Blood Transfusions Flashcards
(88 cards)
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
