blood transfusion w3 Flashcards
the hematological system includes
- bone marrow
- blood
- spleen
- lymph system
what does blood transfusion mean?
the administration of whole blood (ex. platelets, packed RBC, or plasma)
safety alert w/ blood transfusion
- dextrose solutions or lactated ringer’s should never be used w/ blood bc they will cause RBC hemolysis
- additives (including medication) must not be given via the same tubing as the blood unless the tubing is first cleared w/ saline solution
what gauge should the nurse use when administrating blood components?
using a 22-gauge IV needles or cannula, or catheter
- larger needles (18 or 16-gauge) may be preferred if rapid transfusion are given or if the infusion is sluggish
- smaller needles are used for platelets, albumin, and clotting factor replacements
patient’s w/ a history of reaction to platelet transfusion may be premedicated w/ __ to decrease the possibility of reaction?
antihistamine and hydrocortisone
what are the nursing consideration when giving blood?
–always have a dual-checking system
-obtain vital signs before administration
-administer blood ASAP to pt when received
-never refrigerated on the nursing unit in food or drug fridge bc the temperature doesn’t meet the requirement for safe storage
-if blood is not used w/in 30 mins return to blood bank
-during the first 15min or 50ml of infused blood, the nurse must remain w/ the pt to monitor (reactions occur most often at this time)
-rate of infusion should be no more than 2mL/min
PRBCS should no be infused quickly unless an emergency
-after 15 mins retake viral signs
-observe pt periodically every 30 mins and up to 1 hour after transfusion
how long should blood transfusion take to be administered?
usually not more than 4 hour bc of the increased risk for bacterial growth in the product once it is out of the refrigerator
what is a blood transfusion reaction?
an adverse reaction to blood transfusion therapy can range in severity from milk, to life threatening conditions
- must have judicious evaluation of the pt
- reactions can be acute or delayed
what is an acute hemolytic reaction?
- most common cause of hemolytic reaction is transfusion of ABO incompatible blood
- when occurs, antibodies in the recipient serum react w/ antigen on the donor’s RBCs. this reaction results in agglutination of cells, which can obstruct capillaries and block blood flow
- may obstruct renal tubules, leading to kidney injury
- death
- usually develops w/in 15 mins of transfusion
- DIC (disseminated intravascular coagulation)
what is a febrile reaction?
- most commonly caused by leukocyte incompatibility
- common in individuals who receive 5 or more transfusions develop circulating antibodies to the small amount of WBCs in the blood product
- is prevent by using additional filters in the tubing to leukocyte-deplete RBCs and platelets
- may give acetaminophen or diphenhydramine 30 min before administration to reduce reactions
allergic reaction to blood transfusion?
- may result d/t recipients sensitivity to plasma proteins of the donors blood
- reactions are common in those who have a history of allergies
- may administer antihistamines to help prevent reactions
- epinephrine or corticosteroids can be used to treat severe reactions
circulatory overload and blood transfusion
- pt w/ cardiac or renal insufficiency is at risk for developing circulatory overload, esp when large quantity of blood is infused in a short period of time (esp in elders)
- nurse should do a fluid balance assessment, obtain baseline auscultation of the pts lung
- complaints of SOB, and presence of adventitious breath sounds may indicate fluid overload in pt
sepsis and blood transfusion
- blood products can become infection from improper handling and storage
- bacterial contamination of blood products can result in bacteremia, sepsis, or septic shock
what is transfusion related acute lung injury? (TRALI)
- characterized by the sudden development of noncardiogenic pulmonary edema (acute lung injury)
- usually develops w/in hours of transfusion
- leading cause of transfusion-related deaths (surpassing hemolytic reactions)
- causes pulmonary capillary inflammation and increased permeability =respiratory distress and death
what is massive blood transfusion reaction?
- complications of transfusing large volumes of blood
- occurs when RBCs or blood exceeds the total blood volume w/in 24hs =imbalance of normal blood elements results bc clotting factors, albumin, and platelets are not found in RBC transfusion
- must monitor hemostatic lab values
- can cause hypothermia (can cause dysrhythmias-warm blood using tool to prevent this), citrate toxicity, hypocalcemia, hyperkalemia
what is delayed transfusion reaction?
- includes hemolytic reactions (24-14 days)
- infections
- iron overload
infection and blood transfusions
-Infectious agents transmitted by blood transfusion include hepatitis B and C viruses, HIV, human herpesvirus type 6 (HSV-6), EBV, HTLV-1, cytomegalovirus (CMV), and malaria. Hepatitis is still the most common viral infection transmitted but is decreasing
what is autotransfusion? /autologous transfusion
- removing whole blood from a person and transfusion that blood back into the SAME person
- problems of incompatibility, allergic reactions, and transmission of disease are avoided
autologous donation
- person donates their blood before a planned surgical procedure
- can be frozen and stored for 10 yrs
- great for pts that have rare blood types
autotransfusion donation
- involves safely and aseptically collecting, filtering, and returning the pt’s own blood that is lost during a major surgery or traumatic injury
- replaces volume and stabilize the condition of bleeding pt
- collection devices most often used during surgeries
- some system allow blood to be automatically and continuously reinfused
S/S of febrile, nonhemolytic reaction
- sudden chills and fever
- headache
- flushing
- anxiety
- vomiting
- muscle pain
S/S of mild allergic reaction to transfusion
- flushing
- itching
- pruritus
- urticaria (hives)
S/S of severe allergic reaction of transfusion
- anxiety
- urticaria
- dyspnea
- wheezing
- progressing to cyanosis
- bronocospams
- cardiac arrest
S/S of circulatory overload blood transfusion reaction
- cough
- dyspena
- pulmonary congestion
- adventitious breath
- headache
- HTN
- tachycardia
- distended neck viens
S/S of sepsis blood reaction
- rapid onset of chills
- high fever
- vomiting
- diarrhea
- hypotension
- shock
S/S of transfusion-related acute lung injury (TRALI) reaction
-fever
-chills
-hypotension
-tachypnea
-frothy sputum
-dyspnea
-hypoxemia
-respiratory failure
-noncardiogenic pulmonary edema
(occurs w/in 1-6 hrs of transfusion)
S/S of massive blood transfusion reaction
- Hypothermia and cardiac dysrhythmias (from massive infusion of large quantities of cold blood).
- Citrate toxicity and hypocalcemia (from the use of citrate as a storage solution).
- Hyperkalemia (from potassium leaking from stored RBCs).
nursing management of acute hemolytic reaction
- treat shock and DIC (disseminated intravascular coagulation)
- draw blood and urine sample
- maintain BP w/ IV colloid solutions
- give diuretics to maintain urine flow
- insert-in-dwelling urinary catheter to measured voided amounts to monitor hourly urine output
- dialysis may be required if renal failure occurs
- stop transfusion
management of febrile nonhemolytic reaction
- give antipyretics
- avoid ASA in pt with thrombocytopenia
- stop transfusion (don’t restart w/out physical orders)
management of mild allergic blood transfusion reaction
- give antihistamine, corticosteroid, epinephrine
- if symptoms are mild transfusion may be restarted slowly w/ an order
- never restart transfusion if fever or pulmonary symptoms develop
management of severe allergic reaction
- CPR
- administer O2
- epinephrine (injection)
- antihistamine
- corticosteroids b2 agonists
- DO NOT RESTART TRANSFUSION
nursing management for circulatory overload reaction
- place pt upright w/ feet in dependent position
- obtain chest radiograph
- administer diuretics, O2, and/or morphine
- phlebotomy may be indicated
management of sepsis transfusion reaction
- obtain culture of patient’s blood and send bag with remaining blood and tubing to blood bank for further study.
- treat septicemia as directed— administration of antibiotics, IV fluids, and/or vasopressors.
management of transfusion-related acute lung injury reaction
- send bag w/ remaining blood and tubing to blood bank
- analyze ABG’s and HLA (human leukocyte antigen)
- provide O2
- administer corticosteroids, diuretics
- CPR
- provide ventilatory and blood pressure support if needed
management of massive blood transfusion reactions
-monitor clotting status and electrolyte levels
what is the purpose of blood transfusions?
- increase (circulating blood volume (hemorrhage, trauma, surgery, hypovolemic shock, burns)
- correct (RBC deficiency and improve oxygen carrying capacity of the blood)
- maintain (blood’s clotting ability ex. pt w/ bone marrow suppression)
- provide (selected blood components as replacement therapy (clotting factors, platelets)
what are the 4 main components of blood?
- plasma
- RBC
- WBC
- platelets
whole blood/packed red blood cells (PRBCs)
whole blood or packed RBC are transfused where major blood loss occurred
- most commonly used
- once plasma has been removed from whole blood, additives are used to resuspend red cells (maintain red cells in optimum condition during storage)
what are the indicates for whole blood or PRBCs?
- RBCs improve oxygen-carrying capacity
- useful as a volume expander after acute blood loss
- symptomatic anemia
what are platelets?
responsible for clotting (coagulation), change fibrinogen into fibrin =creating a mesh onto which red cells collect and clot
indications when we would administer platelets?
-severe micro-vascular bleeding occurs (DIC- disseminated intravascular coagulation)
-for pt with platelet count of less than 10,000 to 20,000/mm3
-pt w/ platelet count of less than 50,000/mm3 who are bleeding
(N=150-400,000/mm3)
what is albumin?
dynamic protein in plasma responsible for maintaining the plasma colloid osmotic pressure thereby regulating intravascular blood volume
indications for albumin
- 5% solution, used for volume expander, hypovolemic shock and hyporoteinemia
- 25% solution used for severe burns and low albumin levels
indications for fresh frozen plasma (FFP)
active bleeding- replacement of plasma coagulation factors when simultaneously blood volume expansion is required
-contains all clotting factors expect platelets and is frozen to preserve factor 5 and 8
indications for cryoprecipitate?
obtained from FFP (fresh frozen plasma) after slow thawing
- indications
- given to increase fibrinogen levels (pt who have developed DIC- by defusing bleeding that results from depletion of platelets and clotting factors)
- for bleeding or immediately prior to an invasive procedure in pts w/ significant hypo-fibrinogenemia
- advantages- can replace these factors w/out the hypervolemia risk w/ FFP
what is intravenous immunoglobulins (IVIG)
IVIG is a protein replacement therapy for pts which have decrease or abolished antibody production capabilities
- it is extracted from donor plasma
- IVIG effect last between 2 weeks and 3 months
what are the indications for IVIG (intravenous immunoglobulins)
- immune deficiencies
- inflammatory and autoimmune disease
- acute infections
- IVIG is administered to maintain adequate antibodies levels to prevent infections and confers a passive immunity
what are the pre transfusion nursing assessments?
-neuro-confusion, decrease energy/LOC, hypoxemia
-respiratory- increase RR, effort, cyanosis, SOB
-cardiac- low B/P (indicates low circulating volume) increase HR
-active bleeding (hemorrhage d/t trauma, surgery, hemorrhagic shock and/or inability to clot effectively)
current treatments-chemo alters a person RBC, WBC and platelets
-factor deficiencies
-lab values (CBC, RBC, HGB HCT, WBC, PLATELETS, ALBUMIN
what blood do we use in emergency situations?
O- blood
what should the nurse do when preparing blood transfusions?
- understand why the pt is receiving the blood
- CONSENT- usually valid up to 1 yr
- take baseline vital signs and auscultate chest
- do not pick up blood until pt is ready, consent is signed and IV is in the pt (correct gauge 22) connected to flushed blood tubing
- larger needles like 18-16 are preferred if raid transfusion are given or if the infusion is sluggish (smaller needles are for platelets, albumin, and clotting factors)
- bedside have 2 RN’s verify
- start transfusion slowly (50ml/hr)x15 mins
- stay w/ pt first 15 mins
- check on pt and repeat vital signs (i.e q15 min for 1st hour, q30 mins)
- doc set of VS on transfusion record
- if not complications after 15 mins INCREASE RATE to infuse as ordered
- IV Furosemide may be ordered between units (client at risk for fluid overload)
why do some pts have reactions to blood products?
- incompatible product-identification errors
- donor WBC and cytokines
- donor antibodies
- bacteria
- allergens
- donor viruses or parasites
