Blood transfusions

Question 1

Whole blood

Answer 1

Plasma, WBC’s, platelets, RBC’s

Treatment of massive bleeding, in exchange with transfusion, and when people donate blood to themselves

Monitor for fluid volume overload- give w diuretic as long as bp can handle it

Question 2

Packed red blood cells (PRBCs)

Answer 2

increases h/h and fluid volume (anemia)
replace moderate blood loss
restore RBC without adding excess fluid

ABO compatibility is essential
Type O blood has neither A or B antigens

Give slowly over 2-4 hrs

Have 30 mins from leaving blood bank to hang it- starts breaking down-> lysis -> hyperkalemia

Question 3

Platelets

Answer 3

given for thrombocytopenia (low plt count, really low 10-15 thousand)

fast infusion (15-20 mins)

ABO not required

30 mins out of fridge, short tubing, pool multiple plt donors into one bag, fragile

Question 4

FFP (fresh frozen plasma)

Answer 4

extra fluid
liver disease
concerned abt kidney failure, heart failure, older adults b/c giving fluid quickly

frozen due to clotting factors- use quickly

given over 30-60 mins

ABO required

Question 5

Procedure- order and consents

Answer 5

1- check physicians order (type of blood product, time, meds- pre admin meds, diuretic btwn units), allergies-> pepcid, benadryl, prednisone

2- review lab work- CBC, type and crossmatch

3- obtain consent

Question 6

Procedure- set up equipment

Answer 6

Assess IV site
- prefer >/ 20 gauge
- flush iv to check patency
- insert iv catheter if needed

Gather equipment
- blood tubing with filter
- NS (0.9%) usually 250 ml (run before and after)
- gloves

Nothing through the same line as blood unless central line

Question 7

Procedure- med admin

Answer 7

meds cannot be admin with blood products in same line
may require a secondary site for emergency

central line must have double or triple lumen

Question 8

Procedure- hang blood

Answer 8

1- set up NS on a pump
2- prior to obtaining blood product
3- remove Y tubing
4- move roller clamps and close
5- spike IV tubing and insert into NS
6- Prime IV tubing and clamp

Spike both bags, clamp, prime blood to filter, then prime saline throughout, then unclamp blood

Question 9

Procedure- getting blood

Answer 9

Should not be removed >30 mins bf infusion
Only good for 4 hours unrefrigerated
flush IV asap, IV access needed
IDV process for all products
Blood consents signed
Premedicate before starting

Question 10

Independent double verification (IDV)

Answer 10

sign off with second nurse if required- after scanning blood into EMR and checking blood product info correct

Question 11

Procedure- hanging blood

Answer 11

Pre-infusion vitals
connect y-tubing, allow blood to enter drip chamber and tubing

Rate- start slow (25-50 mL during first 15 mins)
Most PRBCs should go over 2 hrs

NEVER HANG >4 HOURS

baseline vitals- TEMP (febrile reaction if increase)

Question 12

Vitals during

Answer 12

rn remain for first 15 mins
monitor vs q5 mins for first 15 mins, then every 15-30 mins for one hour, then hourly until done

obtain set of vitals at completion of infusion and 1 hr after

Keep tubing for 12 hr after

Question 13

Patient having adverse reaction

Answer 13

Stop, Call Dr, call rapid, monitor, document

Question 14

S/S of acute transfusion reactions

Answer 14

uncomfy, impending doom, chills, increased temp

Question 15

What to do if acute transfusion reaction

Answer 15

• stop immediately
• change IV tubing and keep vein open with NS
• notify MD and blood bank
• send remaining blood or bag and tubing to blood bank for testing
• follow policy for urine and blood samples
• monitor and treat as ordered
• document

Question 16

Hemolytic transfusion reaction

Answer 16

human error, sometimes just doesnt react well

ABO/Rh mismatch, donor cells are hemolyzed in body

Second transfusion

S/S- chills, lumbar pain, hematuria, hypotension, impending doom

Treatment- supportive, nothing to reverse

Question 17

Bacterial transfusion reaction

Answer 17

contaminated blood, like sepsis

S/S- chills, pain in extremities related to shock

Rapid onset- 15 mins, has to go to ICU, IV antibiotics and supportive care

Question 18

Allergic transfusion reaction

Answer 18

anaphylaxis- epinephrine
mild- benadryl, pepcid, prednisone

S/S- pulmonary edema, shock, hypotension really low

Question 19

Febrile transfusion reaction

Answer 19

first 15 mins

S/S- fever, chills, tachycardia, fever, hypotension, tachypnea

without hemolysis, during or within first 4 hours of transfusion cessation

Fever- tylenol, cooling blankets

ICU if cant fix fever

Question 20

Transfusion associated circulatory overload (TACO)

Answer 20

not acute, after multiple transfusions, kidney and heart failure and older adults

Manifestations- chest pain, tightness in chest, cough, rales, pulmonary edema, tachycardia, elevated BP, JVD, crackles, confusion

Slow down rate, diuretic therapy between infusions

Fluid volume overload

Question 21

Transfusion-related acute lung injury (TRALI)

Answer 21

immune response, usually delayed, stop transfusion, call rapid, notify hcp, supportive treatment- ventilator, intubate

Activation of immune cells in lungs, rapid onset lung injury non cardiogenic pulmonary edema

Manifestations- fever, chills, dyspnea, tachypnea, tachycardia, hypotension, hypoxemia, and noncardiogenic bilateral pulmonary edema- cardiac arrest and code