Perfusion: Blood Transfusion Flashcards
What are LPNs able to do with regard to blood transfusions?
- obtaining unit from blood bank
- Crosschecking of ID prior to initiating transfusion w/ RN
- Monitoring during transfusion
What are the objectives of transfusion therapy?
- replacement or expansion of circulating volume
2. Maintenance of oxygen-carrying capacity of the blood by supplying red blood cells
What are the types of blood products that can be given?
- whole blood
- packed RBC
- Modified packed RBCs
- Fresh Frozen Plasma
- Platelets
- Cryoprecipitate
What are the uses for whole blood?
- acute massive blood loss greater than 25%
2. neonatal exchange transfusion
When is whole blood contraindicated?
In patients with chronic anemia who are normovolemic and require only red cell mass increase
How is Packed Red Cells prepared?
by the removal of 200-250mL of the plasma from a unit of whole blood
What can packed red cells be used for?
- the treatment of anemia in normovolemic patients requiring only an increase in RBC mass and Oxygen-carrying capacity
- Active GI bleed
- Hypovolemic shock
What must the patient and Packed red cells be in order to give Packed Red Cells?
ABO compatible
What are the 4 different types of modified packed RBCs
- Saline-washed RBCs
- Frozen-thawed-deglycerolized PRBCs
- Leukocyte-poor washed RBCs
- Leukocyte-filtered PRBCs
What are saline-washed RBCs used for?
- neonatal and intrauterine transfusion
2. recurrent or severe allergy to plasma proteins
What are frozen-thawed deglycerolized PRBCs used for?
- rare blood types
2. Autologous transfusion
What are Leukocyte-poor washed RBCs used for?
- repeated nonhemolytic febrile transfusion reactions
What are people who have leukocyte-poor washed RBCs at risk for?
- post-transfusion cytomegalovirus
What is Fresh Frozen Plasma?
- plasma separated from cells and frozen with in 6 hours of collection from donor
- contains most clotting factors
What is fresh frozen plasma used for?
- the treatment of actively bleeding patients w/ multiple coagulation deficiencies 2-degree liver disease
- Patients with DIC
- Dilutional coagulopathy 2-degree massive volume load or volume replacement
- warfarin reversal
- to provide blood volume expansion or a source of protein
When should fresh frozen plasma be used by?
w/in 24 hours of thawing
When are platelets usually given?
- presence of functionally abnormal platelets
2. second-degree thrombocytopenia (uremia, leukemia, chemotherapy)
What information is needed before given platelets?
- ABO compatibility (preferred)
- Rh (preferred)
- Specific platelet filter (required)
What is cryoprecipitate?
- extracted from cold-thawed plasma
What should the patient be before giving cryoprecipitate?
ABO compatible
What is cryoprecipitate usually given for?
- used to control bleeding associated with a deficiency or defect in one of the coagulation factors
- Treatment of Hemophilia A, von Willebrand’s disease, Factor VIII deficiency, hypofibrinogenemia, obstetric complications
What are the different types of Plasma Derivatives?
- 5% Albumin
- 25% Albumin (hypertonic)
- Plasma Protein Fraction
- Factor IX Concentration
- WBCs (granulocytes)
When is 5% albumin usually given?
- plasma volume expansion in hypovolemic shock secondary to trauma or surgery
- Supports blood pressure during hypotensive episodes
- Used to induce diuresis in FVE
When is 25% albumin typically used?
- plasma volume expansion
- Treatment of hypovolemic shock
- Treatment of thermal injury associated w/ hyperproteinemia
- Prevention and Treatment of cerebral edema
What is Plasma Protein Fraction typically used for?
Same things as 5% albumin
What is Factor IX concentration typically used for?
- prevention and control of bleeding w/ Hemophilia B
2. Factor VII and X deficiencies
What are WBCs typically given for?
- Profound neutropenia in patients expected to recover
2. severe granulocytopenia
What should physician orders include for blood components?
- blood components to be transfused
- Number of units to be transfused
- Possibly pre-medication
- use of blood warmer
- Microaggregate or leukocyte depleting filtration
What needs to be done with regard to issue and transfer before giving?
- getting the blood from the blood bank
- Mandatory blood transfusion requisition
- Transfer mode to floor depends on the agency
- Generally one unit transported at a time
- Visual exam before leaving blood bank for unusual color, clotting, presence of air bubbles, evidence of contamination, and integrity container
How many people should cross-check the patient before giving blood?
2
What should be cross-checked with the patient before giving blood?
Check the patient’s ID, date of birth, blood tag, transfusion requisition form, ABO and Rh compatibility, and expiration date at the bedside
How should patient identification be done?
- check name and unit number on blood tag with face sheet in patient’s chart
- ask patient to identify himself or herself by complete name
- hospital numbers in ID bracelet must correspond with numbers on blood tag
- Any discrepancy must be investigated and corrected prior to transfusion
- Blood should NEVER be given to patient lacking ID bracelet
How should blood be handled?
- transfusion begins within 30 minutes of leaving the blood bank to prevent excessive warming
- Should never be placed in the nursing division refrigerator
- Unit of blood must be returned to blood bank if 30-minute time limit can’t be met
What is the general rule regarding temperature before giving blood?
Notify the physician if the temp is 1-degree centigrade or 1.8 degrees above the patient’s normal temperature prior to initiation of transfusion
What is the only solution that can initiate a transfusion?
Normal saline