arrives on the unit?
- Patient’s full name and unit number on issue voucher and blood/blood product bag.
- Product against the form from the blood bank - blood type, Rh type, unit # on the unit of blood, expiry date, appearance of the blood, donor number, any particularities (i.e. antibodies)
- Identify the patient’s full name and unit number on the ID bracelet
PRBCs are piggybacked to what solution? Provide a rationale.
Normal Saline is used to prevent coagulation of donor blood
If VS are WNL after the first 15 minutes, at what rate is the unit of PRBCs infused?
25 gtts/min or 150ml/hour. Slower for elderly patients to prevent overload
