Lecture 02 Blood Products & Administration Flashcards
What’s the universal donor?
O-
What’s the universal recipient?
AB+
Rh+ can receive what kind of blood?
+ or - blood
Rh- can receive what kind of blood?
Only - blood
Whole Blood contains? (7)
- red cells
- white cells
- platelets
- electrolytes,
- plasma,
- antibodies,
- added anticoagulant.
Whole Blood:
Unit volume?
Indications?
Unit: roughtly 500 ml
Indications: massive blood loss
Whole Blood:
Adult dosage?
Peds dosage?
Do you need a filter?
Adult dosage depends on clinical situation
Peds dose is 20 ml/kg
filter is needed
Packed RBCs
Contains: (2)
Unit Volume Generally
Contains: mainly red cells withh plasma cells removed, and some white cells
Volume generally 300 ml
Packed RBCs
Indications:
Adult dose:
Peds dose:
Indications: numerous, but mainly to raise Hbg & Hct when dangerously low
Adult dose: depends on clinical situation
Peds Dose: 10 ml/kg
Packed RBCs
One unit of packed cells raises Hgb by what? Raises Hct by what?
Is a filter needed?
One unit pack raises Hgb by 1
One unit pack raises Hct by 3
A filter is needed
Platelets
What occurs during the 2nd reduction process of whole blood?
Volume: What does one unit equal to?
During the 2nd reduction process, platelets are separated from plasma
One volume: one unit equals to approx 50~70 ml of platelets
Platelets
Indication:
What does the dosage depend on? (3)
One unit increases the count by how many?
Is a filter needed?
Indication: stop bleeding when platelet count is low or when platelets are not functioning. Thrombocytopenia.
Dosing: 1. clinical situation 2. presence of bleeding (petechiae, gum bleeding, blood in stool/urine, frank bleeding) 3. Platelet count generally <25,000
One unit increases count by about 5,000
Filter is needed.
Fresh Frozen Plasma
How is the plasma separated?
Volume: One unit general = x ml?
Plasma separated from whole blood and then frozen
Volume: one unit generally = 200~250 ml
Fresh Frozen Plasma
Indications: (4)
What are the doses?
Do you need a filter? Precautions?
Indications: known clotting deficiencies, DIC, liver disease and warfarin reversal
Dose: depends on clinical situation
No filter is needed, but should be matched to patient’s blood type and Rh factor.
Cryoprecipitate
What is it?
Prepared from?
Volume: One unit= ?ml
Indications? (3)
Cryoprecipitate: is a source of fibrinogen. Fibrinogen is vital to blood clotting. It is usually used in the treatment of patients with reduced levels of, or poorly functioning, fibrinogen with clinical bleeding, an invasive procedure or trauma.
Prepared from: plasma and contains Factor VIII, von Willebrand’s factor, factor XIII, fibrinogen
Volume: 1 unit= 5~20 ml
Indications: hemophilia A (Factor VIII deficiency), von Willebrand’s disease, and Factor XIII deficiency
Albumin
This is a plasma derivative but not ABO or Rh matched
What are the 2 concentrations used?
Indication? (1)
Provdies what?
Dosing?
Is a filter used?
Two concentrations used:
5 %
25%
Indications: volume expansion when crystalloid solutions are not adequate and/or when there is capillary leak
Provides oncotic pressure to keep plasma fluid in the intravascular space.
Dosing dependent on clinical situation
Generally use filter to draw up, none with administration
What are 3 plasma derivatives?
- Factor VIII
- Factor IX
- ISG (Immune Serum Globulin)
Blood Administration:
When should Pt vital signs be taken?
then it’s best to send for the blood product after VS are obtained and patency of IV assured
Pt vital signs must be obtained within 30 min of blood transfusion start or according to institution policy.
There’s only a 30 min window from issue from Blood Bank to return blood and be reissued later. If it can’t be hung within 30 min, return it to the Blood bank.
Blood Administration
Do not put the blood in the unit refrigerator, the storage is tightly controlled by Blood Bank.
When is it preferable to hang the blood?
What kind of IV access may be used?
It’s preferableto hang blood within 15 min of arrival on the unit
The largest IV access must be used, it’s preferred to use 18 g to prevent cell destruction, but 20g IV can be used.
Blood Administration
the blood filter must be used
How long is the blood tubing good for?
Whe are clean glvoes and face shield/other PPE mandatory?
What’s the procedure of 2 RNs doing a Blood Product Check?
Blood tubing is good for 24 hours/6 units of blood products
Use of clean gloves/face shield/other PPE are used frequently if concern for blood splashes or mucous membrane exposure
Blood Product Check. One RN reads full name, and medical record number from pt bracelet as 2nd RN compares what is on the blood compatability tag attached to the bag. 2nd RN reads back to verifty 2 patient identifiers.
Blood Transfusion
What’s the procedure for product check?
1st RN reads product type, donor ID #, donor blood type, patient blood type, special preparations for blood such as washed, irradiated, CMV negative, etc. from the blood compatibility tag as 2nd RN compares to actual label on the blood product. This is done in sequence one-at-a-time with repeat back of what is on both blood tag and bag label.
The label on the blood bag is donor information. There will be no name, medical record number, or patient blood type on this label.
If any of the info does not agree, call Blood Bank and send unit back to them.
Blood Administration
What happens after Blood Product check is correct?
If correct, both nurses sign their full names on blood compatibility tag in designated spots, with date and time transfusion is started. This slip stays with the blood product until it has infused. At conclusion of the blood infusion, time ended and amount infused is recorded on slip and placed on Transfusion Record. This is scanned later into patient’s eRecord.
Y tubing used for most transfusions (gravity or pump types available)
Prime with Normal Saline (0.9%). Never use Lactated Ringers or Dextrose solutions. Will hemolyze red cells.
Blood Administration
What should you never do?
The blood is good for how long and why?
Never add meds to blood products or infuse anything by piggy back into blood except for normal saline
Blood is good for 4 hours, out of the blood bank. If it’s out for greater than 4 hours, then the risk of bacterial infections increase and RBCs start to die.
Blood Administration
How do you infuse the blood?
You check for reactions, and if they are none, what do you do?
Infuse at a slow rate for first 15 min of transfusion. No more than 30 ml should be done.
If there’s no reactions, take VS and speed up infusion.
Blood Administration
What does documentation include?
All VS, product type, donor ID number, how long it was infused and how pt tolerated the procedure
Blood Transfusion Reactions
What is the febrile non hemolytic reaction?
What is the pathophys?
What are the symptoms?
Immediate within 6 hours, is the most comomn and often occurs in pt who have had multiple transfusions.
It’s an antigen-antibody response to the donor’s WBCs
Symptoms: sudden chills, fever, headache, flushing, anxiety, muscle pains, N&V, chest pain, dyspnea
Administer antipyretics as ordered
Often seen when giving with RBC transfusions but also can occur with WBC transfusions and platlet transfusions. You may see orders for patients to receive leucocyte reduced blood or HLA single donor matched platelets
Blood Transfusion Reactions
Acute Hemolytic
What is going on?
When does it typically occur?
how often do you check VS?
What are policies?
Acute Hemolytic – ABO incompatibility, happens when blood is mislabeled, patient’s T&C are mislabeled, patient not properly identified. It may also be an RH incompatibility
Usually occurs in first 5 – 15 minutes
Chills, fever, low back/flank pain, tachycardia, tachypnea, hypotension, renal failure, hemoglobinuria, cardiac arrest, and death
If severe, support ABC and notify physician.
Other symptoms your patient might have are …apprehension and headache
For these patients you will be checking frequent VS as often as every 5 minutes
Most policies stipulate the nurse staying at the bedside for the first 15 minutes…my practice is to hang blood and then stay to do things…head to toe, talk to the patient…something that keeps me in the room
These reactions tend to me more severe and can quickly lead to kidney failure…acute tubular necrosis or ATN
Blood Transfusion Reaacions
Anaphylactic
How fast does it occur?
Pathophys behind it?
Symptoms?
Infusion of IgA protein to IgA deficient recipient
Immediately – usually very small amount of blood administered
Anxiety, urticaria, wheezing, respiratory distress, N&V, diarrhea, cramping, shock, cardiac arrest.
Support ABC as needed, administer epinephrine when ordered.
SMH Policy Transfusioni Reactions S&S’s
(1o)
- Change in pulse rate or blood pressure
- Fever (1º or more above baseline) and/or chills.
Fever is the primary sign of both febrile and hemolytic transfusion reactions. It usually is benign, but a fever in a previously afebrile patient or a significant change in degree of fever or pattern in a previously febrile patient requires stopping the transfusion and an investigation by the Blood Bank.
- Pruritus, and/or hives, localized or general (facial flushing).
- Hematuria flank pain or back pain (rare).
- Respiratory symptoms (e.g., SOB and dyspnea), pulmonary edema, and chest tightness.
- Unexplained jaundice or hemoglobinuria.
- Lumbar or sternal pain.
- Any patient complaint of not feeling well or impending
doom.
- Pain at the infusion site.
What kind of infectious disease can be transmitted through blood products?
Name bacterial, protozoal and viral infections.
Many infectious diseases can be transmitted through blood products.
Bacterial infections including gram negative organisms
Protozoal infections (malaria, toxoplasmosis)
Viral infections (hepatitis, herpes simplex virus, Varicella-Zoster, cytomegalovirus, and Epstein-Barr virus)
What’s the Blood Administration Rate by Gravity?
1 units (300mLs) of PRBCs ordered to infuse over 2 hours using gravity tubing
Blood tubing factor 10 gtts/mL
what’s the drip factor?
Amount of blood x drip factor divided by time in minutes to infuse blood.
300 mL x 10 gtts/mL/120 minutes →
3000/120 = 25 gtts/min
First 15 minutes will run at maximum 20 gtts/min = 30 mL of blood per policy
Blood Admin:
What does fluid volume overload look like? (6)
What are special precautions for pts with CHF?
Look for:
- Hypertension
- Bounding pulse
- Distended jugular veins
- Dyspnea
- Restlessness
- Confusion
In patients where this is considered high risk…pts with CHF – you may see orders for lasix to be given after or in between transfusions
