Blood transfusions Flashcards
Blood types, antigens, antibodies, universals
Type A (A antigen, B antibody) Type B (B antigen, A antibody) Type AB (A and B antigens, no antibodies) - Universal recipient Type O (No antigens, antibodies to A and B) - Universal donor
Also consider Rh/Factor D
How to make sure blood is safe to give?
Match the blood type. (Testing, cross matching (?))
Disease testing: Nucleic acid technology, Hep C, HIV, West nile virus, syphilis, etc
Types of blood products
Whole blood RBCs Albumin Platelets FFP Cryoprecipitates
whole blood considerations
rarely given because its a lot of volume, and has a lot more things in it for the patient to potentially react to
RBCs
-packed RBC (usually for anemia, ~350 mL)
-washed RBC (for someone who gets a lot of transfusions)
-frozen RBC (rare)
-leukocyte-reduced RBC (Good for someone who has decreased immune fx ie someone with advanced HIV)
Washed and leukocyte reduced both decrease risk of rxns.
ffp
Plasma always frozen, skinny bag, little volume, defrosts quick.
platelets
for platelet disorders
Clotting factor deficiencies
Cancer patients receiving radiation and chemotherapy
Severely undernourished people
albumin
liver failure pt, someone who has low plasma proteins
cryoprecipitates
clotting factors. ie hemophiliacs
Transfusion methods
- homologous (most common type)
- typical blood transfusion from blood bank - designated, directed blood
- when family wants to give blood to a family member (but takes 2-3 days to test blood and everything still) - autologous *safest, least likely for a rxn
- preop: pt gives blood to self ie for elective surgery, maybe take some blood 5 wks prior
- periop: during surgery, save blood coming from pt, putting it back in
* only possible rxn: sepsis if it somehow gets contaminated.
- postop: common with ortho surgery. put a drain into surgical site, drains into a box and there’s something in there to keep blood from clotting, and if pt blood gets too low then they take the blood from the box.
therapeutic apheresis
take blood out of donor, run it thru machine that separates portions of blood, and rest of blood is sent back to pt.
separates out platelets, wbc, stem cells.
we get just what we need without depleting pt blood supply.
NRSG assess for transfusions
- Transfusion hx: more they’ve had, more susceptible they are to transfusion rxn (watch extra closely)
- Vital signs, lung sounds
- any health problems
- verify order (ALWAYS check blood with another licensed nurse)
- test compatibility
- examine blood bag for ID
- check exp date
- inspect blood for discoloration, gas bubbles, cloudiness
equipment prep for transfusion
- 16-20 gauge catheter (anything smaller will lyse RBC, and tubing will be clogged if too small)
- Y-type blood tubing with in-line filter: one spike goes into blood, one into NS. (blood is ALWAYS given with NS ONLY! not 1/2 NS, not dextrose with NS, nothing else)
- This tubing allows priming with saline, then start blood flow. Also, if rxn, have option to start blood and immediately start running NS.
- Optional equipment
- electronic infusion pump (impt, makes sure blood runs not too slow, not too fast. ~150, but start at abt 100 for first 15-30min and stay with them, then pump it up and check on them later)
- pressure cuffs
- blood warmers
nrsg consideration for timing:
have 30 mins to use blood after taking it from blood bank, or else send it back. cannot leave it in fridge on ur floor (not as reliable).
whole 350 mL should be given less than 4 hrs, so u have 3.5 hrs ish.
when should pt call u for blood transfusion
ANYTHING
chills, itchiness, diff breathing, small tingling
VS reevall for blood transfusions
before transfusion, and after first 15 mins of transfusion.
depending on protocol, u dont have to until after its done. but best to check before, after 15 mins, then q hr. taking BP this often is erring on safe side.
NRSG responsibilities for transfusion
- pt ed
- VS
- administer blood witin 30 mins of receiving from blood bank
- ensure appropriateness of all elements of treatment
- begin tx slow, stay with pt first 15-30 mins
- ask client to report unusual things like hives, itching, chills
- administer blood per protocol
outcome and eval
recheck what was supposed to be fixed:
- RBC
- Hgb
- Hct
- Plt count
- clotting factors
- relief from clinical manifestations
geri considerations for blood transfusion
- IV access: skin thinner, veins prone to scarring, loss of turgor, vasoconstriction, easy rupture/bruising. Loss of fat pad, must tape down the iv well.
- Systemic rxns: much higher risk for fluid overload, prevent fluid volume overload, consider Hx of CHF or renal insufficiency/decline (what if they can’t get rid of the fluids youre giving them?). monitor fluid balance, electrolytes, respiratory insufficiency.
NRSG eval for blood transfusions
- during AND after transfusion
- more product given, higher risk - recognize normal v abnormal rxn + know appropriate interventions
possible blood transfusion rxns:
- hemolytic
- allergic
- febrile
- bacterial
- circulatory overload
hemolytic rxns (acute) to blood transf: what is, and s/s
Incompatibility btwn client’s blood and donor’s blood.
Absolute worst one. Most likely to happen w/in first 15 mins, thats why u stay.
s/s:
*Cyanosis, chest pain, tachycardia, hypotension (shock symptoms, at risk), backache (from agglutinated blood getting caught in diff vessels, same with CP)
Other s/s: dyspnea, chills, fever, headache.
hemolytic rxns nrsg interventions
- stop the transfusion
- Run NS with a new bag, new tubing.
- Run it at KVO - Notify md
- might get an order for colloid cause BP or something for pt, get crash cart. - send remaining blood, sample of pt blood, and urine sample to lab
- monitor VS, I/O
delayed hemolytic rxn
can happen later in transfusion, or days later.
Good news: delayed is not as damaging, not as dangerous, not as life-threat as acute.
