Blood Transfusions

Question 1

What are some common human related errors for blood transfusions?

Answer 1

• Improper labelling
• Poor hand off between nurses
• Person transporting blood
• Method used to complete blood requisition

Question 2

What is important to remember regarding timing of hanging donated blood and its delivery?

Answer 2

• Must be hung w/in 30mins of being received
• Must be delivered to pt within 3hrs

Question 3

What is the workflow pre blood xfusion?

Answer 3

• Check consent is signed
• Ensure venous access and start NS 0.9%
• TWO nurses should (at bedside)
  
  • Confirm ID of pt
  • Check unit is labelled correctly
  • No signs of contamination of unit

Question 4

When a blood xfusion is started, what is the most important nursing action?

Answer 4

• Stay with patient for the first 15min to observe for adverse reactions

Question 5

If an adverse reaction occurs during a blood xfusion, what nursing actions should follow?

Answer 5

• Discontinue xfusion and switch out tubing
• Notify Provider
• Administer fluids, O2 and meds as appropriate (antipyretics, epinephrine, etc) for reaction
• VS q15min
• Send blood back to lab for analysis

Question 6

What is the most common complication occurrence for blood xfusions? What are its s/s and timing?

Answer 6

• Complication: Febrile non-hemolytic reaction
• S/S: temperature, flushing chills and headache
• Timing: 30 mins after initiation to 6 hours post transfusion

Question 7

What are common meds given for a febrile non-hemolytic reaction to a blood xfusion?

Answer 7

• Tylenol
• Antihistamines

Question 8

If providing a pt with FFP, is Rh factor a factor to be considered?

Answer 8

• Nope, Rh factor lives with the RBCs, not the plasma

Question 9

During a blood xfusion, an acute hemolytic reaction occurs when there is

Answer 9

• An ABO Rh incompatibility

Question 10

What are the s/s of an acute hemolytic reaction?

Answer 10

• Severe pain in kidney area and chest
• Significant temperature increase (105° F), chills
• Tachycardia
• HypOtension
• Dyspnea, bronchospasm
• Lower back pain
• Anxiety
• Extreme cases - vascular collapse possible DIC

Question 11

What are the lab tests important to blood xfusions?

Answer 11

• CBC w/ diff
• Blood typing and crossmatch
• Iron metabolism

Question 12

Why is knowing iron metabolism lab important for blood xfusions?

Answer 12

• It gives us the serum iron value and total iron binding capacity which is critical for oxygen perfusion

Question 13

What does the differential in a CBC give us and why is it important?

Answer 13

• Gives us the total amount of the different TYPES of WBCs which can help to diagnose the specific cause of an illness

Question 14

What does a “left shift” of WBCs indicate?

Answer 14

• High number of immature WBCs and a state of being immunocompromised.