Blood Transfusions Flashcards
what is one of the most serious errors associated with blood transfusions?
ABO incompatibilities
what are ways to decrease transfusion-related errors?
- bar code technology to prevent ID errors
- radiofrequency transponder microchips: standardize and document key steps in blood collection and confirm recipient-blood unit matching at a pt’s bedside
- advanced lab screening procedures ensure safe transfusion; identifies and decreases pathogen transmission
- blood alternative therapies w pharm developments such as colloids, crystalloids, EPO, antifibrinolytics, and hematinics
how do you determine what type of blood is needed?
pts medical condition
who is responsible for understanding which components are appropriate in various situations?
the nurse
where should blood be stored?
in fridge but NOT on unit!
can blood be cold or warm?
in emergency situations, cold blood may be rapidly transfused which can lead to dysrhythmias and decreased core temp
blood can be warmed in a special machine for large transfusions >50mL/kg/hr, but should never be warmed in microwave or in hot water (dangerous, destroys RBCs, result in hemolysis and severe rxns)
what should the order include?
specific blood or blood product
date
time to begin transfusion
special instructions (irradiated, leukocyte-depleted)
duration
pretransfusion or posttransfusion meds to admin
what premeds may be admin?
antihistamine or antipyretics
what is important to assess for prior to blood transfusion?
A) transfusion hx, allergies, previous transfusion rxns, cross match and type have been completed within 72hrs of transfusion
B) lab values (Hct, coagulation values, K+, platelets)
C) pt needs to sign consent
D) know indications for transfusion
E) pretransfusion VS and note if pt is febrile
F) assess need for IV fluids or meds while transfusion is infusing
G) pt understanding
what needs to be obtained within a specific time period?
blood sample has been collected and sent to lab within 72 hrs for typing and compatibility screening
nursing diagnoses for initiating blood therapy
activity intolerance altered health protection, risk for infection dec CO deficient or excess fluid volume deficient knowledge ineffective peripheral tissue perfusion
expected outcomes
1) pt understands need for therapy
2) pt experiences improved activity intolerance
3) mucous membranes are pink and pt has brisk cap refill
4) pt’s CO returns to baseline
5) pt’s sBP improves and urine output is 0.5-1.0 mL/kg/h
what do you want to check with a blood bag?
clots, clumping, gas bubbles, purple colour, presence of leaks
expiration date and time
what needs to be compatible?
pt’s blood type and Rh type with donor blood type and Rh type
what are basic s&s of transfusion reactions?
chills, low back pain, SOB, rash, hives, or itching
why do you want the pt to void before initiating therapy?
If transfusion rxn occurs, urine specimen containing urine prod after initiation of transfusion will be sent to lab
why is blood therapy time sensitive?
should be initiated within 30mins from time of release from blood bank
blood serves as medium for bacterial growth
what do you do if you cannot admin blood within 30 mins?
if this cannot be completed because of factors such as an elevated temperature, immediately return blood to blood bank and retrieve it when you can administer it.
It is important that the blood bag not be spiked until you ensure that no factors exist preventing transfusion
how should you set up the blood bag?
gently agitate bag by inverting 2-3x to suspends RBCs in anticoagulant. spike at chest level
what rate should blood be run at?
regulate blood infusion to allow only 2mL/min to infuse in initial 15 mins.
Remain with pt during first 15 mins of transfusion.
Initial flow rate during this time should be 1-2mL/min or 10-20gtt/min (using macrodrip of 10gtt/mL)
why do we stay with pt for first 15 mins and run blood at such a slow rate?
Many transfusions reactions occur within 15 mins of transfusion. Infusing small amount of blood component initially minimizes volume of blood to which pt is exposed, thereby minimizing severity of reaction
signs of a blood transfusion are occurring in your pt. what do you do?
stop the transfusion, start 0.9%NS with a new primed tubing attached directly to the VAD hub, and notify the hcp immediately. Do not discard the blood product or tubing because they may need to be returned to the blood bank. Do not infuse saline through existing tubing because it will cause blood in tubing to enter pt
what do we monitor?
Monitor pt’s VS within 5-15mins of initiating transfusion and at completion of transfusion or according to agency policy
how long can blood hang for?
no longer than 4hrs because of danger of bacterial growth. When a longer transfusion time is indicated clinically, the unit may be divided by the blood bank, and the part not being transfused can be properly refrigerated
when should admin sets be changed?
Admin sets should be changed at the completion of each unit or every 4hrs to reduce bacterial contamination
why do we clear line with IV NS after blood therapy is complete?
Infusing IV NS allows remainder of blood in IV tubing to infuse and keeps IV line patent for supportive measures in case of transfusion rxn
evaluation following blood admin
1) Observe IV site and status of infusion each time vital signs are taken.
2) Observe for any signs of transfusion reactions such as chills, flushing, itching, dyspnea, or rash
3) Observe pt and assess lab values to determine response to admin of blood component
unexpected outcomes
1) Patient displays s&s of transfusion reaction such as chills, flushing, itching, dyspnea, or rash
2) Patient develops irritation or phlebitis at venipuncture site
3) Fluid volume overload occurs, and/or pt exhibits difficulty breathing or has crackles on auscultation of lungs
what interventions will you perform if the pt displays s&s of transfusion rxn?
- Stop transfusion immediately
- Disconnect blood tubing and cap IV
- Connect new NS solution and primed tubing directly to VAD hub to prevent any subsequent blood from infusing into pt from tubing
- Keep vein open with slow infusion of NS at 1-2mL/min to ensure venous patency and maintain venous access for medication or to resume transfusion
- Notify hcp
what interventions will you perform if the pt develops irritation or phlebitis at venipuncture site?
• Transfusion should be stopped at first sign of infiltration, and IV line removed
• Insert new VAD in area above previous location or opposite arm
• Restart product if remainder can be infused within 4hrs of initiation of transfusion
-Institute nursing measures to reduce discomfort at infiltrated or phlebitic area
what interventions will you perform if fluid volume overload occurs, and/or the pt exhibits difficulty breathing or has crackles on auscultation of lungs?
- Slow or stop transfusion, elevate HOB, and inform hcp
- Administer diuretics, morphine, and/or O2 as ordered by hcp
- Continue frequent assessments and closely monitor VS and I&O
what pt teaching is done after blood admin?
- Instruct pt and fc to notify nurse if pt experiences itching, swelling, dizziness, dyspnea, low back pain, and/or chest pain because these may indicate a transfusion rxn
- Instruct pt to inform nurse if redness, pain, tenderness, swelling, bleeding, drainage, or leaking from under dressing occurs at IV site
what are peds considerations for blood admin?
- Infuse the first 50mL or 20% of volume (whichever is smaller) of a blood transfusion very slowly in a peds pt. Nurse should stay with the child during this time frame.
- smaller portions of blood are available
what gauge catheter should be used in peds?
22-24 gauge cannula can be used to infuse PRBCs in small veins that do not need rapid flow rates
what type of catheter or catheter placement can be used in infants/peds pts?
Umbilical catheters or catheters placed in the small saphenous veins
