Care of Patients Receiving Blood Products Flashcards
Red Blood Cells (RBC) or Packed Red Blood Cells (PRBC)
Platelets
Plasma or Fresh Frozen Plasma (FFP)
Granulocyte (White Blood Cells)
Types of transfusions
Typ packed - concentrated
To replace lost blood or anemia
Transplantation of tissues
Infuse over 2-4 hours
Use filtered pump tubing
Red Blood Cells
Compatibility is determined by 2 antigen systems - ESSENTIAL
ABO and Rh
**Donor and recipient blood must be checked carefully for compatibility
Transplantation of tissues
To treat thrombocytopenia or active bleeding: Platelets < 10,000 mm3
Platelets are pooled from multiple donors so do not have to have the same blood type
Use specific tubing: Longer tubing increases the chance that platelets will stick to lumen
Infuse over 15-30 minutes immediately
Platelets
To treat deficiency in plasma coagulation factors; elevated PT or PTT
Must be ABO compatible
Infuse over 15-30 minutes immediately after thawing:
So clotting factors are still active
Use Y set tubing
Plasma
Used with sepsis or neutropenic infection
Rare
More at risk for transfusion reactions: WBC surfaces have many antigens
Usually requires closer monitoring
Infuse over 1 hour
Granulocyte (WBC)
Assess labs and ensure need transfusion
Verify order with another RN
Ensure adequate venous access
Assess vital signs before get bloood
Obtain blood products from blood bank and administer as soon as possible
Safety checks - biggest priority
Inspect blood for discoloration, gas bubbles, cloudiness
Pretransfusion
Must be done by 2 RNs
One of the RNs has to also be responsible for administering the blood product
Verify patient’s identity with another RN
Examine blood bag label, attached tag, and requisition slip for ABO and Rh compatibility with the patient with another RN
Check expiration date with another RN
Safety checks - biggest priority
Could indicate hemolysis or bacteria
Inspect blood for discoloration, gas bubbles, cloudiness
Vital signs
Use appropriate tubing, filters and fluids
Begin transfusion slowly, stay with patient first 15 to 30 minutes
Ask patient to report unusual sensations
Administer blood product per protocol
Assess for hyperkalemia
During transfusion
immediately before starting infusion and again within the first 15-30 minutes
Vital signs
Never add or infuse anything with blood products
Prime tubing with Normal Saline (0.9% NS)
Use appropriate tubing, filters and fluids
chills, shortness of breath, hives, itching
Ask patient to report unusual sensations
Febrile Transfusion Reaction
Hemolytic Transfusion Reaction
Allergic (anaphylactic) Reaction
Bacterial Transfusion Reaction
Transfusion-Associated Circulatory Overload (TACO)
Transfusion related Graft v. Host disease
Acute Pain Transfusion Reaction (APTR)
Nursing Interventions
Complications
Acute
Signs:
Occurs when a patient has had multiple transfusions and develop WBC antibodies
Prevention:
Febrile Transfusion Reaction
Fever, chills, tachycardia, hypotension and tachypnea - check VS
Signs: - Febrile Transfusion Reaction
Give leukocyte reduced blood or single donor blood
Use of WBC filters when administering blood products to filter out WBC
Prevention: - Febrile Transfusion Reaction
Acute
Signs:
Occurs when there is a blood type or Rh incompatibility
Prevention:
Hemolytic Transfusion Reaction
Fever, chills apprehension, HA, chest pain, low back pain, tachycardia, tachypnea, hypotension, sense of impending doom - VS
Signs: - Hemolytic Transfusion Reaction
Antigen-antibody complexes form and destroy cells and cause inflammatory response
Occurs when there is a blood type or Rh incompatibility - Hemolytic Transfusion Reaction
Ensure that all blood products and typed and crossmatched
Adhere to all safety checks prior to blood product administration
Prevention: - Hemolytic Transfusion Reaction
Acute
Signs:
Usually seen in patients with other allergies
Prevention:
Allergic (anaphylactic) Reaction
Urticaria, itching, bronchospasm, anaphylaxis - stop blood if receiving it
Signs: - Allergic (anaphylactic) Reaction
Can occur immediately or within 24 hours
Usually seen in patients with other allergies - Allergic (anaphylactic) Reaction
Give leukocyte reduced blood
Prevention: - Allergic (anaphylactic) Reaction
Acute
Signs:
Caused by contaminated blood and onset is rapid
Bacterial Transfusion Reaction
Tachycardia, hypotension, fever, chills
Signs: - Bacterial Transfusion Reaction
Acute
Signs:
Occurs when blood product is infused too quickly
Fluid overload
Prevention:
Transfusion-Associated Circulatory Overload (TACO)
Hypertension, bounding pulses, JVD, dyspnea, restlessness and confusion
Signs: - Transfusion-Associated Circulatory Overload (TACO)
Infuse blood products slowly esp if high risk
Diuretics if dire enough and acute resp distress
Monitor I&O
Prevention: - Transfusion-Associated Circulatory Overload (TACO)
Not acute; happens later
Bone marrow transplant pats
Signs:
Occurs in immunocompromised patients and occurs within 1-2 weeks - reacting to foreign tissue
Serious if not treated
Prevention:
Transfusion related Graft v. Host disease
Thrombocytopenia, anorexia, N&V, weight loss, infection
Signs: - Transfusion related Graft v. Host disease
Administered irradiated blood products that destroy T cells and cytokine
Prevention: - Transfusion related Graft v. Host disease
Acute
Signs:
Rare and occurs during or immediately after transfusion
Treatment:
Acute Pain Transfusion Reaction (APTR)
Severe chest pain, back pain, joint pain, hypertension, anxiety and redness of head and neck
Signs: - Acute Pain Transfusion Reaction (APTR)
Control symptoms
Rigors - pain meds
Treatment: - Acute Pain Transfusion Reaction (APTR)
Get VS and notify provider
Stop the infusion - first!!!!!
Take down all blood tubing and save with all labels - put in bag because investigation occurs
Oxygen - distress
Diphenhydramine (if allergic)
IV Fluids for severe shock
Antibiotics (if bacterial transfusion rxn if blood contaminated)
Antipyretics for fever - comfort
Meperidine for rigors
Nursing Interventions
Don’t flush tubing and put anymore blood into the patient
Stop the infusion - first!!!!!
