Week 4 - Blood Admin Flashcards
once a blood transfusion starts how long must the RN stay with the patient?
first 5 minutes
when you start administering blood how long is the test dose ran for?
15 minutes
how often do you need to do beside checks ?
every hour
do you need to do a post-transfusion check? When?
- yes
- 1 hour post-transfusion
can students initiate a transfusions?
no
what is blood composed of?
- RBCs
- WBCs
- platelets
- plasma
what percentage of RBCs make up whole blood?
45%
what does RBCs contain?
hemoglobin
what do RBCs transport?
oxygen
where are RBCs formed? what’s the process called?
- bone marrow
- process called erythropoiesis
how long do RBCs live for?
- about 120 days (4 months)
what percentage of WBCs make up whole blood?
< 1%
what are WBCs part of?
inflammatory and immune process
where are WBCs formed?
bone marrow
what is the life span of WBCs?
13-20 days
what percentage of platelets make up whole blood?
< 1%
what are platelets part of?
clotting process
where are platelets formed?
bone marrow
what is the life span of platelets?
about 8-9 days
what is plasma?
liquid portion of the blood
what is included in plasma?
- albumin
- fibrinogen
- globulins
- other molecules
what is fibrinogen involved in?
blood clotting
in regards to plasma, what is included in other molecules that are included in it?
- dissolved nutrients
- waste products
- electrolytes
- hormones
what is a transfusion?
when a blood component/ product made from human blood is given through a needle into a vein
what can be transfused?
- whole blood
- RBC
- plasma
- clotting factors
- plasma derivatives
- platelets
what is included in fractionated blood products ?
- certain clotting factors
- albumin
- immune globulins
what is another name for clotting factors?
cryoprecipitate
if a patient has O positive blood what can they receive for RBCs?
O+ or O-
if a patient has O negative blood what can they receive for RBCs?
O- ONLY
if a patient has A positive blood what can they receive for RBCs?
A+
A-
O+
O-
if a patient has A positive blood what can they receive for RBCs?
A-
O-
if a patient has B positive blood what can they receive for RBCs?
B+
B-
O+
O-
if a patient has B negative blood what can they receive for RBCs?
B-
O-
if a patient has AB positive blood what can they receive for RBCs?
all groups
if a patient has AB negative blood what can they receive for RBCs?
AB-
B-
A-
O-
if a patient has O positive blood what can they receive for plasma?
all groups
if a patient has O negative blood what can they receive for plasma?
all groups
if a patient has A positive blood what can they receive for plasma?
A
AB
if a patient has A negative blood what can they receive for plasma?
A
AB
if a patient has B positive blood what can they receive for plasma?
B
AB
if a patient has B negative blood what can they receive for plasma?
B
AB
if a patient has AB positive blood what can they receive for plasma?
only AB
if a patient has AB negative blood what can they receive for plasma?
only AB
if someone is Rh positive what does that mean?
D antigen is present
if someone is Rh negative what does that mean?
D antigen is absent
not only do we have antigens on the surface of our RBCs we also have antibodies where?
blood plasma
we have what type of antibodies in our plasma, as we have on our blood cells?
opposite
what are the different types of blood products
- packed red blood cells (PRBC)
- fresh frozen plasma (FFP)
- platelets
- cryoprecipitate
- albumin
- IVIG (intravenous immune globulin)
can you give medications the same time you are giving blood products?
NO
what do packed red blood cells (PRBC) contain?
human red blood cells
what is the shelf life in a fridge for packed red blood cells (PRBC)?
42 days
what are the indications for packed red blood cells (PRBC)?
- severe blood loss
- severely anemic
1 unit of blood should raise hemoglobin by what?
10 g/L
how do you know someone has low blood loss?
- known blood loss
- low BP
- tachycardia
how do you know someone has severe anemia?
- low hemoglobin
- pale
- fatigue
- weakness
does a hemoglobin level of < 60g/L require a transfusion?
- likely appropriate
- transfuse 1 unit and re-check pt symptoms and Hb before giving second unit
does a hemoglobin level of <70g/L require a transfusion?
- consider transfusion
- transfuse 1 unit/ re-check pt symptoms and Hb before giving second unit
does a hemoglobin level of <80g/L require a transfusion?
- consider transfusion if pt has pre-existing cardiovascular disease or evidence of impaired tissue oxygenation
does a hemoglobin level of 80-90g/L require a transfusion?
likely inappropriate unless evidence of impaired tissue oxygenation
does a hemoglobin level of >90g/L require a transfusion?
likely inappropriate
does a bleeding patient require a transfusion?
- maintain Hb greater than 70g/L
- if pre-existing cardiovascular disease maintain Hb >80g/L
a unit of packed blood cells contains how many mL?
- approximately 300mL (240-340mL)
- check label on bag for actual volume
fresh frozen plasma contains what?
- plasma proteins
- all clotting factors
- no functional platelets
after collecting plasma how long do you have to freeze it?
within 8 hours of collection
how long does fresh frozen plasma take to thaw?
30 minutes
what are the indications for giving someone fresh frozen plasma?
- replacement of multiple plasma coagulation factors
- massive hemorrhage
- clinical significant coagulation abnormalities
- urgent warfarin therapy reversal
- plasma exchange in TTP or HUS
what do platelets contain?
- human blood cells
- traces of RBC may be present
can you put platelets in a fridge?
no
how do you store platelets?
- 20-24 degrees for up to 5 days
- need to be gently agitated during storage
how many mLs are in 1 unit of platelets
about 350mL
when do you need to check the patient’s platelet count for a transfusion of platelets?
- 15 mins - 1 hour post infusion
what are the indications for using platelets?
- bleeding from thrombocytopenia
- platelet function abnormality
what is cryoprecipitate derived from?
fresh frozen human plasma
what is in cryoprecipitate ?
specific proteins involved in clotting
cryoprecipitate need to be stored at what and for how long?
minus 18 for a max of 12 months
what are the indications for cryoprecipitate use?
- hypofibrinogenemia
- hemophilia A
- massive hemorrahge
- prior to invasive procedures where volume limitations are critical
what is albumin?
human product derived from pooled venous plasma (5% or 25%)
what is albumins equivalency to plasma?
isotonic
what are the indications for using albumin 5%?
- low albumin/ hypoproteinemia
- liver failure
- burn therapy
- renal dialysis
- conditions associated with volume deficit
what are the indications for using albumin 25%?
- same as albumin 5%
- hypovolemic shock
what does IV immune globulin (IVIG) contain?
human plasma or plasma proteins
what does IV immune globulin (IVIG) provide?
- antibodies that body cannot make in its own to fight infections
when do you need to take IV immune globulin (IVIG) out of the fridge prior to using it?
at least 24 hours prior to infusion
what are the indications for IV immune globulin (IVIG)?
autoimmune diseases
infectious diseases
idiopathic diseases
blood components and blood products are always run via what?
dedicated VAD/ lumen as primary line
can you piggyback blood components/ blood products into another IV line?
no
what can you only use for elective blood component transfusions?
single filtered tubing
what is the max hang time for a unit of blood product?
- 4 hours max
- if still running at 4 hours must stop and throw remaining out due to bacterial proliferation
after removing a blood product from a fridge how long do you have to start the infusion?
within 30 minutes after removal from frdige
when do you need to change the filter tubing for blood product administration?
- after 4 units are give
- before platelets
- after 4 hours
- if filter debris is causing sluggish flow
what back-up solution must be primed and hung at the bedside when giving blood products?
- normal saline 500-1000mL
who must obtain written informed consent for blood and blood components?
physician or NP
who confirms consent ?
nurse
what gauge is used for infusing blood?
- 22, 20, 18 ok
- 16 or 14 for trauma
what are the steps in the pre-transfusion process for the nurse?
- confirm consent
- blood type/ crossmatch is ordered
- blood product ordered and checked
- lab draws blood/ puts transfusion band on client
- IV site assessed
what are the steps for blood administration ?
- obtain blood
- verify
- physicians order
- correct patient
- product as per blood product verification record - pre-transfusion assessment
- vitals
- resp/ cardiac assessment
- IV
- patient comfort - verification of correct blood
for the pre-transfusion assessment when must this be done?
within 30 minutes of starting transfusion
what is included in the verification of correct blood step for blood administration?
- pt name, ID#, DOB
- TMS ID number/ band
- product name
- product #
- product & recipient blood group
- inspection of blood
- documentation/ verification check at desk and bedside
when does the pt receive a TMS ID number/ band?
with initial crossmatch for blood group specific products
when do clients not require a TMS number?
when receiving blood components that do not have an ABO designation
what are the 3 mandatory verification checks that must be done with 2 nurses to ensure you have the right patient ?
- blood product check
- document check
- bedside check
all clients require the following identifiers prior to administration/ transfusion of any blood components. What are they?
- wearing a facility patient ID band with ID #
- first and last name
- client’s birth-date
- must be wearing TMS/ lab band with TMS ID number
what products require a 2 person verification ?
- RBC
- FFP
- platelets
- cryoprecipitate
what products require a 1 person verification ?
- albumin
- IVIG
- coagulation factors
- Rh immune globulin
- Hepatitis B immune globulin
- varicella zoster immune globulin
what is the rate of the test dose at the beginning of a blood transfusion?
50mL/hr
how much blood is given in the first 15 minutes (test dose)?
12.5mL
how long must the RN stay with the patient 1:1 after starting the infusion?
5 minutes
When does the RN need to check vital signs before, during and after a blood infusion?
- just before starting
- after 15 minutes starting
- check hourly during transfusion
- check at completion of infusion
- 1 hour post- transfusion
what are you monitoring for throughout a blood product transfusion?
- chills
- abdominal pain
- increased temp
- abnormal VS
- abnormal chest assessment
when would you need to stop a blood tranfusion regarding temperature increasE?
if temp increases 1 degree or more celsius AND temp greater than 38 celsius
what is the max amount of time you have to infuse blood once out of the fridge?
4 hours
after completing a transfusion what do you need to do to the line?
flush with 30-50mL NS or compatible IV fluid
how long must a pt wait to be discharged after a transfusion?
60 minutes
what are some potential reaction symptoms people may experience during the first 24 hours after a transfusion?
- rash/ hives
- vomiting
- difficulty breathing
- increased cough
- headache
- disturbed by bright light
- fever
- chills
- back pain
- red/ brown urine
what are some potential reaction symptoms people may experience AFTER the first 24 hours after a transfusion?
- headache
- disturbed by bright light
- fever
- chills
- back pain
- red/ brown urine
- yellow skin or eyes
- lethargic
what are the different types of transfusion reactions?
- acute hemolytic
- febrile non-hemolytic
- non-immune hemolysis of RBC’s
- allergic/ urticarial
- sepsis
- anaphylactic
what would cause a hemolytic febrile reaction? when would this happen?
- ABO/Rh incompatibility
- within first 15 minutes
what are some signs and symptoms that someone has delayed hemolytic? When would this occur?
- 2-14 days after transfusion
- fever
- decreased Hgb/ Hct
- increased bilirubin
- jaundice
is fluid overload a true reaction from a blood transfusion?
no
what are the steps for an immediate response to anaphylaxis from blood infusion?
- stop infusion
- start resuscitative measures
- disconnect blood admin
- flush line
- connect/ run NS
- confirm pt ID is consistent with blood product
what are some medications a doctor might order for medical treatment for a transfusion reaction?
- diuretics
- antihistamines
- antipyretics
- corticosteroids
what is the most frequent cause of blood transfusion reactions ?
nurses having poor knowledge about changing blood transfusion sets
